Vascular Access–Related Bloodstream Infections in Hemodialysis Patients
Surveillance results: 2016-2017

From April 1st, 2016, to March 31st, 2017, 48 hemodialysis units took part in the surveillance of vascular access–related bloodstream infections (VARBSIs) in hemodialysis (HD) patients, for a combined total of 57,570 patient-periods (Table 1). Participating units reported 127 VARBSIs in 120 patients. Patient-periods involving a fistula account for 40.7% of patient-periods. The VARBSI incidence rate is 0.06 cases per 100 patient-periods for patients with an arteriovenous (AV) fistula, 0.10 for patients with a synthetic fistula (graft), 0.32 for patients with a tunneled catheter and 1.24 for patients with a non-tunneled catheter. In 2016–2017, incidence rates for tunneled and non-tunneled catheters have significantly decreased compared to rates for 2012-2016 (p < 0.05) while rates for AV fistulas and grafts have remained stable. Since 2015-2016, three HD units joined the surveillance. Data were extracted on May 5th, 2017.

Update : October 5, 2017
Version française

Table 1 – Participation of Hemodialysis Units in the Surveillance of VARBSIs in Hemodialysis Patients, Québec, 2012–2013 to 2016–2017

 

2012-2013

2013-2014

2014-2015

2015-2016

2016-2017

Units (N) 

42

42

45

45

48

Patients monitored (average number per period)

3,977

3,984

4,303

4,217

4,428

Patient-periods (N)

51,697

51,791

55,939

54,818

57,570

Patient-months (N)

48,340

48,469

52,316

51,457

53,876

Dialysis sessions (N)

621,516

623,172

672,639

661,588

692,697

Catheter-days (N)

798,816

824,834

891,802

910,884

958,343

VARBSIs (cat. 1a, 1b and 1c, N)

206

150

154

132

127

   VARBSIs with AV fistulas or grafts (N)

44

25

23

17

14

   VARBSIs with tunneled or non-tunneled catheters (N)

162

125

131

115

113

Infected patients (N)

199

142

142

125

120

The 2016-2017 VARBSI incidence rate was 0.22 cases per 100 patient-periods. The incidence rate was 0.06 for patients with an AV fistula, 0.10 for patients with a graft, 0.32 for patients with a tunneled catheter and 1.24 for patients with a non-tunneled catheter (Figure 1). In patients with AV fistulas, the VARBSI incidence rate was higher when the buttonhole technique was used (0.17 per 100 patient-periods versus 0.04, p < 0.05); the incidence rate for patients with tunneled catheters is higher than for patients with an AV fistula without buttonhole (p < 0.05); the incidence rate for patients with non-tunneled catheters is statistically higher than the rate for patients with a permament catheter (p < 0.05).

Therefore, compared to AV fistulas without buttonhole, the incidence rate with a non-tunneled catheter is 32.7 [11.0 ; 97.0] times greater (p < 0.05), with a tunneled catheter, 8.3 [4.1 ; 19.5] times greater (p < 0.05), with a graft 2.6 [0.4 ; 11.6] times greater (p > 0.05) and with an AV fistula with a buttonhole, the incidence rate is 4.5 [1.3 ; 14.7] times greater (p < 0.05). The incidence rate with a non-tunneled catheter is 3.9 [1.7 ; 8.0] times higher than with a tunneled catheter (p < 0.05), this rate itself 5.2 [3.1 ; 9.6] higher than the rate for patients with an AV fistula or a graft (p < 0.05).

Figure 1 – VARBSI Incidence Rate by Type of Vascular Access, Québec, 2016–2017 (Incidence Rate per 100 Patient-periods [95% CI])

Figure 1 – VARBSI Incidence Rate by Type of Vascular Access, Québec, 2016–2017 (Incidence Rate per 100 Patient-periods [95% CI])

Tunneled catheters are the most commonly used type of vascular access (58%), followed by AV fistulas without the use of the buttonhole technique (32%, Figure 2). The proportion of patients with a fistula or a graft is 41%.

Figure 2 – Breakdown of Patient-Periods by Type of Vascular Access, Québec, 2016–2017 (%)

Figure 2 – Breakdown of Patient-Periods by Type of Vascular Access, Québec, 2016–2017 (%)

In 2016–2017, incidence rates for tunneled and non-tunneled catheters have significantly decreased compared to rates for 2012-2016 (p < 0.05, Table 2 and Figure 3) while rates for AV fistulas and grafts have remained stable. A general decreasing trend can be observed in units participating since 2012-2013 (Figure 4).

