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Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance
I Conrick-Martin1, M Foley, F M Roche
1Department of Critical Care Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. iancm25@hotmail.com
Insights
Multi-centre catheter-related infection (CRI) surveillance in Irish intensive care units (ICUs) is feasible. This study demonstrated practical implementation and clinically relevant data collection for improving patient care.
Area of Science:
- Healthcare quality improvement
- Infectious disease surveillance
- Intensive care medicine
Background:
- Catheter-related infection (CRI) surveillance is crucial for healthcare quality.
- Ireland lacks a national CRI surveillance program and standardized definitions for intensive care units (ICUs).
Purpose of the Study:
- To assess the feasibility of multi-centre CRI surveillance in nine Irish ICUs.
- To utilize Hospitals in Europe Link for Infection Control through Surveillance (HELICS) definitions (CRI 1, CRI 2, CRI 3).
Main Methods:
- Included non-tunnelled central venous catheters (CVCs) in adult ICU patients with stays ≥48 hours.
- Conducted surveillance over a three-month period across nine Irish ICUs.
Main Results:
- Achieved a 99.5% study form return rate, demonstrating feasibility.
- Identified 17 CRI episodes across 1209 CVCs (7587 CVC-days), yielding a national rate of 2.2 per 1000 CVC-days.
- CRI was associated with longer ICU stay, increased CVCs, and higher rates when inserted in operating theatres (IRR 3.9).
Conclusions:
- Multi-centre ICU surveillance using HELICS CRI definitions is practical and yields clinically relevant data.
- Despite being labor-intensive, ICU CRI surveillance is recommended for reducing infections and enabling ongoing evaluation.
- Minimal implementation difficulty and manageable data collection time (approx. 1 hour/patient/week) were reported.
Background:
Catheter-related infection (CRI) surveillance is advocated as a healthcare quality indicator. However, there is no national CRI surveillance programme or standardized CRI definitions in Irish intensive care units (ICUs).
Aim:
To examine the feasibility of multi-centre CRI surveillance in nine Irish ICUs, using Hospitals in Europe Link for Infection Control through Surveillance (HELICS) definitions (CRI 1, CRI 2 and CRI 3).
Methods:
All non-tunnelled central venous catheters (CVCs) inserted in patients aged >18 years with an ICU stay ≥48 h were included over a three-month study period.
Findings:
Feasibility was demonstrated by the 99.5% return rate for study forms. Data on 1209 CVCs in 614 patients over 7587 CVC-days showed 17 episodes of CRI, representing a national rate of 2.2 per 1000 CVC-days [95% confidence interval (CI) 1.2-3.3]. Rates of CRI 1, CRI 2 and CRI 3 were 0.13 (95% CI 0.00-0.39), 0.79 (95% CI 0.16-1.42) and 1.39 (95% CI 0.60-2.17) per 1000 CVC-days, respectively. CRI was associated with length of ICU stay (P < 0.001), number of CVCs inserted (P < 0.001) and total number of CVC-days per patient (P < 0.001). CRI was higher in CVCs inserted in operating theatres (incident rate ratio 3.9, 95% CI 1.3-11.5; P = 0.02) compared with CVCs inserted in ICUs. Participant feedback reported minimal difficulty with surveillance implementation, and data collection required approximately 1 h per patient per week.
Conclusion:
The study demonstrated that multi-centre ICU surveillance using HELICS CRI definitions was practical, feasible and provided clinically relevant information. CRI surveillance in ICUs, although labour intensive, is recommended to reduce CRI and allow ongoing evaluation of processes aimed at CRI reduction.
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