Preventing meticillin-sensitive Staphylococcus aureus bacteriemia in children
13 January 2014
22 May 2014
28 July 2015 (online)
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.