Impact of an intensive surveillance on central line associated blood stream infections at an Indian trauma center

BackgroundCentral line associated blood stream infections (CLA-BSIs) are a leading cause of health care associated infections. There is paucity of data on the actual magnitude of CLA-BSIs in most hospitals of developing countries due to lack of surveillance. This study reports the impact of an intensive surveillance, training and feedback on the rates of CLA-BSIs at an Indian trauma center.MethodsThe study was conducted at a level 1 trauma center from June 2010 to January 2013. The clinical details of all patients and microbiology culture reports who were admitted for more than 48 h were recorded in a pre-designed pro forma. These details were further entered in an automated software based upon CDC NHSN's definitions of device associated infections. The CLA-BSI rates in a previous pilot study in 2010 were found to be very high. Intensive surveillance, education and training drive was initiated along with better hand hygiene and device care as a part of hospital infection control measures.ResultsDuring the study period, a total of 2969 patients were followed up for CLA-BSIs. These patients amounted to a total of 27,394 ICU days and 15,443 CVC days. A total of 93 episodes of CLA-BSI occurred during the study, amounting to a CLA-BSI rate of 6.02/1000 CVC days. Staphylococcus aureus (27; 27.5%) was the most common isolate. A total of 101 episodes of secondary BSIs were also observed during the study. Of these, 70 (69%) were secondary to VAP, 18 (18%) were secondary to wound infections and 13 (13%) were secondary to UTI. Of the 92 patients who accounted for the 93 episodes of CLA-BSIs, a total of 20 (21.7%) had a fatal outcome.ConclusionsThus, with the help of the intensive surveillance, using this software, we have been able to monitor the impact of training, surveillance and interventions on the rates of CLA-BSI, which have reduced from 27.6 to 6/1000 CVC days within a span of 2 years at our institute. Although these measures require a dedicated team effort, they are easy and cost effective to implement and can reduce device associated infections across all types of health care facilities.