Infection control in UK neonatal units: the greater impact in surgical units

A national Infection in Critical Care Quality Improvement Programme for England: A survey of stakeholder priorities and preferences

INTRODUCTION

Severe infection is one of the most common causes of critical illness. Healthcare-associated infections complicating critical illness bring the additional challenge of multidrug resistance. However, England lacks a national surveillance system for infections in intensive care units. Prior experience with surveillance systems suggests that they are most effective when placed within a collaborative quality improvement framework.

METHOD

A national survey of adult, paediatric and neonatal intensive care doctors, nurses, microbiologists and infection control practitioners was undertaken throughout the UK to determine stakeholder engagement.

RESULTS

Of 763 respondents (80% ICU physicians; 8% nurses) from 158 hospital Trusts across the UK, 721 (94.4%) supported establishing a surveillance system; 63.5% preferred that data collection be mandatory; 47.5% considered that the work should be undertaken within existing resources. Respondents prioritised catheter-associated and multidrug resistant infections. Free-text responses demonstrated strong support for using the data for epidemiological information and benchmarking for quality improvement.

DISCUSSION

The survey provides a satisfactory foundation for establishing a national surveillance system for infection prevention and control in critical care in England.

Surveillance swabbing for MRSA on neonatal intensive care units – is weekly nasal swabbing the best option?

Most paediatric meticillin resistant Staphylococcus aureus (MRSA) infections occur in neonatal units, but evidence for ongoing MRSA surveillance is lacking and practice varies.

The aim of this study was to determine the optimal strategy for neonatal MRSA screening according to swab site, gestational age and birth weight. MRSA detection on simultaneous weekly nasal and groin surveillance swabs and suspected infected sites was determined for all admissions to a tertiary neonatal unit over eight years. Twenty one thousand, seven hundred and thirty six surveillance specimens were examined (3,784 admissions). Infants colonised with MRSA were smaller and of lower gestational age compared with uncolonised infants ( p<0.0001). Infants initially positive on groin swabs alone (13/68; 19%) were of significantly greater gestational age and weight at birth compared with infants initially positive on nose swabs/both nose and groin swabs (55/68; 80%). Infants initially identified on groin swabs were all subsequently detected on nasal swabs or discharged within two weeks of age. 18/86 (21%) of MRSA cases were initially detected on swabbing suspected infected sites. Surveillance swabbing identified 43% of infants before MRSA bacteraemia. Eighty five per cent of colonised infants would be detected by weekly nasal swabs and by swabbing suspected infected sites. Groin swabs detect a small number of bigger mature babies who are discharged before two weeks of age.