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Healthcare-associated bloodstream infection trends under a provincial surveillance program

Published online by Cambridge University Press:  19 March 2019

Iman Fakih ,
Élise Fortin ,
Marc-André Smith ,
Alex Carignan ,
Claude Tremblay ,
Jasmin Villeneuve ,
Danielle Moisan ,
Charles Frenette ,
Caroline Quach  and
Alexandra M. Schmidt Open the ORCID record for Alexandra M. Schmidt [Opens in a new window]
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Iman Fakih
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
Élise Fortin
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
Marc-André Smith
Affiliation:
CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Québec, Canada
Alex Carignan
Affiliation:
Department of Microbiology and Infectious Diseases, Sherbrooke University, Sherbrooke, Québec, Canada
Claude Tremblay
Affiliation:
CHU de Québec, Québec City, Québec, Canada
Jasmin Villeneuve
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
Danielle Moisan
Affiliation:
CISSS du Bas-Saint-Laurent, Québec, Canada
Charles Frenette
Affiliation:
Department of Medical Microbiology, McGill University Health Centre, Montreal, Québec, Canada
Caroline Quach
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Montreal, Québec, Canada
Alexandra M. Schmidt*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
for SPIN-BACTOT
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Québec, Canada Department of Microbiology and Infectious Diseases, Sherbrooke University, Sherbrooke, Québec, Canada CHU de Québec, Québec City, Québec, Canada CISSS du Bas-Saint-Laurent, Québec, Canada Department of Medical Microbiology, McGill University Health Centre, Montreal, Québec, Canada Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Montreal, Québec, Canada
*
Author for correspondence: Alexandra M. Schmidt, Email: alexandra.schmidt@mcgill.ca
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 3 , March 2019 , pp. 307 - 313
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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