The Prevalence of Device-Related Infection Using Electronic Data and Pharmacy Point-Prevalence Survey Antimicrobial Data as Markers of Healthcare-Associated Infection (HCAI)

Background: In the UK, surveillance of HCAI is targeted at MRSA bacteraemia, C.difficile, and surgical site infection. However, information on other preventable HCAIs such as device-related infections is lacking. We report here the development of a rapid method, using antimicrobial data from a standardised European pharmacy point-prevalence survey and electronic records, for the estimation of the prevalence of device-related HCAI.

Objective: To determine the prevalence of device- related HCAI at two teaching hospitals at ICHNT.

Methods: In June 2009, the regular serial point-prevalence survey of antibiotic prescribing carried out by the pharmacist at ICHNT used the recent European Surveillance of Antimicrobial Consumption project (ESAC) methodology. In addition, for each patient receiving an antimicrobial the presence of certain devices was recorded. Patients with a device receiving antimicrobial therapy starting two days after admission, and with positive electronic microbiological and/or radiology reports, supported by discharge diagnosis, were identified as having device-related HCAI. Denominator data were obtained by a hospital-wide census, conducted concurrently with the Pharmacy survey by the infection control team, to determine the total number of patients, central and peripheral lines, urinary catheters, and ventilators.  

Results: For each hospital, the Pharmacy survey and denominator data collection were completed in 3 days, In addition, the electronic data collection required approximately 15 hours. Of 871 admissions present during the prevalence survey, 360 (41.3%) had a peripheral line, but no infections were related to this device; 124 (14.2%) had a central line, of which 3 (2.4%) had a line-related BSI.  166 admissions (19.1%) had a urinary catheter and 12 of these (7.2%) had a UTI.  Of the 871 admissions, 22 patients (2.5%) were being ventilated (15 adults and 7 neonates) and of these, 3 adults (20 %) and one neonate (14.7%) had ventilator-associated pneumonia.  The prevalence of device-related infection in this study is in line with other studies.  For example, the annual nation-wide prevalence surveys of Spanish hospitals showed, in 2007, a prevalence of CVC-related BSI of 2.7% and of ventilator–associated pneumonia of 20.1% (compared with 2.4% and 18.2%, respectively, in our study).   

Conclusions: The use of standardised pharmacy point-prevalence surveys of antibiotic use as a marker of HCAI, together with electronic microbiology, radiology records, and electronic discharge diagnosis provides a practical means of expediting prevalence surveys of HCAI, in particular device-related infection, and opportunities to benchmark. This may be the method of choice in the digital age.  This study provides the basis for sequential estimates of prevalence to detect trends in device-related HCAI.