Figure 3 – Evolution of VARBSI Incidence Rates by Type of Vascular Access in Units That Have Previously Participated (N=45), Québec, 2012–2016 and 2016–2017 (Incidence Rate per 100 Patient-Periods [95% CI])

Figure 3 – Evolution of VARBSI Incidence Rates by Type of Vascular Access in Units That Have Previously Participated (N=45), Québec, 2012–2016 and 2016–2017 (Incidence Rate per 100 Patient-Periods [95% CI])

NB: Incidence rates for AV fistulas, with or without buttonhole, are rates for 2013-2016 and 2016-2017, as information on the use of the buttonhole technique was not collected before 2013-2014.

Table 2 – Evolution of VARBSI Incidence Rates by Type of Vascular Access in Units That Have Previously Participated (N=45), Québec, 2012–2016 and 2016–2017 (Incidence Rate per 100 Patient-Periods and per 1,000 Vascular-Access-Days [95% CI])

Type of vascular access

Incidence rate /100 patient-periods [95% CI]

Incidence rate /1.000 vascular-access-days. [95% CI]

2012-2016

2016-2017

2012-2016

2016-2017

AV fistula or graft

0.12 [0.10 ; 0.14]

0.06 [0.04 ; 0.11]

---

---

   AV fistula

0.11 [0.09 ; 0.13]

0.06 [0.03 ; 0.10]

---

---

      With buttonhole*

0.40 [0.31 ; 0.52]

0.18 [0.08 ; 0.44]

---

---

      Without buttonhole*

0.04 [0.03 ; 0.06]

0.04 [0.02 ; 0.08]

---

---

   Graft

0.23 [0.15 ; 0.35]

0.10 [0.03 ; 0.41]

---

---

Tunneled or non-tunneled catheter

0.44 [0.40 ; 0.48]

0.33 [0.27 ; 0.40]

0.16 [0.14 ; 0.17]

0.12 [0.10 ; 0.14]

   Tunneled catheter

0.40 [0.36 ; 0.43]

0.31 [0.25 ; 0.38]

0.14 [0.13 ; 0.15]

0.11 [0.09 ; 0.13]

   Non-tunneled catheter

4.85 [3.72 ; 6.31]

1.52 [0.72 ; 3.19]

1.72 [1.32 ; 2.25]

0.55 [0.26 ; 1.15]

Total

0.30 [0.28 ; 0.32]

0.22 [0.18 ; 0.26]

0.16 [0.14 ; 0.17]

0.12 [0.10 ; 0.14]

* Incidence rates for AV fistulas, with or without buttonhole, are rates for 2013-2016 and 2016-2017, as information on the use of the buttonhole technique was not collected before 2013-2014.

Figure 4 – Evolution of VARBSI Incidence Rates by Type of Vascular Access, for Units Participating Since 2012–2013 (N = 40), Québec, 2012–2013 to 2016–2017 (Incidence Rate per 100 Patient-periods)

Figure 4 – Evolution of VARBSI Incidence Rates by Type of Vascular Access, for Units Participating Since 2012–2013 (N = 40), Québec, 2012–2013 to 2016–2017 (Incidence Rate per 100 Patient-periods)

Despite recommendations, the proportion of patients receiving hemodialysis through a catheter, either non-tunneled or tunneled, increased in 2016–2017 compared with 2012–2016 (p < 0.05, Table 3 and Figure 5). In addition, the proportion of patients with a non-tunneled catheter, which is the form of vascular access most likely to lead to a VARBSI, increased significantly (p < 0.05).

Figure 5 – Time Trends in Patient-Periods by Type of Vascular Access, for Units Participating Since 2012–2013 (N = 40), Québec, 2012–2013 to 2016–2017

Figure 5 – Time Trends in Patient-Periods by Type of Vascular Access, for Units Participating Since 2012–2013 (N = 40), Québec, 2012–2013 to 2016–2017

Table 3 – Breakdown of Patient-Periods by Type of Vascular Access, 2012–2016 and 2016–2017 (%)

Type of vascular access

2012-2016

2016-2017

N

%

N

(%

AV fistula

82,773

38.7

20,310

37.1

   With buttonhole*

-

-

2,758

5

   Without buttonhole*

-

-

17,552

32.1

Graft

9,269

4.3

1,966

3.6

Tunneled catheter

120,836

56.5

31,982

58.4

Non-tunneled catheter

1,135

0.5

461

0.8

AV fistula or graft

92,042

43

22,276

40.7

Tunneled or non-tunneled catheter

121,971

57

32,443

59.3

Total (N)

214,013

100

54,719

100

Patients who developed a VARBSI are aged between 0 and 99 years, with a median age of 68 years. The vast majority (89%, or 113 cases) of VARBSIs occurred in patients who receive their hemodialysis treatment via catheter, even though they represent only 59% of the patient-periods monitored (Figures 2 and 6). For 42% of the cases that arose in patients receiving their hemodialysis through an AV fistula, the buttonhole technique is used even though this technique is used among only 14% of patients with AV fistula.

