Abstract
Children are at high risk of bloodstream infection with meticillin-sensitive Staphylococcus aureus (MSSA BSI). We had previously found that the great majority of MSSA BSI (91.0%) in
our hospital occurred in children with co-morbidities, suggesting that there may be
opportunities to prevent at least some cases. An ongoing quality improvement programme
was established, leading to a succession of interventions being introduced from August
2011 onwards. These interventions were based on data obtained from the existing Microbiology
Department blood culture database and, from October 2010, root cause analyses of each
new episode of MSSA BSI. Workstreams targeted the three commonest causes of positive
blood cultures: infected central venous catheters (CVCs); surgical site infections
and contamination of blood cultures. Key interventions were streamlining of the response
to local infections in patients with CVCs; increased dosage of flucloxacillin as prophylaxis
for cardiac surgery; and campaigns to improve blood culture use. There was a marked
reduction in the number of cases of MSSA BSI between the two years before and after
the programme was instigated. Overall, there were 79 MSSA BSI in the first two years,
compared with 45 in the latter two years. A reduction was seen in all categories of
MSSA BSI; pre-48 h decreased by 46.7%; post-48 h decreased by 25%; contaminants decreased
by 70.6%. By contrast, hospital activity and the number of blood cultures received
in the laboratory increased by 8.7% and 12.2% over this period. However, CVCs remain
the commonest cause of MSSA BSI in our hospital, suggesting that there are further
opportunities to prevent MSSA BSI. Areas for future research are identified.
Keywords
Staphylococcus aureus
- bloodstream infection - central venous catheter - prevention
