Abstract: Central Line-Associated Bloodstream Infection Rates in Very Low Birth Weight Infants in Northern Ireland Compared with NHSN and NEO-KISS Rates (Fifth Decennial International Conference on Healthcare-Associated Infections (March 18-22, 2010))

Friday, March 19, 2010

Grand Hall (Hyatt Regency Atlanta)

Eileen Rogers , Queen's University, Belfast, Northern Ireland

Gerard McIlvenny , Northern Ireland Healthcare Infections Surveillance Centre, Public Health Agency, Belfast, Northern Ireland

Stanley Craig, MD , Regional Neonatal Intensive Care Unit, 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: Northern Ireland central line-associated bloodstream infections rates (CLABSI) were determined for all very low birth weight (VLBW) infants from December 2008 to August 2009. Objective: To compare Northern Ireland rates of CLABSI in VLBW infants with reported NHSN and NEO-KISS rates using both CDC and NEO-KISS criteria. Methods: An audit form was developed incorporating both CDC and NEO-KISS criteria for primary bloodstream infections. Data was collected over a nine month period for all VLBW infants admitted to five neonatal units in

Northern Ireland

. These included one tertiary centre and four district general hospital units. Denominator data was collected on patient days and device days to determine device utilization (DU) ratios. Rates were calculated using CDC and NEO-KISS criteria. Results: The DU ratios for infants ≤1500 grams in Northern Ireland was 0.08, which is less than the calculated NHSN ratio of 0.29 and the NEO-KISS DU ratio of 0.24.^1,2 The CLABSI rate, using the CDC criteria, was greater than the calculated NHSN rates for the same birth-weight. The CLABSI rate, using the CDC criteria, per 1000 patient days was also higher than the calculated NHSN rate.¹ The DU ratio and the CLABSI rates (per 1000 central-line days and per 1000 patient days) were also high when compared to the NEO-KISS rates. Table. Northern Ireland CLABSI rate compared to NHSN and NEO-KISS.

Birth-weight ≤1500 g	Northern Ireland using NHSN criteria	NHSN¹	Northern Ireland using NEO-KISS criteria	NEO-KISS ²
Number of central-line associated BSI	38	-	29	-
CLABSI rate per 1000 CVC days	45.7	3.2	34.9	9.3
CLABSI rate per 1000 patient days	3.9	0.9	3.0	2.2

Conclusions: In comparison to NHSN and NEO-KISS, rates of CLABSI in VLBW infants are high in Northern Ireland. These appear to be partly attributed to a very low DU ratio. Patient-day infection rates appear to be useful for describing the situation in combination with device-associated infection rates because of low DU ratios. This is the first step in CLABSI surveillance in VLBW infants in Northern Ireland. Further data collection should be undertaken to determine the most appropriate system to benchmark rates.

1. Edwards JR, Peterson KD, Andrus ML et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. American Journal of Infection Control 2008; 36, (9), 609-626.

2. http://www.nrz hygiene.de/dwnld/RefDaten/200401_200812_NEO_reference.pdf.

168 Central Line-Associated Bloodstream Infection Rates in Very Low Birth Weight Infants in Northern Ireland Compared with NHSN and NEO-KISS Rates