Figure 6 – Breakdown of VARBSIs by Type of Vascular Access, Québec, 2016–2017 (N = 127)

Figure 6 – Breakdown of VARBSIs by Type of Vascular Access, Québec, 2016–2017 (N = 127)

Overall, 13% of VARBSI cases resulted in death within 30 days following the onset of bacteremia. Death occurred in 40% of cases of VARBSI among hospitalized patients (Table 4 and Figure 7), compared with 10% of cases among patients receiving ambulatory care (p < 0.05). A total of 64% of ambulatory patients who developed a VARBSI required hospitalization.

Table 4 – 10-Day and 30-Day Case Fatality, Transfers to ICU and Hospitalizations and Rehospitalizations During a VARBSI Episode, by Origin of Acquisition, Québec, 2016–2017 (N, %)

Origin of acquisition

Complication

Number of VARBSI cases monitored

Presence of complication

N

%

During hospitalization

Death within 10 days

15

3

20

 

Death within 30 days

15

6

40

 

Transfer to ICU

15

1

7

 

Rehospitalization

15

1

7

During ambulatory care

Death within 10 days

112

5

4

 

Death within 30 days

112

11

10

 

Transfer to ICU

112

14

13

 

Hospitalization

112

72

64

Figure 7 – 10-Day and 30-Day Case Fatality, Percentage of Transfers to ICU and Percentage of Hospitalizations and Rehospitalizations During a VARBSI Episode, by Origin of Acquisition, Québec, 2016–2017 (%)

Figure 7 – 10-Day and 30-Day Case Fatality, Percentage of Transfers to ICU and Percentage of Hospitalizations and Rehospitalizations During a VARBSI Episode, by Origin of Acquisition, Québec, 2016–2017 (%)

Figure 8 shows that Staphylococcus aureus is the most frequently isolated microorganism in all VARBSI cases (65%). It is followed by coagulase-negative Staphylococcus (CoNS, 12%) and enterobacteria (Escherichia coli, Klebsiella sp. and other enterobacteria, 12%). S. aureus is the most frequently isolated microorganism in cases resulting in death (44%).

Figure 8 – Categories of Isolated Microorganisms in All Reported Cases (N = 129) and Cases Resulting in Death Within 30 Days (N = 18), Québec, 2016–2017 (%)

Figure 8 – Categories of Isolated Microorganisms in All Reported Cases (N = 129) and Cases Resulting in Death Within 30 Days (N = 18), Québec, 2016–2017 (%)

In 2016–2017, 11% of S. aureus strains are oxacillin-resistant, which is not significantly different compared with the 2012–2016 percentage (Table 5 and Figure 9). Please note that results presented in the second graph of Figure 9 exclude Pseudomonas sp.

Table 5 – Percentage of Strains Tested and Percentage of Resistance to Antibiotics for Certain Isolated Microorganisms, Québec, 2016–2017 (N, %)

Microorganism

Antibiotic

Isolated

Tested

Resistant

N

N

%

N

%

Staphylococcus aureus

Oxacillin

84

84

100

9

10.7

Enterococcus faecium

Vancomycin

0

0

-

-

-

Enterococcus faecalis

Vancomycin

5

5

100

0

0

Klebsiella sp.

CSE 4

2

2

100

0

0

Imipenem  ou meropenem

2

1

50

0

0

Multiresistant 1

2

2

100

0

0

Escherichia coli

CSE 4

3

3

100

0

0

Fluoroquinolones 3

3

3

100

0

0

Imipenem  ou meropenem

3

2

66.7

0

0

Multiresistant 1

3

3

100

0

0

Enterobacter sp.

CSE 4

5

5

100

2

40

Imipenem  ou meropenem

5

4

80

0

0

Multiresistant 1

5

4

80

0

0

Pseudomonas sp.

Amikacin, gentamicin or tobramycin

3

3

100

0

0

CSE 2

3

3

100

1

33.3

Fluoroquinolones 2

3

3

100

0

0

Imipenem  ou meropenem

3

2

66.7

1

50

Piperacillin/tazobactam

3

3

100

0

0

Multiresistant 2

3

3

100

0

0

Acinetobacter sp.

Imipenem  ou meropenem

0

0

-

-

-

Multiresistant 3

0

0

-

-

-

CSE 2: cefepime or ceftazidime;
CSE 4: cefepime, cefotaxime, ceftazidime or ceftriaxone;
Fluoroquinolones 2: ciprofloxacin or levofloxacin;
Fluoroquinolones 3: ciprofloxacin, levofloxacin or moxifloxacin;
Multiresistant 1: intermediate or resistant to an agent in three of the following five categories: cephalosporins 4, fluoroquinolones 3, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam.
Multiresistant 2: intermediate or resistant to an agent in three of the following five categories: cephalosporins 2, fluoroquinolones 2, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam.
Multiresistant 3: intermediate or resistant to an agent in three of the following six categories: cephalosporins 2, fluoroquinolones 2, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam, ampicillin/sulbactam.

