The use of invasive devices in patient care can be associated with serious infections, particularly bacteremia and pneumonia. These infections are a major cause of mortality and morbidity. The goal of this surveillance program, combined with evaluation and training initiatives, is to reduce these infections.

Indeed, under the leadership of Santé publique France, the National Mission for the Surveillance and Prevention of Infections Associated with Invasive Devices (SPIADI) has developed a program aimed at reducing the incidence of infections associated with invasive devices. This program comprises three synergistic components: infection surveillance for three months each year across all healthcare sectors, an annual campaign to observe practices, and training for healthcare professionals responsible for the insertion and use of invasive devices. The combination of these elements makes it possible to reduce infections linked to these devices by up to 50%.

Conducted over a three-month period between January 1 and July 15, 2020, this surveillance effort is the second edition of the surveillance of infections associated with invasive devices carried out within the framework of the national SPIADI network, following the one conducted in 2019 by the Center for the Prevention of Healthcare-Associated Infections (CPias) in the Val-de-Loire region.

Participation figures for 2020

Despite the COVID-19 pandemic, the national surveillance program for infections associated with invasive devices involved one in four healthcare facilities.

Surveillance of infections associated with invasive devices thus involved:

• 878 healthcare facilities

• 255 adult or pediatric intensive care units (+4% compared to 2019)

• 34 neonatal intensive care units (+21% compared to 2019)

• 140 specialized hemodialysis units

• 163,454 monitored beds

• 10,002,213 hospital days

Key findings from the 2nd National Surveillance Survey of Infections Associated with Invasive Devices (SPIADI)

Surveillance of catheter-related bloodstream infections: monitoring incidence in intensive care

• In 2020, the incidence of central venous catheter (CVC)-related bacteremias in intensive care was 1.67 per 1,000 catheterization days, whereas the Propias target for this indicator is less than 1 per 1,000 catheterization days

• The main microorganisms responsible for catheter-related bacteremias are coagulase-negative staphylococci (38%), S. aureus (20%), and Enterobacteriaceae (22.4%)

Surveillance of ventilator-associated pneumonia (VAP): no decrease in incidence in 2020

• 896 ventilator-associated pneumonia (VAP) cases were reported

• The incidence of ventilator-associated pneumonia (VAP) was estimated at 22.67 per 1,000 ventilator days

• The main microorganisms associated with VAP are Enterobacteriaceae (42.8%), P. aeruginosa (20.6%), S. aureus (14.4%), and Candida (3.4%)

The impact of the COVID-19 pandemic

The COVID-19 pandemic has altered department activities, both in and outside of intensive care units.

A comparison of incidence rates observed in 2019 and 2020 for a cohort of 65 intensive care units shows an increase in the incidence rate of central line-associated bacteremia in 2020 in university hospitals, regional hospitals, and acute care hospitals, without an increase in the incidence of VAP.

What lessons can be drawn from this?

The results presented in the report confirm the strategic decisions made at the national level, particularly the decision to expand surveillance beyond intensive care units.

Despite the challenging context of the health crisis, the high level of participation (nearly 900 participating healthcare facilities) and the diversity of institutions that took part in the campaign are very encouraging. Nevertheless, during the COVID-19 pandemic, the expected decline in rates was not observed, and the target of the National Propias Program was not met. This period of intense activity in healthcare facilities, the severity of the patients being treated (both COVID-19 and non-COVID-19), and shortages of healthcare staff may help explain these results.

Local officials are encouraged to continue participating or to join the network in order to assess their situation and determine their priorities for action. Their participation in each annual campaign allows for monitoring the impact of prevention efforts implemented on the ground.