Background and importance An infection is healthcare-associated (HCA) if it occurs during the care of a patient. Nosocomial infections (NI) are infections acquired in a healthcare setting. Bloodstream infections are the fourth most common NI in France and half the cases are associated with a vascular catheter. Reducing invasive device-related bloodstream infections is a major priority of the national programme: prevention of HCA infections.
Aim and objectives In our hospital we noticed an increase in healthcare-associated bloodstream infections (HCA-BSI) including those related to invasive devices. The objective of the study was to describe HCA-BSI acquired in our establishment in order to reduce the number of infections related to invasive devices by promoting their correct use.
Material and methods We applied the methodology of the French network SPIADI to compare our results with those of the other hospitals monitored. Each positive blood culture corresponding to a HCA infection was analysed to define the portal-of-entry of the infection. For HCA-BSI related to invasive devices, data on vascular and urinary catheters were collected. The study was carried out between January and April 2020. The intensive care, paediatrics, nephrology, haemodialysis and surgery services were excluded (no electronic medical records).
Results We included 156 patients with HCA-BSI: 60% were aged over 65 years and 66% were immunosuppressed. HCA-BSIs (n=164) were most frequently identified in oncology (21%) and in haematology (17%). Urinary infection (44/164; 27%) and presence of a catheter (40/164; 24%) were mainly associated with HCA-BSI. Enterobacteriaceae were mostly responsible for HCA-BSI with a urinary portal-of-entry and staphylococci for central line-associated bloodstream infections (CLABSI). Implantable port catheters (IPC) were the most frequent cause of CLABSI (25/40; 62.5%). The incidence of HCA-BSI was comparable to that of other institutions, except for oncology, where it was higher (8.37 vs 3.65 per 1000 hospital days), and this was particularly the case for IPC (2.87 vs 0.96 per 1000 hospital days).
Conclusion and relevance In the light of these results, we implemented a strategy involving the reporting of surveillance data, the updating of protocols with professionals, practice observations, and the training of professionals in charge of handling invasive devices. The impact of all these measures will be assessed through the results of future monitoring.
Conflict of interest No conflict of interest