Developing a Registry of Healthcare-Associated Infections at Intensive Care Units in West China: Study Rationale and Patient Characteristics

Figures & data

Figure 1 Data sources for establishing the ICU-HAI registry.

Table 1 Key Details About the ICU-HAI Registry

	HAI System	EMR System	ICU System
Methods of data collection	Prospective surveillance by infection control practitioners. Basic information were extracted from EMR	Routinely collected health data from clinical process	Critical care information recorded by nurse
Information recorded	Catheterization information, hospital-acquired infection, prevention and control measures	Demographics, diagnosis, laboratory and microbiology tests, prescription, operation, admissions records, discharge summaries and costs	Shift records, nurse notes, vital signs, life supports, checklists
Frequency of data collection	Prospective surveillance data were collected every day; basic information were extracted in real time	Same as actual clinical process: admissions records were recorded within 24 hrs of admission;	Vital signs, life supports, intake and output volume were recorded every hour; shift records were recorded every 8 hrs; APACHE score were recorded within 24 hrs of admission
Follow-up time	During ICU stay	During hospital stay	During ICU stay
Department coverage	Six ICUs of WCH	Both ICU and non-ICU	Six ICUs of WCH

Figure 2 Process of registry development.

Table 2 Characteristics of Patients in the ICU-HAI Registry

	GICU	SICU	NICU	RICU	TICU	PICU	Total
Basic information
No. Patients	4543 (19.7)	4343 (18.8)	2033 (8.8)	1338 (5.8)	6407 (27.8)	5183 (22.5)	23,062 (100)
No. Admissions	4812 (20.2)	4422 (18.5)	2098 (8.8)	1373 (5.8)	6539 (27.4)	5261 (22.1)	23,847 (100)
Men, n (%)	2946 (64.8)	2669 (61.5)	1106 (54.4)	907 (67.8)	3295 (51.4)	2788 (53.8)	13,711 (57.5)
Age, year, median (Q1-Q3)	57 (44, 68)	54 (44, 67)	52 (42, 64)	67 (52, 78)	52 (45, 62)	1 (0, 7)	52 (30–65)
<18 years, n (%)	83 (1.8)	72 (1.7)	78 (3.8)	18 (1.3)	56 (0.9)		4623 (19.4)
18–44 years, n (%)	1072 (23.6)	1042 (24.0)	515 (25.3)	191 (14.3)	1480 (23.1)	-	4006 (16.8)
45–64 years, n (%)	1868 (41.1)	1948 (44.9)	943 (46.4)	392 (29.3)	3726 (58.2)	-	8793 (36.9)
≥65 years, n (%)	1520 (33.5)	1281 (29.5)	497 (24.4)	737 (55.1)	1145 (17.9)	-	6425 (26.9)
Diagnosis
Valvulopathy	3 (0.1)	0 (0.0)	0 (0.0)	4 (0.3)	3445 (53.8)	99 (1.9)	3551 (14.9)
Heart septal defectsatrial	2 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	507 (7.9)	1666 (32.1)	2175 (9.1)
Cerebral hemorrhage	38 (0.8)	556 (12.8)	1009 (49.6)	35 (2.6)	1 (0.0)	30 (0.6)	1669 (7.0)
Pneumonia	511 (11.2)	22 (0.5)	24 (1.2)	824 (61.6)	33 (0.5)	38 (0.7)	1452(6.1)
Aortic dissection	38 (0.8)	160 (3.7)	0 (0.0)	1 (0.1)	694 (10.8)	1 (0.0)	894 (3.7)
Outcome
ICU stays, median days (Q1-Q3)	6 (2, 14)	4 (2, 8)	8 (4, 8)	11 (6, 19)	3 (2, 4)	4 (3, 7)	4 (3, 8)
Hospital stays, median days (Q1-Q3)	18 (11, 28)	17 (11, 25)	17 (11, 28)	19 (10, 30)	15 (12, 19)	13 (9, 19)	16 (12, 24)
ICU mortality, n (%)	463 (10.2)	136 (3.1)	170 (8.4)	322 (24.1)	54 (0.8)	99 (1.9)	1244 (5.4)
Hospital mortality, n (%)	481(10.6)	151 (3.5)	180 (9.0)	348 (26.0)	61 (1.0)	100 (1.9)	1321 (5.5)

Abbreviations: GICU, general intensive care unit; SICU, surgical intensive care unit; NICU, neurological intensive care unit, RICU, respiratory intensive care unit; TICU, thoracic surgery intensive care unit; PICU, pediatric intensive care unit.

