Healthcare-associated infection in the Grey's Hospital paediatric intensive care unit: does an Infection Control Programme work?

Background: Healthcare-associated infections are an important cause of morbidity and mortality globally. Grey's Hospital introduced an Infection Control Programme in August 2016, which included Best Care Always bundles for reducing the occurrence of central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilator-associated pneumonia. Methods: An observational before-after quasi-experiment was conducted retrospectively reviewing healthcare-associated infection rates in the Grey's Hospital paediatric intensive care unit a year prior to (August 2015 to July 2016) and after (September 2016 to August 2017) implementation of an Infection Control Programme. Results: There was an absolute decrease in healthcare-associated infection from 102 to 81 and a statistically significant decrease in bloodstream infections per 1 000 central venous catheter days from 36/1 000-15/1 000 after intervention (RR 0.42, 95% CI 0.23-0.79, p= 0.004). The rate of healthcare-associated infection decreased from 23/100 admissions prior to the intervention to 20/100 admissions after the intervention (RR 0.87, 95% CI 0.51-1.48, p=0.61) and from 40/1 000 patient days to 32/1 000 patient days (RR 0.80, 95% CI 0.51-1.26, p= 0.34). Reductions in healthcare-associated infection were also seen in bloodstream infections and urinary tract infections. Conclusion: The observed downward trend in overall healthcare-associated infections, bloodstream infections and urinary tract infections did not reach statistical significance except for bloodstream infections per 1 000 central venous catheter days. Further research or audit is needed to ascertain reasons for this less than expected decrease in healthcare-associated infections. In the meantime, meticulous adherence to bundles should be encouraged.