impact of mrsa guidelines in québec 843
table 2. Number of Facilities (Full and Partial Participators) and Incidence of HA-MRSA and CLABSI by Year and Facility Type With 95% Confidence Interval
All Facilities 2006–2015a
Teaching 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
All yearsb
Nonteaching 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
All yearsb
Facilities in SPIN-SARM
86 22
24 24 24 24 24 24 24 24 24 22
58 58 60 61 61 62 62 62 62 62 57
Facilities in SPIN- BACC
56 16
18 18 20 20 20 20 20 20 20 16
22 22 22 24 26 27 29 31 33 33 21
HA-MRSA Incidence, Cases/100,000 PD (95% CI)
4.24 (4.04–4.44) 9.56 (8.34–10.9)
8.11 (6.99–9.36) 6.30 (5.32–7.40) 5.73 (4.81–6.78) 5.01 (4.16–5.99) 4.76 (3.92–5.71) 3.73 (3.01–4.57) 3.33 (2.63–4.16) 2.91 (2.24–3.72) 1.86 (0.85–3.53) 5.44 (5.14–5.76)
3.42 (2.70–4.37) 4.26 (3.46–5.20) 3.88 (3.13–4.76) 2.94 (2.30–3.71) 3.04 (2.38–3.82) 3.06 (2.40–3.84) 2.71 (2.11–3.43) 2.58 (1.98–3.30) 2.34 (1.77–3.03) 2.79 (1.56–4.60) 3.06 (2.84–3.30)
CLABSI Incidence, Cases/1,000 CVC days (95% CI)
1.13 (1.06–1.20) 2.24 (1.86–2.67)
1.49 (1.21–1.81) 1.51 (1.30. 1.83) 1.27 (1.01–1.56) 1.09 (0.86–1.36) 0.92 (0.71–1.18) 0.77 (0.59–1.00) 0.93 (0.72–1.19) 0.68 (0.50–0.90) 0.68 (0.35–1.20) 1.16 (1.08–1.25)
1.71 (1.19–2.38) 1.32 (0.88–1.91) 1.04 (0.65–1.58) 1.57 (1.13–2.13) 0.87 (0.57–1.29) 1.12 (0.78–1.55) 1.05 (0.74–1.45) 0.74 (0.48–1.09) 0.66 (0.42–1.00) 0.46 (0.13–1.19) 1.05 (0.93–1.18)
NOTE. HA-MRSA, hospital-associated methicillin-resistant Staphylococcus aureus; CLABSI, central-line–associated bloodstream infection; SPIN, Surveillance Provinciale des Infections Nosocomiales; SPIN-SARM, SPIN program that monitors HA-MRSA; SPIN-BACC, SPIN program that monitors CLABSI; PD, patient days; CI, confidence interval;
CVC, central venous catheter. aParticipation at any time during the study period. bContinuous participation during the study period.
for interval 2 (95% CI, 0.979–0.998) and an IRR of 0.987 for interval 3 (95% CI, 0.982–0.992), corresponding to incidence decreases of 1.1% and 1.3% per 4-week period or, cumula- tively, of 30% and 49%, respectively. Teaching facilities also showed a significant decrease in baseline incidence between intervals 1 and 2, with an IRR of 0.706 (95% CI, 0.522–0.955) a decrease of 29.4%. Nonteaching facilities did not have significant incidence rate reductions for any time interval. The IRR was 0.957 (95% CI, 0.917–1.00) for CLABSI
including all facilities before the guidelines were published. This IRR indicated a significantly decreasing incidence rate corresponding to a 4% decrease per 4-week period (Table 3). CLABSI IRR did not show any decrease in rates immediately after MRSA guideline publication (IRR, 1.00; 95% CI, 0.990– 1.01), but the decrease became significant again during interval 3 (IRR, 0.993; 95% CI, 0.987–0.998) when a decrease of 1% per 4-week period was observed. When stratifying by facility type, teaching facilities had a significant 1% incidence rate reduction per 4-week period from 2010 to 2015; nonteaching facilities had no significant reduction for any interval.
discussion
Our study’s overarching findings revealed that in Québec, HA- MRSA incidence significantly decreased after MRSA guidelines were implemented, while CLABSI rates remained stable. Later, rates for both infections followed similar decreasing trends over time, with teaching facilities driving these decreases. Our analysis showed nonsignificant rate fluctuations in HA-MRSA incidence but significant decreases in CLABSI incidence at 4% per 4-week period when all facilities were included. Because of the small sample size, CLABSI IRR became nonsignificant when stratified by facility type. During that period, because provincial guidelines had not yet been released, we did not expect any significant decreases in HA-MRSA incidence. The first break point of January 1, 2007, represents the
period immediately after the publication of INSPQ MRSA guidelines. A statistically significant sudden decrease in teaching facilities’ HA-MRSA incidence rates was observed, followed by a decrease of 1% per 4-week period from 2007 to 2009. In comparison, CLABSI incidence rates did not change
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