Table 3 Healthcare-Associated Infections Across ICUs

	GICU	SICU	NICU	RICU	TICU	PICU	Total
Person-time monitoring	4844	4448	2108	1378	6563	5271	24,612
Total ICU stays (days)	57,106	35,201	28,190	21,518	26,064	31,913	199,992
HAI cases	354	144	205	114	48	107	972
Case-time infection (%)*	7.31	3.24	9.72	8.27	0.73	2.03	3.95
Cases per 1000 patient-day (%)^#	6.20	4.09	7.27	5.30	1.84	3.35	4.86

Notes: *Case-time infection rates = total number of cases developing HAI/total number of person-time monitoring; ^#Cases per 1000 patient-days = total number of cases developing HAI/total number of ICU stays.

Abbreviations: GICU, general intensive care unit; SICU, surgical intensive care unit; NICU, neurological intensive care unit, RICU, respiratory intensive care unit; TICU, thoracic surgery intensive care unit; PICU, pediatric intensive care unit.

Table 4 Healthcare-Associated Infections in the ICU-HAI Registry

Catheterization	Ureter	Central Line	Invasive Mechanical Ventilation
n (%)	22,804 (95.6)	14,069 (59.0)	21,792 (91.6)
Patient-time	23,408	14,460	22,456
Patient-days	147,612	66,747	106,173
HAI rate	CAUTI	CLABSI	PVAP
Case-time infection (%)*	199 (0.87)	216 (1.54)	171 (0.78)
Cases per 1000 patient-days^#	1.38‰	3.23‰	1.61‰

Notes: *Case-time infection rates = total number of cases developing catheter related infection/total number of patients placed catheterization; ^#Cases per 1000 patient-days = total number of cases developing catheter related infection/total number of patient days of catheterization.

Abbreviations: HAI, healthcare-associated infections; CAUTI, catheter-associated urinary tract infection; CLABSI, central line-associated bloodstream infection; PVAP, possible ventilator-associated pneumonia.

Figure 3 Microbial culture rates of patients included into the ICU-HAI registry.

Table 5 Complement of Laboratory Test of the ICU-HAI Registry

Key Variables	No. Admissions with Tests (%)	Total Numbers of Test	Median Numbers of Tests/Admission
White blood cell	23,774 (99.7)	157,005	5 (3, 8)
Platelet	23,774 (99.7)	157,003	5 (3, 8)
Hemoglobin	23,774 (99.7)	157,000	5 (3, 8)
Direct bilirubin	23,783 (99.7)	144,267	5 (3, 7)
Albumin	23,783 (99.7)	144,093	5 (3, 7)
Serum creatinine	23,783 (99.7)	144,436	4 (3, 7)
Serum natrium	23,734 (99.5)	140,986	4 (3, 7)
Serum kalium	23,734 (99.5)	140,986	4 (3, 7)
Triglyceride	23,694 (99.4)	131,241	4 (3, 6)
Total cholesterol	23,694 (99.4)	131,243	4 (3, 6)
Low density lipoprotein	23,694 (99.4)	131,236	4 (3, 6)
Prothrombin time	23,555 (98.8)	105,878	3 (2, 5)
International normalized ratio	23,544 (98.7)	105,580	3 (2, 5)
D-dimer	16,132 (67.6)	57,511	2 (1, 4)
Blood glucose	23,780 (99.7)	143,857	5 (3, 7)
Microbial culture
Bacterial culture	8007 (33.6)	57,212	1 (0, 7)
Fungal culture	1634 (6.9)	3208	0 (0, 0)
Antimicrobial susceptibility testing	5515 (23.1)	23,235	0 (0, 0)