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National Surveillance of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Canadian Acute-Care Hospitals
- Linda Pelude, Jennifer Campbell, Suzanne Bakai-Anderson, Pat Bedard, Jeannette Comeau, Joan Durand, John Embil, Joanne Embree, Gerald Evans, Charles Frenette, Allana Ivany, Kevin Katz, Pamela Kibsey, Joanne Langley, Bonita Lee, Jerome Leis, Allison McGeer, Jennifer Parsonage, Donna Penney, Anada Silva, Jocelyn Srigley, Paula Stagg, Jen Tomlinson, Joseph Vayalumkal, Connie Gittens-Webber, Stephanie Smith, CNISP PHAC
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s72-s73
- Print publication:
- October 2020
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Background: Bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA) are important causes of morbidity and mortality in hospitalized patients. Long-term national MRSA BSI surveillance establishes rates for internal and external comparison and provide insight into epidemiologic, molecular, and resistance trends. Here, we present and discuss National MRSA BSI incidence rates and trends over time in Canadian acute-care hospitals from 2008 to 2018. Methods: The Canadian Nosocomial Infection Surveillance Programme (CNISP) is a collaborative effort of the Association of Medical Microbiology and Infectious Disease Canada and the Public Health Agency of Canada. Since 1995, the CNISP has conducted hospital-based sentinel surveillance of MRSA BSIs. Data were collected using standardized definitions and forms from hospitals that participate in the CNISP (48 hospitals in 2008 to 62 hospitals in 2018). For each MRSA BSI identified, the medical record was reviewed for clinical and demographic information and when possible, 1 blood-culture isolate per patient was submitted to a central laboratory for further molecular characterization and susceptibility testing. Results: From 2008 to 2013, MRSA BSI rates per 10,000 patient days were relatively stable (0.60–0.56). Since 2014, MRSA BSI rates have gradually increased from 0.66 to 1.05 in 2018. Although healthcare-associated (HA) MRSA BSI has shown a minimal increase (0.40 in 2014 to 0.51 in 2018), community-acquired (CA) MRSA BSI has increased by 150%, from 0.20 in 2014 to 0.50 in 2018 (Fig. 1). Laboratory characterization revealed that the proportion of isolates identified as CMRSA 2 (USA 100) decreased each year, from 39% in 2015 to 28% in 2018, while CMRSA 10 (USA 300) has increased from 41% to 47%. Susceptibility testing shows a decrease in clindamycin resistance from 82% in 2013 to 41% in 2018. Conclusions: Over the last decade, ongoing prospective MRSA BSI surveillance has shown relatively stable HA-MRSA rates, while CA-MRSA BSI rates have risen substantially. The proportion of isolates most commonly associated with HA-MRSA BSI (CMRSA2/USA 100) are decreasing and, given that resistance trends are tied to the prevalence of specific epidemic types, a large decrease in clindamycin resistance has been observed. MRSA BSI surveillance has shown a changing pattern in the epidemiology and laboratory characterization of MRSA BSI. The addition of hospitals in later years that may have had higher rates of CA-MRSA BSI could be a confounding factor. Continued comprehensive national surveillance will provide valuable information to address the challenges of infection prevention and control of MRSA BSI in hospitals.
