Publications by authors named "Geoffrey Taylor"

70 Publications

Patients in hospital with laboratory-confirmed COVID-19 in a network of Canadian acute care hospitals, Mar. 1 to Aug. 31, 2020: a descriptive analysis.

CMAJ Open 2021 Jan-Mar;9(1):E149-E156. Epub 2021 Mar 2.

Public Health Agency of Canada (Mitchell, Choi, Pelude, Rudnick); Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont.; University of Alberta Hospital (Taylor [deceased]), Edmonton, Alta.

Background: Information on the epidemiology of patients in hospital with laboratory-confirmed coronavirus disease 2019 (COVID-19) in Canadian acute care hospitals is needed to inform infection prevention and control strategies and public health measures. The aim of this surveillance was to describe the epidemiology of patients in hospital with laboratory-confirmed COVID-19 in a network of Canadian acute care hospitals between Mar. 1 and Aug. 31, 2020.

Methods: Through prospective surveillance, we identified adult and pediatric patients in hospital with laboratory-confirmed COVID-19 using a standard definition between Mar. 1 and Aug. 31, 2020, through the Canadian Nosocomial Infection Surveillance Program (CNISP), a network of 78 hospitals. Patient demographic and clinical characteristics and data on treatment, interventions and outcomes were reviewed and described.

Results: As of Aug. 31, 2020, the CNISP had received data for 1906 patients in hospital with COVID-19 in 49 sentinel hospitals in 9 provinces. The majority of patients in hospital with COVID-19 were older (median age 71 yr) and had underlying medical conditions (85.8%). Few children with COVID-19 were admitted to a participating hospital ( = 37, 1.9%). Acquisition of COVID-19 in hospitals was infrequent (6.4% of all cases). A total of 32.8% of patients were admitted from a long-term care facility or retirement home. Health care workers constituted 10.6% of adult patients aged 18-65 years in hospital with COVID-19. Thirty-day attributable mortality was 16.2%. Hospital admission rates peaked in mid-April and were highest in Ontario and Quebec.

Interpretation: Surveillance findings indicate that a high proportion of Canadian patients in hospital with COVID-19 during the first 6 months of the pandemic were older adults with underlying medical conditions. Active surveillance of patients in hospital with COVID-19 is critical to enhancing our knowledge of the epidemiology of COVID-19 and to identifying populations at risk for severe outcomes, which will help guide Canada's response in the coming months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.9778/cmajo.20200246DOI Listing
March 2021

Steroid-Responsive Mania Secondary to Pachymeningitis of the Right Frontal Lobe.

Psychosomatics 2020 Oct 3. Epub 2020 Oct 3.

Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Psychiatry, Hospital of the University of Pennsylvania, Philadelphia, PA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psym.2020.09.011DOI Listing
October 2020

Interpreting ancient food practices: stable isotope and molecular analyses of visible and absorbed residues from a year-long cooking experiment.

Sci Rep 2020 08 27;10(1):13704. Epub 2020 Aug 27.

Archaeological Research Facility, University of California, Berkeley, USA.

Chemical analyses of carbonized and absorbed organic residues from archaeological ceramic cooking vessels can provide a unique window into the culinary cultures of ancient people, resource use, and environmental effects by identifying ingredients used in ancient meals. However, it remains uncertain whether recovered organic residues represent only the final foodstuffs prepared or are the accumulation of various cooking events within the same vessel. To assess this, we cooked seven mixtures of C and C foodstuffs in unglazed pots once per week for one year, then changed recipes between pots for the final cooking events. We conducted bulk stable-isotope analysis and lipid residue analysis on the charred food macro-remains, carbonized thin layer organic patina residues and absorbed lipids over the course of the experiment. Our results indicate that: (1) the composition of charred macro-remains represent the final foodstuffs cooked within vessels, (2) thin-layer patina residues represent a mixture of previous cooking events with bias towards the final product(s) cooked in the pot, and (3) absorbed lipid residues are developed over a number of cooking events and are replaced slowly over time, with little evidence of the final recipe ingredients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-70109-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452889PMC
August 2020

Trends in health care-associated infections in acute care hospitals in Canada: an analysis of repeated point-prevalence surveys.

CMAJ 2019 Sep;191(36):E981-E988

Public Health Agency of Canada (Mitchell, Rudnick, Alexandre, Gravel-Tropper, Pelude, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor, Granfield, Smith), Edmonton, Alta.; Alberta Health Services (Bush), Calgary, Alta.; Vancouver Coastal Health (Forrester), Vancouver, BC; McGill University Health Centre (Frenette), Montréal, Que.; Infection Prevention and Control Canada (Happe), Edmonton, Alta.; London Health Sciences Centre (John), London, Ont.; Hopital Maisonneuve-Rosemont (Lavallee), Montréal, Que.; Mount Sinai Hospital (McGeer), Toronto, Ont.; Department of Medicine, McMaster University and Hamilton Health Sciences (Mertz), Hamilton, Ont.; Hospital for Sick Children (Science); Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; Alberta Children's Hospital (Vayalumkal), Calgary, Alta.; Royal University Hospital (Wong), Saskatoon, Sask.

Background: Health care-associated infections are a common cause of patient morbidity and mortality. We sought to describe the trends in these infections in acute care hospitals, using data from 3 national point-prevalence surveys.

