ICU HAI Surveillance

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ICU HAI Surveillance

• Dr Brian Cook
• Royal Infirmary, Edinburgh

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RIE HAI Surveillance

• 2004
• Pilot units with HPS
• Funded surveillance nurse
• HELICS database and definitions
• ICU Consultant support
• Microbiology Consultant support

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Lessons in the First Year

• It takes time!
• 3-4hrs per day 5 days/week
• Dont look at lt48hours
• Follow up needs to be up to 14 days
• Capture all culture results
• HELICS v WW

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Lessons in the First Year

• Count denominators well- CVC, Ventilator days
• Identify antibiotics given
• Stickers!!
• MRSA screen admissions
• Feedback results to staff

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Stickers!
CENTRAL/ARTERIAL LINE INSERTION COMPLETE ALL
INFORMATION (Circle appropriate) Date Time Oper
ator Name Line
Type Right ? Left ? Standard Technique
Followed Triple Lumen ? Int Jugular
? Antiseptic hand scrub ? Quad
Lumen ? Subclavian ? Gown, gloves, hat and mask
? PA catheter sheath ? Femoral ? Chlorhexidine
skin prep ? CVVH line ? Radial ? Aseptic
insertion, drapes ? Other-specify ?
Other -specify ? Smart Sites Used
? Ultrasound Anatomy Check ?
Visualised Insertion ? Not Used
? Difficulties/Complications/Deviation from
Standard Technique? - Explain         Post
Insertion CXR checked? ? by     Operator
Sign  
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Stickers!
Date
Time Antimicrobial name New Antimicrobial
Antimicrobial Change
Reason for change ..
Infection Suspected/Confirmed in Lung Blood
Line Abdomen Uncertain Prophylactic other
(specify) Have you identified pathogen at
time of prescription? Yes No
Organism..
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Lessons in the First Year

• Count denominators well- CVC, Ventilator days
• Identify antibiotics given
• Stickers!!
• MRSA screen admissions
• Feedback results to staff
• Make sure they understand why?

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ICU HAI SurveillanceWhat it can deliver?

• Patient Safety
• Quality improvement
• Staff education
• Infection Control Strategy
• (Research)

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HAI Surveillance
Process Audit
Safety/Quality Improvement Change
Act
Staff Education Practice Changes
Measure/Audit Process Compliance
Plan
Study
Do
Implement Care Bundles, etc
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Lessons in the First YearStaff Feedback- Keep
it simple, stupid!!
It is not research
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HAI Staff feedback- SPC Charts
http//www.indicators.scot.nhs.uk/SPC/SPC.html
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HAI Staff feedback- Newsletter/Posters
Central Line Bundle Compliance with central line
insertion and maintenance bundle has been
consistently 100 (monthly spot audit) Number
of Days since last CRBSI   No Catheter related
blood stream infections since 8th February  
 
81 Days
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RIE Progress after 4 Years
Decrease from 17.3 (2006) to lt5 /1000 ventilator
days
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RIE Progress after 4 Years
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RIE Progress after 4 Years
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Targets!
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Targets!
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ICU HAI SurveillanceWhat it can deliver?

• Patient Safety
• Quality improvement
• Staff education
• Infection Control Strategy
• (Research)

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How to Succeed or Fail?

• Clinically credible staff
• Critical Care background
• Recognise Educational Role and Opportunities
• Medical Staff buy in
• Have financial control of your surveillance staff
• Deliver data
• Do it well- becomes indispensible
• Check against what your IC team tell you!
• Continuous as part of IC Strategy
• Feedback which everyone understands