Feasibility of surveillance of ICU-associated infections in Scotland

Introduction

Healthcare-associated infections (HAI) affect around 9% of all patients in hospital [1]. It is generally accepted that the infection rate in the ICU is higher than elsewhere in the hospital and these patients are subject to many invasive procedures that increase their risk of acquiring an HAI. Our aim was to study the feasibility of utilising the current Scottish audit database (Ward Watcher; Critical Care Audit Ltd, Yorkshire, UK) to collect surveillance data electronically, and the application of the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) definitions for ICU-associated infection in Scotland.

Methods

Between 1 May 2005 and 31 August 2005, five of the 25 adult, general ICUs in Scotland participated for 3 months each in a prospective pilot audit of HAI in ICUs. Daily data were recorded on software modified to enable identification of the first episode of infection: HELICS Level 2 surveillance of blood stream infections (BSI), catheter-related infections and ventilator-associated pneumonia surveillance.

Results

The results of the pilot audit indicate that surveillance of infections acquired in ICUs in Scotland using Ward Watcher for data collection and the HELICS definitions for infection is a feasible process. The HELICS definitions for ICU-associated infection are applicable in Scotland; definitions for pneumonia, bloodstream infections and CVC-related blood stream infections could be applied in all hospitals. Feedback for Ward Watcher as a tool to collect data for surveillance purposes was positive; all participants found that the system was easy to use. The major criticism of the system was that data from patients admitted for less than 2 days were required as some of these data would not be analysed. The initial decision to include these patients was taken as an attempt to simplify data collection. It is probable that further development of Ward Watcher could facilitate the requirement to collect data only for those patients who have a stay of more than 2 days.

Conclusion

The pilot was successful. Surveillance activity throughout Scotland would be dependent on several factors including some refinements to Ward Watcher to improve the efficiency, accuracy and ease of data collection.