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).


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

  • Gram-negative BSI system overview tool – 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

Antimicrobial stewardship

Focus of infection

Urinary tract

Catheter associated urinary tract

Skin or soft tissue

Intravascular associated infection

Surgical site infections

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Patient Information

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Education and training

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Local examples

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Prevention of sepsis

Monitoring E.coli

  • E. coli rates in 2016/17 by trust – This map shows the former clinical commissioning groups and NHS providers that reported the highest and lowest rates of E. coli bacteraemia in 2016/17.
  • Trust level impact of E.coli BSIs – 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.
  • GNBSI reduction toolkit – Produced and published by us in 2020, the GNBSI toolkit is an online collection of guidance notes, action plans and resources you can use to shape your approach to reducing GNBSI.

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