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904 Is There a Relationship Between Antimicrobial Use and Device-Associated Infection Rates in a Regional Intensive Care Unit in Northern Ireland?

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Hilda Crookshanks , Northern Ireland Healthcare Infections Surveillance Centre, Public Health Agency, Belfast, Northern Ireland
Seosamh McCauley, MB , Northern Ireland Healthcare Infections Surveillance Centre, Public Health Agency, Belfast, Northern Ireland
Judith Troughton, MB , Belfast HSC Trust, Belfast, Northern Ireland
Gerard McIlvenny , Northern Ireland Healthcare Infections Surveillance Centre, Public Health Agency, Belfast, Northern Ireland
Irene Thompson, BSc , Belfast HSC Trust, Belfast, Northern Ireland
Joanna McCormick, MSc , Belfast HSC Trust, Belfast, Northern Ireland
Gavin Lavery, MD , Belfast HSC Trust, Belfast, Northern Ireland
Brian McCloskey, MD , Belfast HSC Trust, Belfast, Northern Ireland
Anthony Stevens, MD , Belfast HSC Trust, Belfast, Northern Ireland
Lorraine Doherty, MB , Northern Ireland Healthcare Infections Surveillance Centre, Public Health Agency, Belfast, Northern Ireland
Edward TM Smyth, MD , Northern Ireland Healthcare Infections Surveillance Centre, Public Health Agency, Belfast, Northern Ireland
Background: The Belfast HSC Trust participated in the Safer Patient Initiative (SPI) project coordinated by the Institute of Healthcare Improvement (IHI, USA) and the Health Foundation (UK). The focus was on the occurrence of device-associated infections in the regional intensive care unit (RICU) from April 2007 to July 2009.

Objective: To investigate if there was a relationship between lower device-associated infection rates (ventilator-associated pneumonias [VAPs], central line-associated bloodstream infections [CLABSIs]) and antimicrobial consumption.

Methods: In April 2007 care bundles recommended by the IHI were applied to patients requiring mechanical ventilation and central line insertions. Ventilator care and central line insertion bundle compliance was recorded daily. Device-associated infections were recorded using CDC definitions of infection. Denominator data was collected daily to calculate device utilisation rates. Data was recorded on a scannable form and data fed back monthly as per the SPI protocol.  Retrospective review of antimicrobial use in the unit was performed.  The total antimicrobial consumption (excluding antivirals, antifungals and antibacterials deemed not to be used in the treatment of VAPs or CLABSIs) was converted to Defined Daily Doses (DDD) as recommended by the WHO (ATC/DDD Index 2009).

Results: In April 2007, VAP rate was 8.93 per 1000 ventilator days and CLABSI rate was 45.45 per 1000 catheter days.  In July 2009 the VAP rate was 0.00 per 1000 ventilator days and the CLABSI rate was 6.85 per 1000 central line days. From April 2007 to July 2009 there was a downward trend in total antimicrobial consumption. This decrease can largely be attributed to an observed reduction in the use of clindamycin and ciprofloxacin. Trends relating to denominator data: patient days; patient average length of stay; and device utilisation ratios remained constant.

Figure 1 Device-associated infections and antimicrobial consumption April 07 - July 09

Conclusions: Where care bundles were implemented in the management of the prevention of device-associated infections a steady improvement was recorded in infection rates. There was also an observed reduction in antimicrobial consumption, mainly attributable to a reduction in the use of clindamycin and ciprofloxacin. This seems to be explained by an antimicrobial policy change (July 08) and a prior drive by microbiology to discourage the use of clindamycin and ciprofloxacin within RICU. This disparity made establishing a link between the reductions in device-associated infections with the reduction in antimicrobial use unattainable. Given the decline in device-associated infections without establishing a related decrease in antimicrobial use we recommend a validation study be carried out to establish if the observed reductions in device-associated infections are real or otherwise.