Infection Control & Hospital Epidemiology (2019), 40, 307–313 doi:10.1017/ice.2018.357
Original Article
Healthcare-associated bloodstream infection trends under a provincial surveillance program
Iman Fakih MSc1, Élise Fortin PhD2,3, Marc-André Smith MD4, Alex Carignan MD5, Claude Tremblay MD6, Jasmin Villeneuve MD2, Danielle Moisan MD7, Charles Frenette8, Caroline Quach MD1,2,3,9 and Alexandra M. Schmidt PhD1
for SPIN-BACTOT
1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada, 2Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada, 3Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada, 4CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Québec, Canada, 5Department of Microbiology and Infectious Diseases, Sherbrooke University, Sherbrooke, Québec, Canada, 6CHU de Québec, Québec City, Québec, Canada, 7CISSS du Bas-Saint-Laurent, Québec, Canada, 8Department of Medical Microbiology, McGill University Health Centre, Montreal, Québec, Canada and 9Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Montreal, Québec, Canada
Abstract
Objective: BACTOT, Quebec’s healthcare-associated bloodstream infection (HABSI) surveillance program has been operating since 2007. In this study, we evaluated the changes in HABSI rates across 10 years of BACTOT surveillance under a Bayesian framework.
Design: A retrospective, cohort study of eligible hospitals having participated in BACTOT for at least 3 years, regardless of their entry date. Multilevel Poisson regressions were fitted independently for cases of HABSI, catheter-associated bloodstream infections (CA-BSIs), non– catheter-associated primary BSIs (NCA-BSIs), and BSIs secondary to urinary tract infections (BSI-UTIs) as the outcome and log of patient days as the offset. The log of the mean Poisson rate was decomposed as the sum of a surveillance year effect, period effect, and hospital effect. The main estimate of interest was the cohort-level rate in years 2–10 of surveillance relative to year 1.
Results: Overall, 17,479 cases and 33,029,870 patient days were recorded for the cohort of 77 hospitals. The pooled 10-year HABSI rate was 5.20 per 10,000 patient days (95% CI, 5.12–5.28). For HABSI, CA-BSI, and BSI-UTI, there was no difference between the estimated posterior rates of years 2–10 compared to year 1. The posterior means of the NCA-BSI rate ratios increased from the seventh year until the tenth year, when the rate was 29% (95% confidence interval, 1%–89%) higher than the first year rate.
Conclusions: HABSI rates and those of the most frequent subtypes remained stable over the surveillance period. To achieve reductions in incidence, we recommend that more effort be expended in active interventions against HABSI alongside surveillance.
(Received 22 September 2018; accepted 15 December 2018)
Surveillance has been cited as a useful tool to reduce healthcare- associated infections (HAIs).1–8 Despite the substantialmorbidity and mortality of healthcare-associated bloodstreaminfections (HABSIs), surveillance programs for allHABSIs are rare. Networksmore com- monlyperformtargeted surveillance that favor themonitoring of cer- tain HABSIs, such as central-line–associated bloodstream infections (CLABSIs),9–11 or limit surveillance to certain wards, such as inten- sive care units (ICUs).9,12,13 However, surveillance limited to CLABSI would miss 70%–80%
of HABSI cases,14 most of which would be secondary infections that are often more morbid with higher case-fatality rates than pri- mary infections. Similarly, surveillance limited to ICUs would miss infections arising in acute-care wards, which can represent ~40%– 70% of HABSIs.15,16 Although it is reasonable that institutions with limited resources focus their attention on the most frequent sub- types or the most vulnerable patients, such methods have impeded
Author for correspondence: Alexandra M. Schmidt, Email:
alexandra.schmidt@
mcgill.ca Cite this article: Fakih I, et al. (2019). Healthcare-associated bloodstream infection
trends under a provincial surveillance program. Infection Control & Hospital Epidemiology, 40: 307–313,
https://doi.org/10.1017/ice.2018.357
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
a more complete understanding of HABSIs and have hindered a potentially more extensive reduction in preventable cases. To our knowledge, the handful of hospital-wide HABSI surveil-
lance programs in progress have been established in Belgium,17,18 Finland,19,20 Australia,21,22 andQuebec, Canada.23,24 In 2007, the Sur- veillance des bactériémies nosocomiales panhospitalières (BACTOT) program was initiated in Quebec to monitor all HABSI in the prov- ince’s acute-care
hospitals.BACTOThas grown from 40 participating hospitals in 2007–2008 to 89 in 2016–2017.16 AlthoughBACTOThas been operating for>10 years, the effect of surveillance onHABSIrates has not yet been characterized. In this retrospective cohort study, we evaluated the association between each BACTOT surveillance year and hospital HABSI rates, using the first year of surveillance as a baseline. It was hypothesized that rates would drop progressively in the first few years of surveillance then begin to level off.
Methods Data collection
BACTOT data collection has been described elsewhere.24 In brief, beginning on April 1, 2007, Surveillance provinciale des infections
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