Title : Monitoring quality of care through linkage of administrative data : national trends in bloodstream infection in UK paediatric intensive care units 2003 - 2012

(project number 08/13/47). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the ABSTRACT Objectives: Interventions to reduce hospital-acquired bloodstream infection (BSI) have succeeded in reducing rates in US paediatric intensive care units (PICUs) but there is a lack of evidence for the impact of similar interventions in the UK. We assessed variation in BSI rates within and between PICUs over a 10-year period, during which time infection control strategies (care bundles) were implemented. Design: Observational study linking laboratory data to national audit data of paediatric intensive care admissions (PICANet). Interventions: Implementation of infection control strategies in PICU captured through a survey of clinicians. Measurements and main results: Rates of BSI per 1000 bed-days were estimated from samples taken between 2 days after admission and up to 2 days following discharge from PICU. 2.0% of children experienced at least one BSI, corresponding to 5.11 (95% CI 4.90-5.31) per 1000 bed-days. There was a significant difference in trends pre-implementation of infection control strategies (annual decrease of 8.0%; 95% CI 6.3%-9.7%) versus post-implementation (annual decrease of 13.4%; 95% CI 10.3%-16.4%). By 24 months post-implementation, the rate of BSI fell 25.5% since the reported implementation date and was 15.1% lower than would have been expected if pre-implementation trends had continued. Conclusions: Our population-based study of PICUs in England and Wales demonstrates a steady decline in BSI rates over time. In addition, there was a significant and incremental further decrease in rates associated with timing of implementation of infection control strategies. Assessment of BSI trends before as well as after implementation of infection control strategies can be facilitated using data linkage and is important to avoid overestimating the impact of unit level interventions to improve infection control. Advances in collection and linkage of real-time data could further support quality improvement efforts.