Methods: The Canadian Nosocomial Infection Surveillance Program (CNISP) conducted descriptive point-prevalence surveys to assess the burden of health care-associated infections on a single day in February of 2002, 2009 and 2017. Surveyed infections included urinary tract infection, pneumonia, infection, infection at surgical sites and bloodstream infections. We compared the prevalence of infection across the survey years and considered the contribution of antimicrobial-resistant organisms as a cause of these infections.

Results: We surveyed 28 of 33 (response rate 84.8%) CNISP hospitals (6747 patients) in 2002, 39 of 55 (response rate 71.0%) hospitals (8902 patients) in 2009 and 47 of 66 (response rate 71.2%) hospitals (9929 patients) in 2017. The prevalence of patients with at least 1 health care-associated infection increased from 9.9% in 2002 (95% confidence interval [CI] 8.4%-11.5%) to 11.3% in 2009 (95% CI 9.4%-13.5%), and then declined to 7.9% in 2017 (95% CI 6.8%-9.0%). In 2017, device-associated infections accounted for 35.6% of all health care-associated infections. Methicillin-resistant (MRSA) accounted for 3.9% of all organisms identified from 2002 to 2017; other antibiotic-resistant organisms were uncommon causes of infection for all survey years.

Interpretation: In CNISP hospitals, there was a decline in the prevalence of health care-associated infection in 2017 compared with previous surveys. However, strategies to prevent infections associated with medical devices should be developed. Apart from MRSA, few infections were caused by antibiotic-resistant organisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1503/cmaj.190361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733684PMC
September 2019

Results from the Canadian Nosocomial Infection Surveillance Program for detection of carbapenemase-producing Acinetobacter spp. in Canadian hospitals, 2010-16.

J Antimicrob Chemother 2019 02;74(2):315-320

Antimicrobial Resistance and Nosocomial Infections, Public Health Agency of Canada, Winnipeg, MB, Canada.

Objectives: Globally there is an increased prevalence of carbapenem-resistant Acinetobacter spp. (CRAs) and carbapenemase-producing Acinetobacter spp. (CPAs) in the hospital setting. This increase prompted the Canadian Nosocomial Infection Surveillance Program (CNISP) to conduct surveillance of CRA colonizations and infections identified from patients in CNISP-participating hospitals between 2010 and 2016.

Methods: Participating acute care facilities across Canada submitted CRAs from 1 January 2010 to 31 December 2016. Patient data were collected from medical records using a standardized questionnaire. WGS was conducted on all CRAs and data underwent single nucleotide variant analysis, resistance gene detection and MLST.

Results: The 7 year incidence rate of CRA was 0.02 per 10 000 patient days and 0.015 per 1000 admissions, with no significant increase observed over the surveillance period (P > 0.73). Ninety-four CRA isolates were collected from 58 hospitals, of which 93 (98.9%) were CPA. Carbapenemase OXA-235 group (48.4%) was the most common due to two separate clusters, followed by the OXA-23 group (41.9%). Patients with a travel history were associated with 38.8% of CRA cases. The all-cause 30 day mortality rate for infected cases was 24.4 per 100 CRA cases. Colistin was the most active antimicrobial agent (95.8% susceptibility).

Conclusions: CRA remains uncommon in Canadian hospitals and the incidence did not increase from 2010 to 2016. Almost half of the cases were from two clusters harbouring OXA-235-group enzymes. Previous medical treatment during travel outside of Canada was common.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jac/dky416DOI Listing
February 2019

The evolving epidemiology of infection in Canadian hospitals during a postepidemic period (2009-2015).

CMAJ 2018 06;190(25):E758-E765

North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont.

Background: The clinical and molecular epidemiology of health care-associated infection in nonepidemic settings across Canada has evolved since the first report of the virulent North American pulsed-field gel electrophoresis type 1 (NAP1) strain more than 15 years ago. The objective of this national, multicentre study was to describe the evolving epidemiology and molecular characteristics of health care-associated infection in Canada during a post-NAP1-epidemic period, particularly patient outcomes associated with the NAP1 strain.

Methods: Adult inpatients with infection were prospectively identified, using a standard definition, between 2009 and 2015 through the Canadian Nosocomial Infection Surveillance Program (CNISP), a network of 64 acute care hospitals. Patient demographic characteristics, severity of infection and outcomes were reviewed. Molecular testing was performed on isolates, and strain types were analyzed against outcomes and epidemiologic trends.

Results: Over a 7-year period, 20 623 adult patients admitted to hospital with health care-associated infection were reported to CNISP, and microbiological data were available for 2690 patients. From 2009 to 2015, the national rate of health care-associated infection decreased from 5.9 to 4.3 per 10 000 patient-days. NAP1 remained the dominant strain type, but infection with this strain has significantly decreased over time, followed by an increasing trend of infection with NAP4 and NAP11 strains. The NAP1 strain was significantly associated with a higher rate of death attributable to infection compared with non-NAP1 strains (odds ratio 1.91, 95% confidence interval [CI] 1.29-2.82). Isolates were universally susceptible to metronidazole; one was nonsusceptible to vancomycin. The proportion of NAP1 strains within individual centres predicted their rates of health care-associated infection; for every 10% increase in the proportion of NAP1 strains, the rate of health care-associated infection increased by 3.3% (95% CI 1.7%-4.9%).

