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Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Québec: Impact of Guidelines

Published online by Cambridge University Press:  05 June 2017

Lynne Li ,
Elise Fortin ,
Claude Tremblay ,
Muleka Ngenda-Muadi ,
Christophe Garenc ,
Danielle Moisan ,
Jasmin Villeneuve ,
Caroline Quach  and
for SPIN-BACC and SPIN-SARM
Lynne Li
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University
Elise Fortin
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec
Claude Tremblay
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Department of Medical Microbiology, CHU de Québec
Muleka Ngenda-Muadi
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec
Christophe Garenc
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Department of Medical Microbiology, CHU de Québec
Danielle Moisan
Affiliation:
Department of Medical Microbiology, CSSS Rivière-du-Loup
Jasmin Villeneuve
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec
Caroline Quach*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Infection Prevention & Control Unit, CHU Sainte-Justine Department of Microbiology, Infectious Disease, and Immunology, University of Montreal
*
Address correspondence to Caroline Quach, CHU Sainte-Justine, 3175 ch. de la Côte Ste-Catherine, Bureau B.17.102, Montréal (QC) H3T1C5 ([email protected]).
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Abstract

OBJECTIVE

We examined the impact of methicillin-resistant Staphylococcus aureus (MRSA) guidelines in Québec adult hospitals from January 1, 2006, to March 31, 2015, by examining the incidence rate reduction (IRR) in healthcare-associated MRSA bloodstream infections (HA-MRSA), using central-line associated bloodstream infections (CLABSIs) as a comparator.

METHODS

In this study, we utilized a quasi-experimental design with Poisson segmented regression to model HA-MRSA and CLABSI incidence for successive 4-week surveillance segments, stratified by teaching status. We used 3 distinct periods with 2 break points (April 1, 2007, and January 3, 2010) corresponding to major MRSA guideline publications and updates.

RESULTS

Over the study period, HA-MRSA incidence decreased significantly in adult teaching facilities but not in nonteaching facilities. Prior to MRSA guideline publication (2006–2007), HA-MRSA incidence decrease was not significant (P=.89), while CLABSI incidence decreased by 4% per 4-week period (P=.05). After the publication of guidelines (2007–2009), HA-MRSA incidence decreased significantly by 1% (P=.04), while no significant decrease in CLABSI incidence was observed (P=.75). HA-MRSA and CLABSI decreases were both significant at 1% for 2010–2015 (P<.001 and P=.01, respectively). These decreases were gradual rather than sudden; break points were not significant. Teaching facilities drove these decreases.

CONCLUSION

During the study period, HA-MRSA and CLABSI rates decreased significantly. In 2007–2009, the significant decrease in HA-MRSA rates with stable CLABSI rates suggests an impact from MRSA-specific guidelines. In 2010–2015, significant and equal IRRs for HA-MRSA and CLABSI may be due to the continuing impact of MRSA guidelines, to the impact of new interventions targeting device-associated infections in general by the 2010–2015 Action Plan, or to a combination of factors.

Infect Control Hosp Epidemiol 2017;38:840–847

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 840 - 847
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors with equal contribution.

