Central-Line–Associated Bloodstream Infections in Québec Intensive Care Units: Results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN)

Abstract

BACKGROUND Following implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks. METHODS CLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007-2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs). RESULTS In total, 1,355 lab-confirmed CLABSIs over 911,205 central venous catheter days (CVC days) were recorded. The overall pooled incidence rate (IR) was 1.49 cases per 1,000 CVC days. IRs for adult teaching ICUs, nonteaching ICUs, neonatal ICUs (NICUs), and pediatric ICUs (PICUs) were 1.04, 0.91, 4.20, and 2.15 cases per 1,000 CVC days, respectively. Using fixed SPIN 2007-2009 benchmarks, CLABSI rates had decreased significantly in all ICUs except for PICUs by 2014. Rates declined by 55% in adult teaching ICUs, 52% in adult nonteaching ICUs, and 38% in NICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower and adult nonteaching ICUs had lower or comparable rates, whereas NICU and PICU rates were higher. CONCLUSION Québec ICU CLABSI surveillance shows declining CLABSI rates in adult ICUs. The absence of a decrease in CLABSI rate in NICUs and PICUs highlights the need for continued surveillance and analysis of factors contributing to higher rates in these populations. Infect Control Hosp Epidemiol 2016;1-9.

A ten-year review of healthcare-associated bloodstream infections from forty hospitals in Québec, Canada

“…The CA-BSI rates began as the highest subtype in Y1 and showed a statistically significant drop in rates in Y8 (2014-2015) that was not sustained. A 2014 decrease was also seen in a recent study by Li et al 25 on another SPIN surveillance program (SPIN-BACC) that targets CLABSI in ICUs; it may be explained by bundled practices introduced in the beginning of Y3. While this drop may have contributed to the results seen here, our study includes an overall insubstantial number (6.4%) of patient days spent in ICUs compared to the Li et al study, which was limited to CLABSI in the ICU.…”

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

“…CLABSI reporting has been mandatory for all intensive care units (ICUs) with ≥10 beds in the province of Québec since 2007. 15 Retrospective analysis of the SPIN-BACC reporting validity showed excellent results compared with other regional surveillance networks with a sensitivity of 88% and specificity of 92%. 18 Overall, 37 of 56 adult facilities (66%), including 21 nonteaching and 16 adult teaching ICUs, participated in the ICU CLABSI surveillance program for the entire study period.…”

“…14 We aimed to quantify the change in incidence rate for HA-MRSA following the implementation of MRSA prevention guidelines and policy directives by comparing changes in HA-MRSA incidence with incidence variations for another HAI, intensive care unit (ICU)associated CLABSI. Although CLABSI incidence decreased during the study period, 8,15 we expect that the timing of CLABSI decrease should be, for the most part, independent from that of HA-MRSA because ICU CLABSIs are not organism specific, and only a few cases (eg, MRSA CLABSI in the ICU) are common to both surveillances. In this study, we looked at incidence rate fluctuations for the following periods: (1) prior to the release of INSPQ MRSA guidelines (January 1, 2006, to March 31, 2007), (2) immediately after MRSA guideline release (April 1, 2007, to January 2, 2010), and (3) during the postguideline period (January 3, 2010, to March 31, 2015, a timeframe within the updated second MHSS Action Plan for 2010-2015) ( Table 1).…”

Healthcare-associated bloodstream infection trends under a provincial surveillance program

“…Nonetheless, it is unlikely that Quebec hospitals have reached the limit of HABSI preventability, as other SPIN surveillance initiatives, such as SPIN-BACC (CLABSI in the ICUs) and SPIN-HD (BSI associated with venous access for dialysis), have been successful at reducing rates. 35,36 Both infection types were subject to bundle interventions and their programs use more specific denominators (catheterassociated days), which allow the detection of smaller changes in incidence than BACTOT.…”