Laboratory-based surveillance of hospital-acquired catheter-related bloodstream infections in Catalonia. Results of the VINCat Program (2007–2010)Vigilancia de bacteriemias relacionadas con el uso de catéteres venosos en los hospitales de Cataluña. Resultados del Programa VINCat (2007–2010)

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Abstract

The VINCat Program is an institutional surveillance program for hospital-acquired infections developed in the healthcare institutions of Catalonia, Spain. The program includes the monitoring of various components of hospital-acquired infection, among which is catheter-related bloodstream infection (CRBSI). The aim of this study was to describe the frequency of CRBSI in hospitals participating in the VINCat Program over a period of 4 years (2007–2010).

The monitoring of the CRBSI component is carried out continuously in all inpatient units by performing a daily assessment of all blood culture results issued by the Microbiology Laboratories. Precise definitions are used for CRBSI, and adjusted rates are expressed per 1,000 days of hospitalization, hospital size and type of catheter. The rates of CRBSI in catheters used for parenteral nutrition are adjusted and expressed per 1,000 days of device use. The aggregate data of the total period are shown in percentiles (10%, 25%, 50% or median, 75%, and 90%).

From 2007 to 2010, a total of 2977 episodes of CRBSI were reported in 40 hospitals participating in the VINCat Program. The cumulative incidence of CRBSI has been 0.26 episodes per 1,000 days of hospitalization (CI95% 0.2 to 0.3). The overall incidence varied depending on hospital size: 0.36‰ for hospitals in Group I (>500 beds), 0.17‰ for Group II (200–500 beds), and 0.09‰ for Group III (<200 beds). 76% of the episodes were associated with central venous catheters (CVC), 19% of the episodes with peripheral venous catheters (PVC), and the remaining 5% with peripherally inserted CVCs (PICC). The most common organisms causing CRBSI were staphylococci, the group Klebsiella, Serratia and Enterobacter, Candida spp., and Pseudomonas aeruginosa. There are important differences in the etiology of CRBSI in relation to these variables. During the reporting period, a significant reduction (38.1%, CI95%, 29.0–46.0%) of CRBSI rates have been observed in Group I hospitals.

CRBSI surveillance is an important element of the VINCat Program, offering to us the possibility of establishing standard values for this component and implementing intervention strategies for its reduction.

Resumen

El Programa VINCat es un programa institucional de vigilancia de las infecciones nosocomiales desarrollado en el ámbito de las instituciones sanitarias de Cataluña, España. En el programa se incluye la vigilancia de diferentes componentes, entre los que se encuentran las bacteriemias relacionadas con el uso de catéteres venosos (BRCV). El objetivo de este estudio ha sido aportar las frecuencias de este componente en los hospitales participantes del Programa VINCat durante un período de 4 años (2007–2010).

La vigilancia de este componente se realiza de manera continuada en todas las unidades de hospitalización, mediante la evaluación diaria de todos los resultados de los hemocultivos emitidos por los laboratorios de microbiología. Se utilizan unas definiciones precisas de bacteriemia relacionada con el uso de los catéteres vasculares y se expresan las tasas ajustadas por 1.000 días de hospitalización, por tamaño de hospital y por tipo de catéter. En los catéteres utilizados para la nutrición parenteral las tasas se ajustan por 1.000 días de uso del dispositivo para esta indicación terapéutica. Los datos agregados del período total se desglosan en interquartiles (10, 25, 50% o mediana, 75 y 90%).

Desde 2007 hasta 2010 se ha detectado un total de 2.977 episodios de BRCV en los 40 hospitales participantes en el Programa VINCat. La incidencia acumulada de la BRCV ha sido de 0,26 episodios por 1.000 días de hospitalización (IC del 95%, 0,2–0,3). La incidencia global fue diferente en función del tamaño del hospital: 0,36‰ para hospitales del grupo I (> 500 camas), 0,17‰ para los del grupo II (200–500 camas) y 0,09‰ para los del grupo III (< 200 camas). El 76% de los episodios se asoció a los catéteres venosos centrales (CVC), el 19% a los catéteres venosos periféricos y el 5% restante a los CVC de inserción periférica. Los microorganismos más frecuentes causantes de BRCV fueron los estafilococos, el grupo Klebsiella, Serratia y Enterobacter, Candida spp. y Pseudomonas aeruginosa. Existen importantes diferencias en la etiología de la BRCV en relación con las diferentes variables analizadas. Durante el período analizado se ha observado una disminución importante (38,1%; IC del 95%, 29–46) de las tasas de BRCV en los hospitales del grupo I.

La vigilancia de las BRCV es un elemento relevante en el Programa VINCat por la posibilidad de establecer los valores estándar de este componente y para poder implementar estrategias de intervención para su reducción.

References (27)

  • R.P. Vonberg et al.

    Device-associated infection rates for non-intensive care unit patients

    Infect Control Hosp Epidemiol

    (2006)
  • J. Marschall

    Catheter-associated bloodstream infections: looking outside of the ICU

    Am J Infect Control

    (2008)
  • T.T. Trinh et al.

    Peripheral venous catheter-related Staphylococcus aureus bacteremia

    Infect Control Hosp Epidemiol

    (2011)
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