Interpretation: Rates of health care-associated infection have decreased across Canada. In nonepidemic settings, NAP4 has emerged as a common strain type, but NAP1, although decreasing, continues to be the predominant circulating strain and remains significantly associated with higher attributable mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1503/cmaj.180013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019340PMC
June 2018

Influenza vaccine effectiveness to prevent influenza-related hospitalizations and serious outcomes in Canadian adults over the 2011/12 through 2013/14 influenza seasons: A pooled analysis from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network).

Vaccine 2018 04 13;36(16):2166-2175. Epub 2018 Mar 13.

Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address:

Background: Ongoing assessment of influenza vaccine effectiveness (VE) is critical to inform public health policy. This study aimed to determine the VE of trivalent influenza vaccine (TIV) for preventing influenza-related hospitalizations and other serious outcomes over three consecutive influenza seasons.

Methods: The Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) conducted active surveillance for influenza in adults ≥16 years (y) of age during the 2011/2012, 2012/2013 and 2013/2014 seasons in hospitals across Canada. A test-negative design was employed: cases were polymerase chain reaction (PCR)-positive for influenza; controls were PCR-negative for influenza and were matched to cases by date, admission site, and age (≥65 y or <65 y). All cases and controls had demographic and clinical characteristics (including influenza immunization status) obtained from the medical record. VE was estimated as 1-OR (odds ratio) in vaccinated vs. unvaccinated patients × 100%. The primary outcome was VE of TIV for preventing laboratory-confirmed influenza-related hospitalization; secondary outcomes included VE of TIV for preventing influenza-related intensive care unit (ICU) admission/mechanical ventilation, and influenza-related death.

Results: Overall, 3394 cases and 4560 controls were enrolled; 2078 (61.2%) cases and 2939 (64.5%) controls were ≥65 y. Overall matched, adjusted VE was 41.7% (95% Confidence Interval (CI): 34.4-48.3%); corresponding VE in adults ≥65 y was 39.3% (95% CI: 29.4-47.8%) and 48.0% (95% CI: 37.5-56.7%) in adults <65 y, respectively. VE for preventing influenza-related ICU admission/mechanical ventilation in all ages was 54.1% (95% CI: 39.8-65.0%); in adults ≥65 y, VE for preventing influenza-related death was 74.5% (95% CI: 44.0-88.4%).

Conclusions: While effectiveness of TIV to prevent serious outcomes varies year to year, we demonstrate a statistically significant and clinically important TIV VE for preventing hospitalization and other serious outcomes over three seasons. Public health messaging should highlight the overall benefit of influenza vaccines over time while acknowledging year to year variability. ClinicalTrials.gov Identifier: NCT01517191.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vaccine.2018.02.093DOI Listing
April 2018

Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

Am J Infect Control 2017 Oct 18;45(10):1116-1126. Epub 2017 Jul 18.

W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Infection Prevention and Control, Alberta Health Services, Edmonton, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada; Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address:

Background: Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain.

Purpose: To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

Methods: A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis.

Results: A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak.

Discussion: Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2017.05.014DOI Listing
October 2017

Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae, 2010 to 2014.

Antimicrob Agents Chemother 2016 11 21;60(11):6787-6794. Epub 2016 Oct 21.

Antimicrobial Resistance and Nosocomial Infections, Public Health Agency of Canada, Winnipeg, MB, Canada

Carbapenemase-producing Enterobacteriaceae (CPE) are increasing globally; here we report on the investigation of CPE in Canada over a 5-year period. Participating acute care facilities across Canada submitted carbapenem-nonsusceptible Enterobacteriaceae from 1 January 2010 to 31 December 2014 to the National Microbiology Laboratory. All CPE were characterized by antimicrobial susceptibilities, pulsed-field gel electrophoresis, multilocus sequence typing, and plasmid restriction fragment length polymorphism analysis and had patient data collected using a standard questionnaire. The 5-year incidence rate of CPE was 0.09 per 10,000 patient days and 0.07 per 1,000 admissions. There were a total of 261 CPE isolated from 238 patients in 58 hospitals during the study period. bla (64.8%) and bla (17.6%) represented the highest proportion of carbapenemase genes detected in Canadian isolates. Patients who had a history of medical attention during international travel accounted for 21% of CPE cases. The hospital 30-day all-cause mortality rate for the 5-year surveillance period was 17.1 per 100 CPE cases. No significant increase in the occurrence of CPE was observed from 2010 to 2014. Nosocomial transmission of CPE, as well as international health care, is driving its persistence within Canada.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/AAC.01359-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075087PMC
November 2016

Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence surveys.

Antimicrob Resist Infect Control 2016 21;5:19. Epub 2016 May 21.

Royal University Hospital, Saskatoon, Saskatchewan Canada.

Background: Healthcare acquired infections (HAI) are an important public health problem in developed countries, but comprehensive data on trends over time are lacking. Prevalence surveys have been used as a surrogate for incidence studies and can be readily repeated.

Methods: The Canadian Nosocomial Infection Surveillance Program conducted prevalence surveys in 2002 and 2009 in a large network of major Canadian acute care hospitals. NHSN definitions of HAI were used. Use of isolation precautions on the survey day was documented.

