Affiliations: Department of Infection, Birmingham Children's
Hospital, Birmingham, UK
Note: [] Correspondence: James W. Gray, FRCPath, Department of Infection,
Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. Tel.:
+44 121 333 9815; Fax: +44 121 333 9811; E-mail: [email protected]
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
