1. S
Infection surveillance in
Intensive care
Dr C Clarke
Consultant in Intensive Care Medicine & Anaesthesia
Craigavon Area Hospital

2. Positive Blood Cultures:
Laboratory Reports, NI
1st Jan 2009 – 31st Dec 2012*
Gram Negative Bacteria 2009 2010 2011 2012*
Acinetobacter sp 41 31 23 24
Aeromonas sp 4 2 5 5
Brucella sp 0 0 0 0
Campylobacter sp 2 2 2 6
Citrobacter sp 14 13 16 11
Enterobacter sp 63 59 58 46
Escherichia coli 879 891 971 992
Escherichia sp 0 1 0 0
Haemophilus influenzae (all types) 12 17 19 12
Haemophilus parainfluenzae 2 0 2 3
Klebsiella sp 195 197 193 187
Legionella sp 0 0 0 0
Leptospira 0 0 0 0
Neisseria meningitidis 22 17 15 11
Neisseria sp 2 0 0 0
Proteus sp 75 97 95 93
Providencia sp 3 1 2 2
Pseudomonas aeruginosa 75 71 80 73
Pseudomonas sp 38 40 30 16
Salmonella sp 4 3 4 4
Serratia sp 48 40 42 21
Other gram negative bacteria 31 35 14 45
Total 1510 1517 1571 1551

3. Surveillance
S The systematic collection and analysis of data on
nosocomial infection occurrences
S Incidence of nosocomial infection
S ID patterns and potential solutions
S Outcome objectives (IHI)

4. Surveillance
S Requires cooperation between infection control and ICU
S Agree the aims and goals
S Ensure quality of ICU care

5. Surveillance
S Expensive and labour intensive
S Accuracy- over and under diagnosis eg miss
outbreak/cluster
S Benchmarking-eg comparing a cancer hospital with
Burns Unit
S Potential for data to be hidden
S Those that do worst at finding infection-”look the best”

7. Surveillance
S Well established CDC (USA-centre for disease control)
S KISS - Krankenhaus Infektions Surveillance Systems
S Tend to underestimate
S Benchmark infection rates and establish standards of
preventative care
S Confidential, Voluntary, Methodologically sound

10. Outcomes
S CVC infection rates 2.1-1,5 Bloodstream infections per
1000 CVC days (29% reduction
S Neonatal Unit –No change in infection rates over 10
years
S Overall the evidence supports this approach

11. Key points
S A surveillance program should be in place to monitor the
incidence and features of local nosocomial infection and
to help develop strategies to decrease the incidence of
infection in the ICU
S Handwashing and specific isolation protocols key factors
S CVCs, indwelling catheters and ventilation-discontinue
ASAP

12. Quality Indicators-according to
ICS
S 20 indicators in order of importance
S 3 hand hygiene
S 6 unit acquired bacteraemias
S 7 unit acquired MRSA infection
S 8 catheter related blood stream infection
S 9 unit acquired C. Difficle
S 12 Appropriate infection isolation

13. Colonisation v infection
S Clinical indicators of infection
S Colonisation common of respiratory and urinary tracts in ICU
S SIRS often present due to non-infective causes
S CRP PCT
S Quantitative culture (eg >106 cfu/ml of resp secretion)
S Immunocompromised?

15. ICS

17. CDC Definitions
S a nosocomial infection as a localized or systemic
condition 1) that results from adverse reaction to the
presence of an infectious agent(s) or its toxin(s) and 2)
that was not present or incubating at the time of
admission to the hospital (7, and NNIS Manual, Section
XIII, May 1994, unpublished). For most bacterial
nosocomial infections, this means that the infection
usually becomes evident 48 hours (i.e., the typical
incubation period) or more after admission.

22. A central line associated blood stream infection is a
laboratory-confirmed bloodstream infection (BSI) in a patient
who had a central line within the 48 hour period before the
development of the BSI and that is not related to an infection
at another site.

23. The CLABSI must meet one of the following criteria:
Criterion 1 Patient has a recognised pathogen cultured from one or
more blood cultures and Organism cultured from blood
is not related to an infection at another site.
Criterion 2 Patient has at least one of the following signs or
symptoms: fever (>38°C), chills, or hypotension and signs and
symptoms and positive laboratory results are not related to an
infection at another site and Common skin contaminant is
cultured from two or more blood cultures drawn on separate
occasions
Criterion 3 Patient < 1 year of age has at least one of the following signs or symptoms: fever
(>38°C core) hypothermia (<36°C core), apnoea, or bradycardia and Signs and symptoms and
positive laboratory results are not related to an infection at another site and Common skin
contaminant is cultured from two or more blood cultures drawn on separate occasions.

24. Summary
S Surveillance is an integral of Intensive Care
S Dependent of data collection
S Definitions are complex
S Microbiology must always be interpreted with clinical
information.