Surveillance could cut number of blood stream infections

A study from Imperial College London and Hammersmith Hospitals NHS Trust shows how a surveillance programme designed to monitor blood stream infections in dialysis units could cut the number of infections among patients.

The study, in the British Medical Journal, shows how the implementation of the surveillance scheme for patients undergoing haemodialysis significantly reduced the numbers of dialysis related blood stream infections, hospital admissions and the use of antibiotics.

The researchers found levels of bacteraemia (bacteria in the blood stream) fell from a rate of 6.2 percent of patients a month to 2.0 percent of patients a month over a two year period, a fall of almost 70 percent.

Dr Alison Holmes from Imperial College London, who led the research said: "The results from this study show we could have a nationwide way to effectively reduce the rates of blood stream infection and improve the quality of care in haemodialysis units through a simple and highly cost effective monitoring system. Despite surveillance being critical for monitoring infection control, no standardised surveillance scheme exists in the UK. We hope this study will encourage the creation of such a scheme."

Haemodialysis requires vascular access, either through the use of vascular catheters or through the creation of fistulas or grafts. These can all increase the risk of infection, but the use of catheters carry the greatest risk of blood stream infections.

The team of doctors and researchers introduced a US designed scheme to monitor patients undergoing dialysis at the Hammersmith Hospital haemodialysis unit, monitoring 3418 patient months of care between June 2002 and December 2004.

After setting up the scheme, and embedding it into the day to day activities of the unit, it took up approximately two hours per month of a dialysis physician's time.

They found that as well as reducing the numbers of access related infections, the scheme was also important for raising awareness about minimising risks, and led to less antibiotics being prescribed.

Dr Holmes added: "By reducing antibiotic use not only do we reduce the risks of bacteria becoming more resistant and potentially harder to treat, but we can also reduce complications associated with antibiotic therapy, and the cost to the NHS."