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A Toolkit for Monitoring Hospital-Acquired Bloodstream Infection in Neonatal Intensive Care

Published online by Cambridge University Press:  02 January 2015

Pamela Leighton ,
Mario Cortina-Borja ,
Michael Millar ,
Stephen Kempley  and
Ruth Gilbert
Pamela Leighton*
Affiliation:
Medical Research Council Centre of Epidemiology for Child Health, University College London Institute of Child Health, London, United Kingdom
Mario Cortina-Borja
Affiliation:
Medical Research Council Centre of Epidemiology for Child Health, University College London Institute of Child Health, London, United Kingdom
Michael Millar
Affiliation:
Department of Medical Microbiology, Barts and the London National Health Service Trust, Whitechapel, London, United Kingdom
Stephen Kempley
Affiliation:
Centre for Paediatrics, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Whitechapel, London, United Kingdom
Ruth Gilbert
Affiliation:
Medical Research Council Centre of Epidemiology for Child Health, University College London Institute of Child Health, London, United Kingdom
*
Medical Research Council Centre of Epidemiology for Child Health, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom (ph.leighton@gmail.com)
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Abstract

Objective.

In neonatal intensive care units (NICUs), monitoring hospital-acquired bloodstream infection (BSI) is critical to alert clinicians to variations in the incidence of infection between units and over time. We demonstrate a toolkit of monitoring techniques that account for case mix and could be implemented using routinely available clinical data. This toolkit could enable quality of care comparisons between hospitals to facilitate the sharing of improved practices.

Design.

Prospective study over 4 years.

Setting and Patients.

Babies admitted to 2 tertiary London NICUs.

Methods.

We derived expected numbers of BSI episodes using a Poisson regression risk model adjusting for variations in birth weight, transfers to the NICU from other hospitals, postnatal age, and days spent at each National Health Service level of care. We compared observed and expected numbers of BSI episodes using 2 monitoring techniques: standardized infection ratios (SIRs) and the sequential probability ratio test (SPRT).

Results.

Using the SIR method, observed BSI incidence increased over expected incidence in 2002 at both NICUs, but this increase did not reach statistical significance at the 1% level. Using the SPRT method, neither unit showed a clinically important increase or decrease, defined as a 30% deviation from expected incidence.

Conclusions.

Risk-adjusted BSI monitoring can be performed using routine hospital data. NICUs could use SIRs for an annual look back at infection incidence and SPRTs for prospective, quarterly monitoring. The SIR and the SPRT methods have different strengths, and both could help clinicians improve infection control and patient care in NICUs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 8 , August 2012 , pp. 831 - 836
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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