Funding: None
Disclosures: None
Collaborative Approach to Developing Infection Prevention Control Recommendations at a Tertiary-Care Pediatric Hospital
- Bonita Lee, Joan Durand, Helen Jones, Nicole Gartner, Jennifer Driscoll, Cheryl Watson, Uma Chandran, Veena Sivarajan, Nichole Pereira, Maria Clonfero, Jaylene Degroot, Michelle Childs
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s173
- Print publication:
- October 2020
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Background: Stollery Children’s Hospital (SCH) is a tertiary-care pediatric hospital with a complex infrastructure: 3 NICUs located at 3 different hospitals, and all of the pediatric inpatient beds, PICU, PCICU, and a medical-surgical NICU at the main SCH site shared buildings with an academic adult hospital. We describe a collaborative process used to develop standardized SCH Infection Prevention and Control (IPC) recommendations. Methods: The SCH IPC formed a working group with Patient and Family-Centered Care (PFCC) and family representatives in 2014 to enhance the engagement of families in regards to IPC issues and initiatives. The working group identified inconsistent messages provided to families when a child was admitted as a patient requiring additional precautions (PRAP). The working group then developed a framework of key questions to be answered for family care providers of PRAP. The working group held several consultative meetings with frontline staff followed by a review of published guidelines and consultations with other pediatric hospitals about contentious issues. A consensus meeting with all key stakeholders was held to finalize IPC recommendations. Results: The key contentious issues included (1) whether personal protective equipment is required for family care providers who stay overnight with PRAP and (2) whether family care providers of PRAP are allowed to access nutrition centers on clinical units and family lounges in PCICU–PICU–NICU that were stocked with free hot meals for the families. No directly applicable recommendation was available IPC guidelines on these issues. Discussions of these topics were directed by PFCC at family councils of various clinical programs with efforts to seek opinions from more family representatives. Expert opinions and current practice were also obtained from Canadian hospitals through emails and from US hospitals through SHEA Open Forum by ICP. A final consensus meeting revisiting all available information was held, and a new Stollery IPC guideline was created with families as partners sharing the IPC vision of minimizing transmission risk at SCH. Conclusions: A consultative engagement and consensus process was successful in the development of IPC recommendations for family care providers for PRAP for implementation at a tertiary-care pediatric hospital with a complex infrastructure. The next step is to develop family-friendly educational and resource materials with clear and concise messages.
Funding: None
Disclosures: None
Sherlock Holmes: Whose Tissue Is It Anyway?
- Bonita Lee, Jason Silverman, Atilano Lacson, Iyare Izevbaye, Hien Huynh, Consolato Sergi, Remegio Maglantay, Cheryl Mather, Adrian Box, Teresa Paonessa, Rebecca Nawaz, Jesusa Pulongbarit, Mario Tremblay, Kathy VanVeen, Joan Durand, Melody Cordoviz, Nancy Aelick, Catherine Williamson
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s388-s389
- Print publication:
- October 2020
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Background: The medical device reprocessing department (MDRD) is a crucial patient safety area with checkpoints to ensure appropriate reprocessing. Objective: We report the application of molecular pathology in the investigation of potential blood and body fluid exposure (BBFE) during endoscopy. Methods: When there is a potential BBFE from a medical device, our hospital has a systematic process whereby the clinical area involves the MDRD and the infection prevention control (IPC) team. The MDRD provides reprocessing documentation, including detailed information regarding the prior use of the devices. The clinician and the IPC physician discuss the risk of BBFE. If patient disclosure occurs, the IPC physician provides follow-up as appropriate. This report illustrates the collaboration of clinicians, the IPC team, the MDRD, pathologists, and molecular pathologists in investigating the possibility of residual human tissue and BBFE during endoscopy. Case reports: Two independent but similar events occurred in September 2016 and September 2019 in the pediatric endoscopy suite at our site, a tertiary-care pediatric hospital with 163 beds in Edmonton, Canada. During both endoscopies, the pediatric gastroenterologists observed a piece of tissue ejected from the gastroscope into the intestinal lumen when the biopsy forceps were pushed out of the channel for the first time. This observation raised concerns of possible gaps in the reprocessing of the endoscope and residual tissue remaining in the working channel after its last use. Both gastroenterologists were able to retrieve the presumed foreign tissue; however, both patients had possible BBFE because the mucosal surface was breached by the biopsy forceps. The MDRD reprocessing of both endoscopes was reviewed, and no gap was identified. In discussion with the pathologists and molecular pathologists, human identity testing using genetic markers was performed on the biopsy blocks of the previous patient on whom the endoscope was used, the potentially exposed patient, and the presumed foreign tissue for each event. The test results indicated that the presumed foreign tissue was in fact from the potentially exposed patient and therefore there was no BBFE. It is presumed that the working channel itself captured a small amount of the patient’s tissue during scope insertion. The results were a relief to the patients and families. Conclusions: It is prudent to investigate residual foreign tissue in a medical device that is being used on patients with mucosal breaches. Molecular pathology involving human identity testing is a very useful tool in the investigation of these types of events.
Funding: None
Disclosures: None