Results: In 2009, 9,953 acute care inpatients were surveyed; 1,234 infections (124/1000) were found, compared to 111/1000 in 2002, (p < 0.0001). There was increased prevalence of urinary tract infection (UTI) and Clostridium difficile, offset by decreases in pneumonia and bloodstream infection. Use of isolation precautions increased from 77 to 148 per 1000 patients (p < 0.0001), attributable to increased use of contact precautions in patients infected or colonized with antimicrobial resistant organisms.

Conclusion: Between 2002 and 2009 HAI prevalence increased by 11.7 % in a network of major Canadian hospitals due to increases in Clostridium difficile and urinary tract infection. The use of isolation precautions increased by 92.2 % attributable to increased contact isolation. National prevalence surveys are useful tools to assess evolving trends in HAI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13756-016-0118-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875760PMC
May 2016

Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review.

Syst Rev 2015 Nov 7;4:152. Epub 2015 Nov 7.

W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.

Background: Though often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment.

Methods: We searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality.

Results: We included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted.

Conclusions: With no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13643-015-0131-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636845PMC
November 2015

The molecular epidemiology of incident methicillin-resistant Staphylococcus aureus cases among hospitalized patients in Alberta, Canada: a retrospective cohort study.

Antimicrob Resist Infect Control 2015 14;4:35. Epub 2015 Sep 14.

Infection Prevention and Control, Alberta Health Services, Calgary, AB Canada ; Department of Community Health Sciences, University of Calgary, Calgary, AB Canada.

Background: Infection Prevention and Control (IPC) surveillance for incident methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized patients is performed in a complete provincial surveillance network of all acute care facilities in Alberta, Canada. IPC surveillance is centralized using a web-based data entry platform so that each patient is counted only once. All diagnostic laboratories submit the first clinical MRSA isolate associated with a patient without previous MRSA positive clinical cultures in the preceding year to the Provincial Laboratory for Public Health (ProvLab) for molecular typing. This study will investigate the relationship between the IPC epidemiological classification based on time of detection following admission to hospital (Hospital Acquired and Community Associated) and the matched laboratory MRSA surveillance data using a retrospective cohort study design.

Methods: Incident IPC MRSA cases were classified according to IPC epidemiologic definitions. DNA sequencing of the Staphylococcus protein A (spa) gene and pulsed-field gel electrophoresis (PFGE) typing was performed. IPC MRSA surveillance data were matched to the ProvLab molecular surveillance data. Univariate comparisons of proportions were performed for categorical variables and the Student's t test for continuous variables.

Results: MRSA molecular typing data were available for matching for 46.7 % (2248/4818) of incident IPC cases. There was agreement in definitions for traditional nosocomial clones (USA100/CMRSA2) with Hospital Acquired (HA)-MRSA (65.1 % of all IPC HA-MRSA) and traditional community clones (USA400/CMRSA7 and USA300/CMRSA10) with Community Acquired (CA)-MRSA (62.4 % of CA-MRSA). However, we observed discordance for both traditional nosocomial/CA-MRSA (30.4 % of CA-MRSA) and for traditional community/HA-MRSA (26.9 % of HA-MRSA).

Conclusions: We note agreement between traditional nosocomial clones and HA-MRSA, and traditional community clones and CA-MRSA. However, approximately one-quarter of HA-MRSA are those of traditional community clones while approximately one-third of CA-MRSA are those of traditional nosocomial clones. Collaborative provincial MRSA surveillance is important as the distinction between IPC case attribution in acute care settings and the historical definitions of MRSA clones as community- or healthcare-associated have blurred.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13756-015-0076-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4570609PMC
September 2015

Prevalence of antimicrobial use in a network of Canadian hospitals in 2002 and 2009.

Can J Infect Dis Med Microbiol 2015 Mar-Apr;26(2):85-9

Royal University Hospital, Saskatoon, Saskatchewan.

Background: Increasing antimicrobial resistance has been identified as an important global health threat. Antimicrobial use is a major driver of resistance, especially in the hospital sector. Understanding the extent and type of antimicrobial use in Canadian hospitals will aid in developing national antimicrobial stewardship priorities.

Methods: In 2002 and 2009, as part of one-day prevalence surveys to quantify hospital-acquired infections in Canadian Nosocomial Infection Surveillance Program hospitals, data were collected on the use of systemic antimicrobial agents in all patients in participating hospitals. Specific agents in use (other than antiviral and antiparasitic agents) on the survey day and patient demographic information were collected.

Results: In 2002, 2460 of 6747 patients (36.5%) in 28 hospitals were receiving antimicrobial therapy. In 2009, 3989 of 9953 (40.1%) patients in 44 hospitals were receiving antimicrobial therapy (P<0.001). Significantly increased use was observed in central Canada (37.4% to 40.8%) and western Canada (36.9% to 41.1%) but not in eastern Canada (32.9% to 34.1%). In 2009, antimicrobial use was most common on solid organ transplant units (71.0% of patients), intensive care units (68.3%) and hematology/oncology units (65.9%). Compared with 2002, there was a significant decrease in use of first-and second-generation cephalosporins, and significant increases in use of carbapenems, antifungal agents and vancomycin in 2009. Piperacillin-tazobactam, as a proportion of all penicillins, increased from 20% in 2002 to 42.8% in 2009 (P<0.001). There was a significant increase in simultaneous use of >1 agent, from 12.0% of patients in 2002 to 37.7% in 2009.

