Surveillance of device-associated infection rates at adult intensive care units in the VINCat program (2010-2022).

Abstract

Introduction: Surveillance is an essential part of the control of device-related nosocomial infections (NI) in intensive care units (UCIs). The aim of this study was to analyze the evolution of device-related infection rates in ICUs over the last 13 years, including ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI).

Material and methods: Patients admitted to the 44 ICUs at 43 participating hospitals of the VINCat Program from 2010 to 2022 were included, taking into account three periods: first period (2010-2013), second period (2014-2017) and third period (2018-2022). Hospitals were classified into three groups according to their size: small (<200 beds), medium (200-500 beds) and large (>500 beds). Complexity was assessed based on the use of invasive mechanical ventilation. The incidence rate of VAP, CRBSI and CAUTI was recorded at least during three consecutive months/year in each unit by an intensivist with extensive experience.

Results: The device utilization ratio (DUR) of mechanical ventilation was 0.39, varying between 0.38 in large hospitals and 0.42 in small hospitals. The DUR of central venous catheter was 0.6, ranging from 0.59 (large hospitals) to 0.64 (small). The DUR of urinary catheter was 0.66, with a range of 0.65 (large hospitals) to 0.68 (small). The complexity of the different ICUs influenced the DUR of the different devices and the infections associated with them. The average rates of VAP, CRBSI, and CAUTI were 6.4, 1.9, and 3.4 episodes per 1000 device days respectively.

Conclusions: Surveillance systems provide information on intra-ICU infections. ICU complexity, measured in terms of the use of mechanical ventilation, influences device-associated infections.