Dr Benjamin Lazarus1,2,3, Prof Kevan Polkinghorne1,2, Dr Alex Duong2, Ms Mechelle Seneviratne2, A/Prof Ben Rogers1,2
1Monash University, Melbourne, Australia, 2Monash Health, Clayton, Australia, 3The George Institute for Global Health, Newtown, Australia
Aim: To measure the incidence of haemodialysis access-related bloodstream infection (ARBSI) using routinely collected electronic health dat
Background: Accurate surveillance of ARBSI among haemodialysis patients is important for delivering high quality healthcare. Existing surveillance systems require substantial manual data collection, which may be prone to error and resource intensive. A system that uses automated analysis of routinely collected data may be more accurate and less burdensome.
Methods: We linked routinely collected data from the electronic medical record (EMR) between 1st January 2021 and 31st December 2021 to laboratory blood culture data identifying haemodialysis (HD) treatments, vascular access modality, and positive blood cultures among adult HD patients. We calculated exposure time by access type. The source of infection for patients with a positive blood culture within 30 days of HD was evaluated by manual review of the EMR. Center for Disease Control National Healthcare Surveillance Network definitions for HD catheter-related BSI (HDCRBSI) and arteriovenous ARBSI (AV-ARBSI) events were used.
Results: In total we identified 648 patients who received haemodialysis, 21,189 catheter days and 127,873 arteriovenous access days of exposure, and 51 cases of positive blood cultures, of which 10 were HDCRBSI, 4 were AV-ARBSI, 11 were contaminants, and 26 were from alternative sources. The incidence rate of HDCRBSI (0.47 events per 1000 catheter days, 95% CI, 0.18-0.76) was 15.1 times higher (95% CI, 4.35 – 65.90) than for AV access-related BSI (0.03 events per 1000 access days, 95% CI, 0.0006-0.06). Staphylococcus aureus was predominant among HDCRBSI (6/10) and AV-ARBSI (3/4).
Conclusion: Routinely collected electronic health data can be used to enhance the surveillance of access-related bloodstream infections, although retrospective assessment of positive cultures is still required
Biography:
Ben is an early career nephrologist at Monash Health and a full time PhD candidate at Monash University and The George Institute of Global Health. His thesis examines the risks of using central venous catheters for haemodialysis in Australia, and the opportunities we all have to make these devices safer for patients.