Conclusion: From 2002 to 2009, the prevalence of antimicrobial agent use in Canadian Nosocomial Infection Surveillance Program hospitals significantly increased; additionally, increased use of broad-spectrum agents and a marked increase in simultaneous use of multiple agents were observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419819PMC
http://dx.doi.org/10.1155/2015/468987DOI Listing
May 2015

Complete Sequence of Four Multidrug-Resistant MOBQ1 Plasmids Harboring blaGES-5 Isolated from Escherichia coli and Serratia marcescens Persisting in a Hospital in Canada.

Microb Drug Resist 2015 Jun 29;21(3):253-60. Epub 2014 Dec 29.

1National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.

The usefulness of carbapenems for gram-negative infections is becoming compromised by organisms harboring carbapenemases, enzymes which can hydrolyze the drug. Currently KPC (class A), NDM (class B), and OXA-48 types (class D) are the most globally widespread carbapenemases. However, among the GES-type class A extended-spectrum β-lactamases (ESBLs) there are variants that hydrolyze carbapenems, with blaGES-5 being the most common. Two Escherichia coli and two Serratia marcescens harboring blaGES-5 on plasmids were isolated by the Canadian Nosocomial Infection Surveillance Program (CNISP) from four different patients in a single hospital over a 2-year period. Complete sequencing of the blaGES-5 plasmids indicated that all four had nearly identical backbones consisting of genes for replication, partitioning, and stability, but contained variant accessory regions consisting of mobile elements and antimicrobial resistance genes. The plasmids were of a novel replicon type, but belonged to the MOBQ1 group based on relaxase sequences, and appeared to be mobilizable, but not self-transmissible. Considering the time periods of bacterial isolation, it would appear the blaGES-5 plasmid has persisted in an environmental niche for at least 2 years in the hospital. This has implications for infection control and clinical care when it is transferred to clinically relevant gram-negative organisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/mdr.2014.0205DOI Listing
June 2015

A consensus development conference model for establishing health policy for surveillance and screening of antimicrobial-resistant organisms.

Clin Infect Dis 2015 Apr 26;60(7):1095-101. Epub 2014 Dec 26.

Infection Prevention and Control, Alberta Health Services Department of Medicine, Snyder Institute for Chronic Diseases and Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.

The Canadian Consensus Development Conference on Surveillance and Screening for Antimicrobial-Resistant Organisms (AROs) was sponsored by the Alberta Ministry of Health to provide evidence to update policies for ARO screening in acute care settings. A rigorous evidence-based literature review completed before the conference concluded that that neither universal nor targeted screening of patients was associated with a reduction in hospital-acquired ARO colonization, infection, morbidity, or mortality. Leading international clinicians, scientists, academics, policy makers, and administrators presented current evidence and clinical experience, focusing on whether and how hospitals should screen patients for AROs as part of broader ARO control strategies. An unbiased and independent "jury" with a broad base of expertise from complementary disciplines considered the evidence and released a consensus statement of 22 recommendations. Policy highlights included developing an integrated "One Health" strategy, fully resourcing basic infection control practices, not performing universal screening, and focusing original research to determine what works.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/ciu1168DOI Listing
April 2015

Clonal expansion of early to mid-life mitochondrial DNA point mutations drives mitochondrial dysfunction during human ageing.

PLoS Genet 2014 Sep 18;10(9):e1004620. Epub 2014 Sep 18.

Newcastle University Centre for Brain Ageing and Vitality, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom; Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom.

Age-related decline in the integrity of mitochondria is an important contributor to the human ageing process. In a number of ageing stem cell populations, this decline in mitochondrial function is due to clonal expansion of individual mitochondrial DNA (mtDNA) point mutations within single cells. However the dynamics of this process and when these mtDNA mutations occur initially are poorly understood. Using human colorectal epithelium as an exemplar tissue with a well-defined stem cell population, we analysed samples from 207 healthy participants aged 17-78 years using a combination of techniques (Random Mutation Capture, Next Generation Sequencing and mitochondrial enzyme histochemistry), and show that: 1) non-pathogenic mtDNA mutations are present from early embryogenesis or may be transmitted through the germline, whereas pathogenic mtDNA mutations are detected in the somatic cells, providing evidence for purifying selection in humans, 2) pathogenic mtDNA mutations are present from early adulthood (<20 years of age), at both low levels and as clonal expansions, 3) low level mtDNA mutation frequency does not change significantly with age, suggesting that mtDNA mutation rate does not increase significantly with age, and 4) clonally expanded mtDNA mutations increase dramatically with age. These data confirm that clonal expansion of mtDNA mutations, some of which are generated very early in life, is the major driving force behind the mitochondrial dysfunction associated with ageing of the human colorectal epithelium.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pgen.1004620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4169240PMC
September 2014

Reply to Vanhems et al.

Infect Control Hosp Epidemiol 2014 Aug;35(8):1075

University of Alberta Hospital, Edmonton, Alberta, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1086/677168DOI Listing
August 2014

Risk of injury to the axillary nerve during antegrade proximal humeral blade nail fixation - an anatomical study.

Injury 2014 Aug 17;45(8):1185-9. Epub 2014 May 17.

