Preventing healthcare associated Gram-negative bloodstream infections (GNBSI)


An improvement resource to help health and social care economies reduce the number of GNBSIs, with an initial focus on Escherichia coli (E.coli).

Preventing healthcare associated Gram-negative bloodstream infections PDF, 461.2 KB

We've developed this resource with Public Health England and colleagues across the health economy, including those working on the front line.

We're focusing on reducing healthcare associated E. coli bloodstream infections because they represent 55% of all Gram-negative BSIs.

As approximately three-quarters of E. coli BSIs occur before people are admitted to hospital, reduction requires a whole health economy approach.

If you'd like to feedback on this resource, please email

Tools for local teams

We've made suggestions rather than prescriptions about how to reduce these infections and pulled together a collection of tools for local teams. We recognise that effective prevention of infection is multifaceted and requires strong leadership, effective training programmes, and evidence-based guidelines and interventions.

If you notice there are resources missing please let us know

This tool has been designed to allow organisations or systems to assess the overall approach to reducing E.coli blood stream infections (BSIs) and the engagement with the wider health economy in delivering a reduction. It is also intended to assist organisations or systems to produce a focused and effective action plan for reducing E.coli BSIs. 

We would welcome any feedback on the content and utilisation of the tool by emailing the our IPC email address:

Evidence and resources

We've collated a range of evidence, guidance, examples of practice and supportive resources into one place, providing easier access for health and social care workers leading on or interested in preventing Gram-negative bloodstream infections (GNBSI).

Essential standards

Guidance on the definition of healthcare associated Gram-negative bloodstream infections PDF, 163.6 KB

The guidance explains, for the purposes of the NHS ambition to reduce healthcare-associated Gram-negative BSIs, how these infections will be defined according to where they are detected (community or hospital settings), and key healthcare-associated risk factors.

Antimicrobial stewardship

Focus of infection

Urinary tract

Catheter associated urinary tract

Skin or soft tissue

Intravascular associated infection

Surgical site infections

Patient Information

Education and training

Local examples



Prevention of sepsis

Monitoring E.coli

E. coli rates in 2016/17 by clinical commissioning group and trust PDF, 476.7 KB

This map shows the clinical commissioning groups (CCGs) and NHS providers that reported the highest and lowest rates of E. coli bacteraemia in 2016/17.

Trust and CCG level impact of E.coli BSIs XLSX, 289.5 KB

An indicative tool showing NHS providers and commissioners how many infections are happening, the length of time patients stay in hospital, how many deaths are associated with E. coli and the financial cost to the NHS.

Online GNBSI reduction toolkit


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    • nhsi
    • 3 Apr '17

    resource was opened for discussion.

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