infection control & hospital epidemiology july 2017, vol. 38, no. 7 original article
Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Québec: Impact of Guidelines
Lynne Li,MDCM;1,a Elise Fortin, PhD;2,a Claude Tremblay,MD;2,3 Muleka Ngenda-Muadi, MScN;2 Christophe Garenc, PhD;2,3 Danielle Moisan,MD;4 Jasmin Villeneuve,MD;2 Caroline Quach, MD,MSc;1,2,5,6 for SPIN-BACC and SPIN-SARM
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.Weused 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
Healthcare-associated methicillin-resistant Staphylococcus aureus bloodstream infections (HA-MRSA) result in sig- nificant morbidity, mortality, and healthcare costs.1 Over the past 20 years, decreases in HA-MRSA incidence in the United States,2,3 Germany,4 Europe,5 and Australia have been well documented.6 Concomitantly, decreases in central-line– associated bloodstream infection (CLABSI) incidence have also been reported;7–10 these were largely attributed to evidence-based interventions in infection prevention and control such as hand hygiene and checklist bundles. Many of these interventions are also cornerstones of MRSA prevention. In the Canadian province of Québec, the Institut national de santé publique du Québec (INSPQ), through its healthcare- associated infection (HAI) surveillance program (Surveillance Provinciale des Infections Nosocomiales [SPIN]), reported on
S. aureus bloodstream infections, with decreasing rates of HA-MRSA between 2006 and 2015.11 Given the increases in MRSA incidence and associated costs
as well as the sense of urgency in the early 2000s, the Québec Ministry of Health and Social Services (MHSS) included the prevention ofHA-MRSA in its strategic goals for the prevention of HAIs. A first Action Plan was published for 2006–2009. The updated and reaffirmed Action Plan for 2010–2015 included progress and milestones and reinforced the fundamental goals in HAI prevention: (1) creating a strong and easily accessible surveillance program, (2) facilitating laboratory and disinfection processes, (3) facilitating antibiotic stewardship, and (4) using evidence-based practices for preventingHAIs including CLABSI and bacteremia from multidrug-resistant organisms.12,13 Pro- vincial MRSA prevention guidelines were developed in 2006,
Affiliations: 1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University; 2. Direction des risques biologiques et de la santé au
travail, Institut national de santé publique du Québec; 3. Department of Medical Microbiology, CHU de Québec; 4. Department of Medical Microbiology, CSSS Rivière-du-Loup; 5. Infection Prevention & Control Unit, CHU Sainte-Justine; 6. Department of Microbiology, Infectious Disease, and Immunology,
University of Montreal. aAuthors with equal contribution. © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0011. DOI: 10.1017/ice.2017.81
Received February 3, 2017; accepted March 29, 2017; electronically published June 5, 2017
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