Buckinghamshire Healthcare NHS Trust, Wycombe General Hospital, Queen Alexandra Road, High Wycombe, Buckinghamshire, United Kingdom.

Introduction: The antegrade intramedullary Locking Blade Nail (Marquardt, Germany) is a device aimed at improving purchase in the humeral head and reducing varus displacement by providing medial buttress support and triangular stability within the humeral head. The aim of this study is to measure the relationship of the proximal fixation screws to the axillary nerve.

Methods: 13 whole cadavers underwent insertion of an antegrade proximal humeral blade nail via a deltoid split approach to both shoulders. The anatomic proximity of the anterior branch of the axillary nerve to the screws was measured following soft tissue dissection and inspection of the nerve.

Results: The mean distance of the nerve from the anterolateral acromion was 62 mm (range 45-81 mm). The nerve lay closest to the distal blade fixation screw 4.9 mm (range 0-19 mm). In three cases the nerve lay directly underneath the washer and in all three cases there was macroscopic evidence of damage to the nerve. In 5 cases the nerve travelled obliquely in a cranial direction to lie 1.8 mm (range 0-3 mm) from the distal blade fixation screw, in 2 of these cases the nerve lay beneath the washer.

Conclusion: The anterior branch of the axillary nerve is placed at risk during insertion of the locking screws despite use of protection sleeves and trocars. We advocate that when using antegrade intramedullary nails that incorporate an inferomedial calcar screw an extended anterolateral acromial approach is undertaken.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2014.05.006DOI Listing
August 2014

Healthcare-associated influenza in Canadian hospitals from 2006 to 2012.

Infect Control Hosp Epidemiol 2014 Feb 8;35(2):169-75. Epub 2014 Jan 8.

University of Alberta Hospital, Edmonton, Alberta, Canada.

Objective: To determine trends, patient characteristics, and outcome of patients with healthcare-associated influenza in Canadian hospitals.

Design: Prospective surveillance of laboratory-confirmed influenza among hospitalized adults was conducted from 2006 to 2012. Adults with positive test results at or after admission to the hospital were assessed. Influenza was considered to be healthcare associated if symptom onset was equal to or more than 96 hours after admission to a facility or if a patient was readmitted less than 96 hours after discharge or admitted less than 96 hours after transfer from another facility. Baseline characteristics of influenza patients were collected. Patients were reassessed at 30 days to determine the outcome.

Setting: Acute care hospitals participating in the Canadian Nosocomial Infection Surveillance Program.

Results: A total of 570 (17.3%) of 3,299 influenza cases were healthcare associated; 345 (60.5%) were acquired in a long-term care facility (LTCF), and 225 (39.5%) were acquired in an acute care facility (ACF). There was year-to-year variability in the rate and proportion of cases that were healthcare associated and variability in the proportion that were acquired in a LTCF versus an ACF. Patients with LTCF-associated cases were older, had a higher proportion of chronic heart disease, and were less likely to be immunocompromised compared with patients with ACF-associated cases; there was no significant difference in 30-day all-cause and influenza-specific mortality.

Conclusions: Healthcare-associated influenza is a major component of the burden of disease from influenza in hospitals, but the proportion of cases that are healthcare associated varies markedly from year to year, as does the proportion of healthcare-associated infections that are acquired in an ACF versus an LTCF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1086/674858DOI Listing
February 2014

Trends in antiviral therapy of adults hospitalized with influenza in Canada since the end of the 2009 pandemic.

Antimicrob Resist Infect Control 2014 Jan 10;3(1). Epub 2014 Jan 10.

University of Alberta Hospital, Edmonton, Alberta, Canada.

Background: Multiple observational studies have associated antiviral treatment of patients hospitalized with influenza with improved outcome, including reduced mortality. During the 2009-2010 H1N1 pandemic increased use of antiviral treatment of hospital patients was reported. We have carried out prospective surveillance for influenza in patients in a large network of Canadian hospitals since 2006. We wished to assess trends in antiviral use in the two seasons (2010-2011 and 2011-2012) since the end of the pandemic.

Findings: Adults (>16 years) testing positive for influenza at the time of or during admission to participating Canadian hospitals were prospectively reviewed. In 2009-2010 there were 1132 confirmed cases, 1107 in 2010-2011 and 631 in 2011-2012. Information on antiviral therapy was available in >95% in each year. Rising to 89.6% in 2009, the proportion of adult patients treated with antiviral therapy fell to 79.9% and 65.7% in the two subsequent seasons (p < 0.001). Oseltamivir was the antiviral agent used in >98% of cases in each year. The median time from onset of symptoms to initiation of antiviral therapy was three days. The treatment proportion fell across all age groups, co-morbid conditions and disease severity.

Conclusion: Despite evidence for benefit of antiviral therapy, and clinical practice guidelines recommending treatment of this population, antiviral therapy of Canadian adults hospitalized with influenza has progressively fallen in the two seasons since the end of the 2009-2010 influenza pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/2047-2994-3-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895698PMC
January 2014

Understanding the burden of influenza infection among adults in Canadian hospitals: a comparison of the 2009-2010 pandemic season with the prepandemic and postpandemic seasons.

Am J Infect Control 2013 Nov;41(11):1032-7

Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, Ottawa, Ontario, Canada. Electronic address:

Background: The degree to which the 2009-2010 influenza pandemic season differed from previous and subsequent influenza seasons in Canadian hospitals has not yet been assessed.

