surveillance of bloodstream infections in belgian …...habsi and clabsi trends 2013-2017 year 2013...
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SURVEILLANCE OF
BLOODSTREAM
INFECTIONS IN BELGIAN
HOPITALS
Workgroup meeting
19 November 2018
Els Duysburgh, MD, MPH, PhD
Els.duysburgh@sciensano.be
Objectives meeting
Presentation bloodstream infection (BSI) surveillance results: 2018 report – data up to and including 2017
Discussion
• Results national report
• Protocol: update 2019
• Healthdata BSI surveillance registration and reporting
General remark: overall very similar findings since 2013
2
Contents
Introduction
•Background
•Objectives
Main results report 2018
•Participation
•Hospital-associated bloodstream infections (HABSI)
Incidences 2013-2017
Description of bloodstream infection episodes 2017
Microorganism (MO) and antimicrobial resistance
Recommendations
Discussion
3
INTRODUCTION
Background
National surveillance of BSI in hospitals
•Case-based - laboratory confirmed
•Mandatory since 2014 (minimum 3 months)
•HABSI
infection date – admission date ≥2
5 BackgroundBackground
Objectives of BSI surveillance
Monitor
• HABSI and CLABSI trends
• Causal microorganism (MO) and their resistance profile
Level
• Hospital-wide and intensive care unit (ICU)
• National
Tool for prevention
6 ObjectivesObjectives
Data up to and including 2017
MAIN RESULTS REPORT 2018
Participation 2017
105 of the 109 (96%) eligible hospitals reported data for at least one quarter
57% hospitals reported the whole year
8 ParticipationParticipation
HABSI and CLABSI trends 2013-2017
Year 2013 2014 2015 2016 2017
Cumulative incidence per 1,000 admissions
mean – hospital-wide* 5.4 5.6 5.7 5.2 5.5
mean – ICU-level** 14.1 13.9 13.5 14.8 13.8
Incidence density per 10,000 patient-days
mean – hospital-wide* 7.5 7.8 8.0 7.6 8.2
mean – ICU-level** 32.0 31.6 29.8 31.9 29.8
Incidence HABSI, hospital-wide and at ICU-level, Belgium 2013-2017
Notes:
* Total HABSI/total patient-days at hospital-level
** Total ICU-associated BSI/total patient-days at ICU-level
Incidences 2013-2017
HABSI and CLABSI trends 2013-2017
Mean incidence HABSI per 10,000 patient days, Belgium 2013-2017
Hospital-wide ICU
Incidences 2013-2017
HABSI and CLABSI trends 2013-2017
Mean incidence central line-associated bloodstream infection (CLABSI)
per 10,000 patient days, Belgium 2013-2017
Hospital-wide ICU
Incidences 2013-2017
Variation HABSI incidence between
hospitals, Belgium 2017
P, percentiles
Unit of analysis is reporting quarter
HABSI/10,000
patient-days
smallest 0.4
P 25 4.5
P 50 (median) 6.9
P 75 9.5
largest 23.4
Incidences 2013-2017
Microorganism specific HABSI, 2000-
2017
HABSI mean incidence per microorganism (MO), Belgium 2000-
2017
Incidences 2013-2017
HABSI characteristics, Belgium 2017
• Total 10,463 BSI of which 7,821 HABSI
• 20% (1,558) ICU-associated BSI
Department of HABSI diagnosis, Belgium 2017
Department %
Medical department 24
ICU 22
Surgery 14
Geriatrics 15
Hemato-oncology 14
Paediatrics 1
Obstetrics/gynaecology 1
Other 9
Total 100
Description of BSI episodes 2017
HABSI characteristics, Belgium 2017
Hospital-wide ICU
Invasive device-associated: directly (CL or
peripheral catheter) or indirectly (urinary
catheter or endotracheal tube)
38% 55%
CLABSI 23% 32%
Central line-related bloodstream infection
(confirmed CLABSI)8% 11%
Suspected source confirmed 43%
Median (IQR) time to infection 12 (6-24) days 10 (5-19) days
Crude mortality 20% 29%
Description of BSI episodes 2017
Source HABSI, Belgium 2017
Hospital-wide
ICU
Description of BSI episodes 2017
* Includes ‘confirmed’, ‘probable’ and ‘possible’ central line-associated bloodstream infections
Most frequent isolated MO in BSI,
Belgium 2017
HABSI Other BSI
N % N %
E. coli 1,908 23 1,082 38
S. aureus 881 10 298 11
S. epidermidis 728 9 82 3
K. pneumoniae 650 8 154 5
E. faecium 453 5 41 1
P. aeruginosa 419 5 62 2
MO and antimicrobial resistance
Microorganism and antimicrobial
resistance
Antimicrobial resistance in S. aureus strains isolated from hospital-
associated bloodstream infections, Belgium 2013-2017
MO and antimicrobial resistance
Microorganism and antimicrobial
resistance
