National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project

doi:10.1016/j.jhin.2008.07.014

Journal of Hospital Infection

Volume 71, Issue 1, January 2009, Pages 66-73

https://doi.org/10.1016/j.jhin.2008.07.014 Get rights and content

Summary

This study was performed to evaluate associations between organisational characteristics, routine practices and the incidence densities of central venous catheter-associated bloodstream infections (CVC-BSI rates) in European intensive care units (ICUs) as part of the HELICS project (Hospitals in Europe Link for Infection Control through Surveillance). Questionnaires were sent to ICUs participating in the national nosocomial infection surveillance networks in 2004. The national networks were asked for the CVC-BSI rates of the ICUs participating for the time period 2003–2004. Univariate and multivariate risk factor analyses were performed to identify which practices had the greatest impact on CVC-BSI rates. A total of 526 ICUs from 10 countries sent data on organisational characteristics and practices, demonstrating wide variation in care. CVC-BSI rates were also provided for 288 ICUs from five countries. This made it possible to include 1383 444 patient days, 969 897 CVC days and 1935 CVC-BSI cases in the analysis. Adjusted logistic regression analysis showed that the categorical variables of country [odds ratio (OR) varying per country from OR: 2.3; 95% confidence interval (CI): 0.5–10.2; to OR: 12.8; 95% CI: 4.4–37.5; in reference to the country with the lowest CVC-BSI rates] and type of hospital ‘university’ (OR: 2.08; 95% CI: 1.02–4.25) were independent risk factors for high CVC-BSI rates. Substantial variation existed in CVC-BSI prevention activities, surveillance methods and estimated CVC-BSI rates among the European countries. Differences in cultural, social and legal perspectives as well as differences between healthcare systems are crucial in explaining these differences.

Introduction

Central venous catheter-associated bloodstream infections (CVC-BSIs) are one of the most common nosocomial infections in intensive care units (ICUs). They are associated with a substantial mortality, prolongation of ICU stay and related costs.1, 2, 3, 4 It is well-known that up to 70% of these infections are preventable.5, 6 To understand which practices have the greatest impact on the development of CVC-BSI and to help the ICUs to better target their prevention measures, risk factor analyses are useful. These risk factor analyses should not only include a large number of institutions, they also require a wide variation of practices. Due to the relatively low heterogeneity of infection control measures within a given country, risk factor analyses on a European level seem to be effective for identifying the most relevant risk factors.

The HELICS project (Hospitals in Europe Link for Infection Control through Surveillance) as a supranational network offers the chance to collect data about infection control measures in various European countries (http://helics.univ-lyon1.fr/).⁷ This project was initiated to encourage the development of surveillance systems for detection of healthcare-acquired infection (HCAI), to share expertise in surveillance for HCAI between countries, and to establish a European dataset on HCAIs.

This network was used to collect information about organisational and care practices in various European countries and to associate these data with CVC-BSI rates from the individual ICUs.

Section snippets

Organisational and patient care characteristics

A draft of the questionnaire was developed and sent to the national surveillance networks for comments. All comments were discussed and the final version of the questionnaire was established at the HELICS meeting in November 2003. The questionnaire contained questions about structure and size of the hospital/ICU, surveillance methods, CVC insertion techniques and CVC management.

All national nosocomial surveillance networks participating in HELICS were invited to participate in the study.

Descriptive analysis

Ten national networks (Belgium, Finland, France, Germany, Hungary, Lithuania, Poland, Slovenia, Sweden and Spain) sent descriptive data from 526 ICUs. The organisational characteristics are described in Table I. Most of the participating ICUs were from Germany, France, Belgium and Hungary. The size of the participating ICUs varied from median six beds in Poland to median 12 beds in Lithuania. There were substantial differences concerning the percentage of ventilated patients in the ICUs,

Discussion

In this surveillance-based study, organisational characteristics and patient care parameters concerning CVC use were described at a European level. Parameters were also associated with CVC-BSI rates in order to identify further risk factors of CVC-BSI. Since the CVC management was a matter of particular interest in the present study, countries were asked for ICUs' CVC-BSI rates as described above instead of BSI rates following the HELICS protocol. The HELICS protocol offers various definitions

Acknowledgements

We thank all the participating ICUs for their invaluable contribution to the data collection.

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National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project

Summary

Introduction

Section snippets

Organisational and patient care characteristics

Descriptive analysis

Discussion

Acknowledgements

Am J Infect Control

Clin Microbiol Infect

J Hosp Infect

Int J Hyg Environ Health

Mayo Clin Proc

Clin Microbiol Infect

Lancet Infect Dis

J Hosp Infect

Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital

Crit Care Med

The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit

Am J Respir Crit Care Med

Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections

Clin Infect Dis

Guidelines for the prevention of intravascular catheter-related infections. Centers for disease control and prevention

MMWR Recomm Rep