Methods: Surveillance for laboratory-confirmed influenza among adults in 51 Canadian Nosocomial Infection Surveillance Program hospitals was conducted between November 1, 2006, and May 31, 2011. Inpatient characteristics, treatment, and outcomes of influenza cases in the pandemic season (2009-2010) were compared with those in the prepandemic (2006-2007 to 2008-2009) and postpandemic (2010-2011) seasons.

Results: The incidence of influenza infection was lower in the postpandemic season (1.59/1,000 admissions) compared with the prepandemic seasons (2.00/1,000 admissions; P < .001) and the pandemic season (1.80/1,000 admissions; P < .001). The proportion of cases classified as health care-associated was much smaller during the pandemic season (6.6%) than in either the prepandemic season (23.2%; P < .001) or the postpandemic season (23.6%; P < .001). Inpatients in the pandemic season were significantly younger compared with those in the prepandemic and postpandemic seasons (P < .001). Inpatients in the pandemic season were less likely to have been vaccinated (P < .001), but more likely to be treated with antiviral agents (P < .001), than inpatients in both the prepandemic and postpandemic seasons. Intensive care unit admission was greater during the pandemic season, but there were no significant differences in 30-day mortality among the seasons.

Conclusions: Among adult inpatients, the pH1N1 pandemic season differed from seasonal influenza in terms of age, vaccination status, antiviral use, and intensive care unit admission, but not in terms of 30-day mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2013.06.008DOI Listing
November 2013

Enterocolic fistula: A rare presentation of cytomegalovirus infection.

Can J Infect Dis Med Microbiol 2012 ;23(2):e41-3

Department of Surgery;

In the present report, the first reported case of cytomegalovirus (CMV)-associated enterocolic fistula in an HIV/AIDS patient is described. CMV colitis is the second most common presentation of CMV infection in immunocompromised patients. CMV-associated enteric fistulae are an exceedingly rare complication, with only four previous cases described: a gastrocolic, an enterocutaneous, a rectovaginal and a colocutaneous fistula. Management of these patient demonstrates the importance of treating the precipitating viral infection before considering surgical intervention of the enterocolic fistula.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403671PMC
http://dx.doi.org/10.1155/2012/314384DOI Listing
June 2013

Comparison of mitochondrial mutation spectra in ageing human colonic epithelium and disease: absence of evidence for purifying selection in somatic mitochondrial DNA point mutations.

PLoS Genet 2012 15;8(11):e1003082. Epub 2012 Nov 15.

Newcastle University Centre for Brain Ageing and Vitality, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom.

Human ageing has been predicted to be caused by the accumulation of molecular damage in cells and tissues. Somatic mitochondrial DNA (mtDNA) mutations have been documented in a number of ageing tissues and have been shown to be associated with cellular mitochondrial dysfunction. It is unknown whether there are selective constraints, which have been shown to occur in the germline, on the occurrence and expansion of these mtDNA mutations within individual somatic cells. Here we compared the pattern and spectrum of mutations observed in ageing human colon to those observed in the general population (germline variants) and those associated with primary mtDNA disease. The pathogenicity of the protein encoding mutations was predicted using a computational programme, MutPred, and the scores obtained for the three groups compared. We show that the mutations associated with ageing are randomly distributed throughout the genome, are more frequently non-synonymous or frameshift mutations than the general population, and are significantly more pathogenic than population variants. Mutations associated with primary mtDNA disease were significantly more pathogenic than ageing or population mutations. These data provide little evidence for any selective constraints on the occurrence and expansion of mtDNA mutations in somatic cells of the human colon during human ageing in contrast to germline mutations seen in the general population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pgen.1003082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499406PMC
May 2013

Are health care workers protected? An observational study of selection and removal of personal protective equipment in Canadian acute care hospitals.

Am J Infect Control 2013 Mar 13;41(3):240-4. Epub 2012 Oct 13.

Public Health Agency of Canada, Ottawa, Ontario, Canada.

Background: The proper use of personal protective equipment (PPE) by health care workers (HCWs) is vital in preventing the spread of infection and has implications for HCW safety.

Methods: An observational study was performed in 11 hospitals participating in the Canadian Nosocomial Infection Surveillance Program between January 7 and March 30, 2011. Using a standardized data collection tool, observers recorded HCWs selecting and removing PPE and performing hand hygiene on entry into the rooms of febrile respiratory illness patients.

Results: The majority of HCWs put on gloves (88%, n = 390), gown (83%, n = 368), and mask (88%, n = 386). Only 37% (n = 163) were observed to have put on eye protection. Working in a pediatric unit was significantly associated with not wearing eye protection (7%), gown (70%), gloves (77%), or mask (79%). Half of the observed HCWs (54%, n = 206) removed their PPE in the correct sequence. Twenty-six percent performed hand hygiene after removing their gloves, 46% after removing their gown, and 57% after removing their mask and/or eye protection.

Conclusion: Overall adherence with appropriate PPE use in health care settings involving febrile respiratory illness patients was modest, particularly on pediatric units. Interventions to improve PPE use should be targeted toward the use of recommended precautions (eg, eye protection), HCWs working in pediatric units, the correct sequence of PPE removal, and performing hand hygiene.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2012.04.332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132671PMC
March 2013

Laboratory-confirmed pandemic h1n1 influenza in hospitalized adults: findings from the Canadian Nosocomial Infections Surveillance Program, 2009-2010.