Antimicrobial resistance in E. coli strains isolated from hospital-
associated bloodstream infections, Belgium 2013-2017
MO and antimicrobial resistance
Microorganism and antimicrobial
resistance
Antimicrobial resistance in K. pneumoniae strains isolated from
hospital-associated bloodstream infections, Belgium 2013-2017
MO and antimicrobial resistance
Microorganism and antimicrobial
resistance
Antimicrobial resistance in E. cloacae strains isolated from
hospital-associated bloodstream infections, Belgium 2013-2017
MO and antimicrobial resistance
Microorganism and antimicrobial
resistance
Antimicrobial resistance in P. aeruginosa strains isolated from
hospital-associated bloodstream infections, Belgium 2013-2017
MO and antimicrobial resistance
Microorganism and antimicrobial
resistance
Antimicrobial resistance in E. faecium strains isolated from
hospital-associated bloodstream infections, Belgium 2013-2017
MO and antimicrobial resistance
RECOMMENDATIONS
For policy makers
• Further support and enable infection control teams at hospitals in
their responsibilities and tasks to decrease HABSI. This includes
ensuring a clear framework and ensuring enough human and
financial resources.
• Enhance the creation at hospital level of a supportive, safe, secure
and not judging environment in which internal quality audits can be
implemented.
• Support the organisation of BSI surveillance data validation and the
assessment on why the HABSI incidence did not changed during the
past five years.
• Continue supporting a national organised surveillance of HABSI
Recommendations
For hospitals
• Assess if there is still room for decrease of HABSI and implement
actions and activities to establish HABSI decrease. For this, the
organisation of internal HABSI audits is suggested. A supporting,
safe, secure and not judging environment is key to have audits
successfully implemented and such environment needs to be
established.
• Continue recording and reporting HABSI data in the national BSI
surveillance to be able to evaluate the HABSI situation at hospital
level over time and evaluate the impact of locally implemented
activities to decrease HABSI incidences.
Recommendations
For Sciensano
• Validation of surveillance data. Comparing, at hospital and ward
level, data from the surveillance with data received through the
MZG/RHM could be a first step in this validation.
• Assess reasons why there is no decline in HABSI incidence in
Belgian hospitals at national level during the past five years.
• Continue implementing the continuous surveillance of BSI in
Belgian hospitals which includes a yearly update of protocol and
data collection tool.
• Further improve the Healthdata data collection and reporting tool.
• Assess if data recording and reporting cannot be further simplified
and streamlined in the future.
Recommendations
DISCUSSION
1. Validation: Comparing MZG/RHM with
BSI surveillance data
Discussion
2. CLABSI reporting by CL-days or patient
days?
• In 2017, CL-days: 4 hospitals (hospital wide)
33 ICU (out of 128 that provided denominators)
• Impact reduction CL-days as preventive intervention on CLABSI
incidence: simulation example
• Use of CL-days to monitor preventive intervention decrease of CL-
days (N CL-days/N patient-days)
Discussion
Before intervention After intervention change
(after-before)/before
Patient-days 10,000 10,000 0%
CL-days 5,000 3,000 -40%
CLABSI 15 10 -33%
CLABSI/1,000 CL-days 3.0 3.3 +10%
CLABSI/1,000 patient-days 1.5 1.0 -33%
3. Periodicity in HABSI and CLABSI
incidence
• Research: Time series analysis shows periodicity assess this
further.
Discussion
02
46
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id_habsi Fitted values
Includes only hospitals that reported HABSI for the whole year
References
32
NSIHweb
http://www.nsih.be/nsih/nsih_nl.asp and http://www.nsih.be/nsih/nsih_fr.asp
Protocol ‘BSI in hospitals’ (revised January 2016)
http://www.nsih.be/download/SEP_protocol_v4%203_NL.pdf and
http://www.nsih.be/download/SEP_protocol_v4.3_FR.pdf
Healthdata
https://healthdata.wiv-isp.be/
http://www.healthdata.be/dcd
https://support.healthdata.be
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