In the Journals

Canada sees 30% decline in hospital infections

Geoffrey Taylor, MD
Geoffrey Taylor

The prevalence of health care-associated infections in Canadian hospitals declined 30% between 2009 and 2017, falling to 7.9%, researchers reported.

Last year, Shelley S. Magill, MD, PhD, a medical officer in the CDC’s Division of Healthcare Quality Promotion, and colleagues reported in The New England Journal of Medicine that the prevalence of health care-associated infections (HAIs) in 2015 fell to 3.2% in the United States.

“Hospital infection prevalence surveys are specific to the population studied, so direct comparisons are difficult,” Geoffrey Taylor, MD, professor of medicine in the division of infectious diseases at the University of Alberta and senior medical director of infection prevention and control at Alberta Health Services, told Infectious Disease News.

“For example, our study involved large urban tertiary-care hospitals and excluded very low-risk units — for example, maternity. The recent study from the U.S. by Magill [and colleagues] involved lower risk hospitals and not surprisingly found lower infection rates,” Taylor continued. “That said, the MRSA (31%) and carbapenemase resistance (negligible) rates we found in hospital infections were quite a bit lower than Magill (45% and 5%, respectively).”

Taylor and colleagues assessed the burden of HAIs through descriptive point-prevalence surveys conducted by The Canadian Nosocomial Infection Surveillance Program. The surveys documented infections on a single day in February 2002, 2009, and 2017, including UTIs, pneumonia, Clostridioides difficile infections (CDIs), surgical site infections (SSIs), and bloodstream infections.

In 2002, 33 hospitals were surveyed, with an 84.8% response rate. In 2009 and 2017, 55 and 66 hospitals were surveyed and 71% and 71.2% responded, respectively.

The prevalence of patients with at least one HAI in 2002 was 9.9% (95% CI, 8.4%-11.5%). It increased to 11.3% (95% CI, 9.4%-13.5%) in 2009, then fell to 7.9% (95% CI, 6.8%-9%) in 2017.

“This supports the conclusion that Canadian hospitals have implemented multiple strategies to reduce infections, such as improved hand hygiene, 'bundled' prevention interventions such as central venous catheter bundles, antimicrobial stewardship,” Taylor said.

According to the study, device-associated infections comprised 35.6% of all HAIs in 2017. Taylor and colleagues reported that of all organisms identified between 2002 and 2017, 3.9% were MRSA, but other antibiotic-resistant pathogens were “uncommon causes” of infection.

With a 32% prevalence, UTIS were the most common infection, followed by pneumonia at 23%, SSIs at 20%, bloodstream infections at 15% and CDI at 9%.

“Our study also suggests future directions: While not high — about 9% overall — antibiotic resistance is growing, so hospitals need to respond,” Taylor said. “More than a third of hospital infections are associated with invasive medical devices (urinary catheters, surgical implants, etc); strategies to eliminate the need for/improve the safety of these devices will prevent more infections.”

In a related commentary, Jennie Johnstone, MD, PhD, physician co-lead of infection prevention and control at Sinai Health System and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, and colleagues explained that although the study findings are “impressive,” they signal a “promising” beginning rather than an end to the fight against HAIs.

“Without ongoing efforts to improve and reduce health care-associated infections and antimicrobial resistance and without frequent measurement of our performance as a country, it is likely that the gains seen in this study will not be sustained and that Canada’s antimicrobial resistance problem may become unmanageable,” they wrote. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

Geoffrey Taylor, MD
Geoffrey Taylor

The prevalence of health care-associated infections in Canadian hospitals declined 30% between 2009 and 2017, falling to 7.9%, researchers reported.

Last year, Shelley S. Magill, MD, PhD, a medical officer in the CDC’s Division of Healthcare Quality Promotion, and colleagues reported in The New England Journal of Medicine that the prevalence of health care-associated infections (HAIs) in 2015 fell to 3.2% in the United States.

“Hospital infection prevalence surveys are specific to the population studied, so direct comparisons are difficult,” Geoffrey Taylor, MD, professor of medicine in the division of infectious diseases at the University of Alberta and senior medical director of infection prevention and control at Alberta Health Services, told Infectious Disease News.

“For example, our study involved large urban tertiary-care hospitals and excluded very low-risk units — for example, maternity. The recent study from the U.S. by Magill [and colleagues] involved lower risk hospitals and not surprisingly found lower infection rates,” Taylor continued. “That said, the MRSA (31%) and carbapenemase resistance (negligible) rates we found in hospital infections were quite a bit lower than Magill (45% and 5%, respectively).”

Taylor and colleagues assessed the burden of HAIs through descriptive point-prevalence surveys conducted by The Canadian Nosocomial Infection Surveillance Program. The surveys documented infections on a single day in February 2002, 2009, and 2017, including UTIs, pneumonia, Clostridioides difficile infections (CDIs), surgical site infections (SSIs), and bloodstream infections.

In 2002, 33 hospitals were surveyed, with an 84.8% response rate. In 2009 and 2017, 55 and 66 hospitals were surveyed and 71% and 71.2% responded, respectively.

The prevalence of patients with at least one HAI in 2002 was 9.9% (95% CI, 8.4%-11.5%). It increased to 11.3% (95% CI, 9.4%-13.5%) in 2009, then fell to 7.9% (95% CI, 6.8%-9%) in 2017.

“This supports the conclusion that Canadian hospitals have implemented multiple strategies to reduce infections, such as improved hand hygiene, 'bundled' prevention interventions such as central venous catheter bundles, antimicrobial stewardship,” Taylor said.

According to the study, device-associated infections comprised 35.6% of all HAIs in 2017. Taylor and colleagues reported that of all organisms identified between 2002 and 2017, 3.9% were MRSA, but other antibiotic-resistant pathogens were “uncommon causes” of infection.

With a 32% prevalence, UTIS were the most common infection, followed by pneumonia at 23%, SSIs at 20%, bloodstream infections at 15% and CDI at 9%.

“Our study also suggests future directions: While not high — about 9% overall — antibiotic resistance is growing, so hospitals need to respond,” Taylor said. “More than a third of hospital infections are associated with invasive medical devices (urinary catheters, surgical implants, etc); strategies to eliminate the need for/improve the safety of these devices will prevent more infections.”

In a related commentary, Jennie Johnstone, MD, PhD, physician co-lead of infection prevention and control at Sinai Health System and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, and colleagues explained that although the study findings are “impressive,” they signal a “promising” beginning rather than an end to the fight against HAIs.

“Without ongoing efforts to improve and reduce health care-associated infections and antimicrobial resistance and without frequent measurement of our performance as a country, it is likely that the gains seen in this study will not be sustained and that Canada’s antimicrobial resistance problem may become unmanageable,” they wrote. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.