Infect Control Hosp Epidemiol 2012 Oct 23;33(10):1043-6. Epub 2012 Aug 23.

Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, Ottawa, Ontario, Canada.

Surveillance for pandemic H1N1 influenza was conducted between June 1, 2009, and May 31, 2010, among adults at 40 participating hospitals in the Canadian Nosocomial Infection Surveillance Program. The first wave was characterized by a higher proportion of Aboriginals and pregnant women as well as severe outcomes, compared to the second wave.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1086/667732DOI Listing
October 2012

Impact of the 2009 influenza A (H1N1) pandemic on Canadian health care workers: a survey on vaccination, illness, absenteeism, and personal protective equipment.

Am J Infect Control 2012 Sep 9;40(7):611-6. Epub 2012 May 9.

Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada.

Background: Data are limited on the impact of the 2009 H1N1 influenza A pandemic on health care worker (HCW) vaccination, illness, absenteeism, and personal protective equipment (PPE) use.

Methods: A survey was completed by HCWs from 14 hospitals participating in the Canadian Nosocomial Infection Surveillance Program who provided direct care to patients with pH1N1 influenza in high-risk units between September and December 2009.

Results: Surveys were returned from 986 HCWs (80% nurses, 14% respiratory therapists, and 6% physicians). HCWs working in an intensive care unit (78%) or a designated influenza ward (67%) were more compliant with wearing an N95 respirator for aerosol-generating medical procedures than those working in an emergency department (47%; P < .001). HCWs who worked in health care for >11 years were more compliant with wearing protective eyewear than those who worked for ≤11 years (69% vs 54%; P < .001). A total of 815 HCWs (83%) reported having received the pH1N1 influenza vaccine, and 372 (38%) reported having received the 2009-2010 seasonal influenza vaccine. Influenza-like illness was reported by 236 (24%) HCWs, 170 of whom (72%) reported missing work.

Conclusions: Experience working in health care improves PPE use and HCWs in emergency departments should be targeted for interventions to improve PPE compliance. pH1N1 influenza vaccine coverage was high, but seasonal influenza vaccine coverage was low, and significant HCW illness and absenteeism were reported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2012.01.011DOI Listing
September 2012

Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions.

Am J Infect Control 2011 Apr;39(3):177-82

Canadian Field Epidemiology Program, Public Health Agency of Canada, Ottawa, ON, Canada.

Background: Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities.

Methods: A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005.

Results: Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program.

Conclusion: Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2011.01.007DOI Listing
April 2011

An integrative review of infection prevention and control programs for multidrug-resistant organisms in acute care hospitals: a socio-ecological perspective.

Am J Infect Control 2011 Jun 23;39(5):368-378. Epub 2011 Mar 23.

Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Background: The infection rates of multidrug-resistant organisms (MDRO) are increasing in Canada and the United States. The prevention and control of MDRO infections remain an important issue in acute care hospitals. Although comprehensive infection prevention and control programs have been recommended, there is little evidence to date of their effectiveness or of what aspects are most important.

Objectives: Our objectives were to review and critique the literature on the relationship between an MDRO infection and control program and MDRO rates in acute care hospitals.

Methods: Studies including original research published between January 1, 1998, and May 14, 2009, were identified through MEDLINE, CINAHL, EMBASE, PUBMED, The Cochrane Library, and expert consultation. A comprehensive search strategy was developed with a librarian to find studies that covered the main subject areas of this integrative review.

Results: Of the 1,382 papers retrieved, 47 were reviewed, and 32 studies met the inclusion criteria. The interventions in the included studies were assessed using the tier 1/tier 2 framework. A total of 18 (56.25%) studies had an administrative measure as an intervention; 20 (62.5%) studies had education and training of health care personnel; 8 (25.0%) studies had judicious use of antimicrobial agents; 17 (53.1%) studies used surveillance; 24 (75.0%) studies had infection control precautions to prevent transmission; 7 studies (21.9%) introduced environmental measures; and 9 (28.1%) studies used patient decolonization. Although all the 32 studies were quasiexperimental studies, only 2 (5.9%) studies provided sample size calculations, and only 5 studies reported confounding factors. Whereas 27 used an interrupted time series design and 2 were controlled pre- and post-intervention designs, 3 were pre- and post-intervention without control groups.

Conclusion: This integrative review demonstrated that the evidence of the relationship between MDRO infection prevention and control programs and the rates of MDRO is weak. Although major methodologic weaknesses exist in the published literature making it not possible to exclude other plausible explanations for the reduction of the acquisition of MDRO, the overall evidence does support the use of multiple interventions to reduce the rates of MDRO in acute care hospitals. Whereas it is unclear which bundles of interventions are effective, there is a clear suggestion that multiple simultaneous interventions can be effective in reducing MDRO infections. In addition, despite the limitations of interrupted time series, multiple studies employing active surveillance cultures were associated with reduced MDRO infections. Future individual reports of outbreaks and intervention studies should be written in a standardized manner using the recommended Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) guidelines. Further research is needed on the proposed tier 1/tier 2 framework clearly indicating all the interventions implemented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2010.07.017DOI Listing
June 2011