References

REFERENCES

1. Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.Google Scholar
2. Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315–322.Google Scholar
3. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Internal Med 2013;173:1970–1978.Google Scholar
4. Meyer, E, Schroder, C, Gastmeier, P, Geffers, C. The reduction of nosocomial MRSA infection in Germany: an analysis of data from the Hospital Infection Surveillance System (KISS) between 2007 and 2012. Deutsches Arzteblatt Int 2014;111:331–336.Google Scholar
5. De Kraker, MEA, Jarlier, V, Monen, JCM, Heuer, OE, van de Sande, N, Grundmann, H. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect 2013;19:860–868.Google Scholar
6. Mitchell, BG, Collignon, PJ, McCann, R, Wilkinson, IJ, Wells, A. A major reduction in hospital-onset Staphylococcus aureus bacteremia in Australia—12 years of progress: an observational study. Clin Infect Dis 2014;59:969–975.Google Scholar
7. Dudeck, MA, Edwards, JR, Allen-Bridson, K, et al. National Healthcare Safety Network report, data summary for 2013, device-associated module. Am J Infect Control 2015;43:206–221.CrossRefGoogle ScholarPubMed
8. Fontela, PS, Platt, RW, Rocher, I, et al. Epidemiology of central line-associated bloodstream infections in Quebec intensive care units: a 6-year review. Am J Infect Control 2012;40:221–226.CrossRefGoogle ScholarPubMed
9. Canada PHAo. Central Venous Catheter-Associated Bloodstream Infections in Intensive Care units in Canadian Acute-Care Hospitals: Surveillance Report January 1, 2006 to December 31, 2006 and January 1, 2009 to December 31, 2011. Public Health Agency of Canada; 2014:55.Google Scholar
10. Worth, LJ, Spelman, T, Bull, AL, Richards, MJ. Staphylococcus aureus bloodstream infection in Australian hospitals: findings from a Victorian surveillance system. Med J Austral 2014;200:282–284.Google Scholar
11. Bactériémies à Staphylococcus aureus résistant à la méthicilline: résultats de surveillance. Institut national de santé publique du Québec (INSPQ) website. https://www.inspq.qc.ca/printpdf/4087. Published 2015. Accessed April 4, 2017.Google Scholar
12. Ministère de la Santé et des Services sociaux (MSSS). Plan d’action sur la prévention et le contrôle des infections nosocomiales 2006–2009. In: sociaux SedS, ed. Quebec: Gouvernement du Québec; 2006.Google Scholar
13. Ministère de la Santé et des Services sociaux du Québec (MSSS). Prevention and control of nosocomial infections—Action Plan 2010-2015 progress of work: summary and highlights. In: sociaux SedS, ed. Quebec: Gouvernement du Québec; 2011.Google Scholar
14. Comité de surveillance provinciale des infections nosocomiales (SPIN-SARM). Étude sur les mesures de prévention et de contrôle du Staphylococcus aureus résistant à la méthicilline (SARM) appliquées dans les centres hospitaliers de soins aigus du Québec. Québec: Institut national de santé publique du Québec; 2009.Google Scholar
15. Li, L, Fortin, E, Tremblay, C, Ngenda-Muadi, M, Quach, C. Central-line-associated bloodstream infections in Quebec Intensive Care Units: results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN). Infect Control Hosp Epidemiol 2016;37:1186–1194.Google Scholar
16. Surveillance des bactériémies à Staphylococcus aureus résistant à la méthicilline (SARM). Institut national de santé publique du Québec (INSPQ) website. https://www.inspq.qc.ca/infections-nosocomiales/spin/sarm. Published 2015. Accessed May 23, 2016.Google Scholar
17. Surveillance des bactériémies nosocomiales sur cathéters centraux aux soins intensifs. Institut national de santé publique du Québec (INSPQ) website. https://www.inspq.qc.ca/infections-nosocomiales/spin/bacc. Published 2016. Accessed April 4, 2017.Google Scholar
18. Fontela, PS, Rocher, I, Platt, RW, et al. Evaluation of the reporting validity of central line-associated bloodstream infection data to a provincial surveillance program. Infect Control Hosp Epidemiol 2013;34:217–219.Google Scholar
19. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
20. Fontela, PS, Platt, RW, Rocher, I, et al. Surveillance Provinciale des Infections Nosocomiales (SPIN) Program: implementation of a mandatory surveillance program for central line-associated bloodstream infections. Am J Infect Control 2011;39:329–335.CrossRefGoogle ScholarPubMed
21. Institut national de santé publique du Québec (INSPQ). Surveillance des bactériémies à Staphylococcus aureus dans les centres hospitaliers de soins aigus du Québec: protocole. Québec: Institut national de santé publique du Québec; 2013.Google Scholar
22. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286–300.Google Scholar
23. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control 2011;39:798–816.Google Scholar
24. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011;39:349–367.CrossRefGoogle ScholarPubMed
25. Dudeck, MA, Weiner, LM, Allen-Bridson, K, et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module. Am J Infect Control 2013;41:1148–1166.Google Scholar
26. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.Google Scholar
27. Katsouyanni, K, Schwartz, J, Spix, C, et al. Short term effects of air pollution on health: a European approach using epidemiologic time series data: the APHEA protocol. J Epidemiol Commun Health (1979–) 1996;50:S12–S18.Google Scholar
28. Schwartz, J, Spix, C, Touloumi, G, et al. Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Commun Health 1996;50:S3–S11.Google Scholar
29. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39:S1–S34.Google Scholar
30. Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31:319–326.Google Scholar
31. Pittet, D, Allegranzi, B, Boyce, J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611–622.Google Scholar
32. Association of Professionals in Infection Control (APIC). Guide to the elimination of catheter-associated urinary tract infections (CAUTIs). Washington, DC: APIC; 2008.Google Scholar
33. Khuri, SF, Najjar, SF, Daley, J, et al. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg 2001;234:370–382.Google Scholar
34. Polanczyk, CA, Lane, A, Coburn, M, Philbin, EF, Dec, GW, DiSalvo, TG. Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state. Am J Med 2002;112:255–261.Google Scholar
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