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Preventing bloodstream infections through effective surveillance, AUDIT and FEEDBACK: evaluation of a 20-year
Gregory Merlo1,2, Belinda Henderson1, Louise Marquart-Wilson1
1School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
Introduction:
Bloodstream infections (BSIs) are a leading cause of healthcare-associated morbidity and mortality, with a significant portion being preventable. Despite this, BSIs remain common, particularly in Australian hospitals. Princess Alexandra Hospital (PAH) in Queensland has implemented a surveillance program that focuses on the preventability of BSIs, with continuous loop, real-time audit-feedback to teach clinicians about preventable factors and possible actions. This study evaluated the program's implementation and impact on reducing infections.
Methods:
A Type I hybrid implementation-effectiveness design was used, combining interrupted time series analysis of BSI data from 2002 to 2023 and focus group discussions with the Infection Management Service team members and ward-based clinicians. Interrupted time series analysis was used to assess the impact of the Staphylococcus aureus bacteraemia (SAB) prevention initiative introduced in November 2011. Statistical analysis employed segmented regression using negative binomial regression with robust standard errors. Focus group data were analysed via the Consolidated Framework for Implementation Research (CFIR).
Results:
The intervention resulted in an immediate, but non-significant, reduction in SAB monthly rates (incidence rate ratio, IRR = 0.839, 95% CI: 0.653-1.078), and a declining trend in monthly rates was also noted postintervention (IRR = 0.998, 95% CI: 0.996-1.000). Focus group feedback identified enablers, including effective collaboration and challenges such as needing to address inconsistent documentation and differing perceptions of the program's intent.
Discussion:
The program's focus on preventability was associated with a reduction in SAB rates and a sustained downward trend over time. While these changes did not reach conventional thresholds for statistical significance, the magnitude and direction of effects, together with qualitative feedback on improved collaboration and targeted prevention strategies, indicate potential for broader application.
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