Figure 9 – Evolution of Percentage of Antibiotic Resistance in Certain Gram-Positive Bacteria, Certain Gram-Negative Bacteria and Pseudomonas sp., Québec, 2012-2016 to 2016–2017 (%)

Figure 9 – Evolution of Percentage of Antibiotic Resistance in Certain Gram-Positive Bacteria, Certain Gram-Negative Bacteria and Pseudomonas sp., Québec, 2012-2016 to 2016–2017 (%)

Figures 10 and 11 show the breakdown of patient-periods monitored in 2016–2017, by type of vascular access and by healthcare facility. In 2016–2017, the percentage of fistulas decreased in 15 healthcare facilities and increased in 8 (Table 6). Twenty-one facilities report a rate of 0 VARBSI per 100 patient-periods, and 1 facility (2% of facilities) reports a rate higher than the 90th-percentile mark for 2012–2016 (Figure 12 and Table 7). Facilities with an incidence rate of 0 have small dialysis units of 4 to 12 chairs, except for three larger units.

Figure 10 – Patient-periods Followed, by Healthcare Facility, Québec, 2016–2017 (%)

Figure 10 – Patient-periods Followed, by Healthcare Facility, Québec, 2016–2017 (%)

Figure 11 – Breakdown of Patient-periods Monitored by Type of Vascular Access and by Healthcare Facility, Québec, 2016–2017 (N)

Figure 11 – Breakdown of Patient-periods Monitored by Type of Vascular Access and by Healthcare Facility, Québec, 2016–2017 (N)

Figure 12 – VARBSI Incidence Rate per Healthcare Facility (2016–2017) and Incidence Rate Percentile (2012–2013 to 2015–2016), Québec, 2016–2017 (Incidence Rate per 100 Patient-periods)

Figure 12 – VARBSI Incidence Rate per Healthcare Facility (2016–2017) and Incidence Rate Percentile (2012–2013 to 2015–2016), Québec, 2016–2017 (Incidence Rate per 100 Patient-periods)

Table 6 – Evolution of the Number of Patient-Periods Monitored and Percentage of Fistulas, by Healthcare Facility, Québec, 2012–2016 and 2016–2017 (N, % [95% CI])

Facility

2012-2016

2016-2017

 

Patient-periods (N)

% with fistula

Patient-periods (N)

% with fistula

Variation (p<0.05)

1

HÔPITAL CHARLES LEMOYNE

1,6571

37 [37 ; 38]

4,454

38 [37 ; 40]

 

3

GLEN - ROYAL VICTORIA

6,367

42 [41 ; 43]

316

16 [12 ; 21]

decrease

4

HÔPITAL NOTRE-DAME DU CHUM

9,202

63 [62 ; 64]

661

33 [29 ; 36]

decrease

5

HÔPITAL GÉNÉRAL JUIF

10,680

21 [20 ; 22]

2,829

19 [18 ; 21]

decrease

6

GLEN - ENFANTS

169

27 [21 ; 34]

17

0

decrease

7

PAVILLON L'HÔTEL-DIEU DE QUÉBEC

15,144

54 [54 ; 55]

3,811

49 [47 ; 50]

decrease

8

PAVILLON MAISONNEUVE/PAVILLON MARCEL-LAMOUREUX

19,732

44 [43 ; 45]

5,054

44 [42 ; 45]

 

9

HÔPITAL DU HAUT-RICHELIEU

6,145

43 [42 ; 44]

1,543

45 [42 ; 47]

 

11

HÔPITAL PIERRE-LE GARDEUR

4,499

40 [38 ; 41]

1,378

33 [31 ; 36]

decrease

12

CENTRE HOSPITALIER UNIVERSITAIRE SAINTE-JUSTINE

246

26 [21 ; 31]

34

44 [27 ; 61]

increase

14

CENTRE HOSPITALIER RÉGIONAL DE LANAUDIÈRE

4,984

25 [23 ; 26]

1,423

23 [21 ; 25]

 

15

HÔPITAL FLEURIMONT

4,713

32 [31 ; 33]

1,008

38 [35 ; 41]

increase

16

HÔPITAL RÉGIONAL DE RIMOUSKI

2,798

58 [56 ; 60]

723

62 [58 ; 66]

increase

18

HÔTEL-DIEU DE LÉVIS

4,314

46 [45 ; 48]

989

49 [46 ; 52]

 

19

HÔPITAL CITÉ DE LA SANTÉ

12,058

64 [64 ; 65]

3,074

58 [56 ; 59]

decrease

20

HÔPITAL DE CHICOUTIMI

3,948

51 [49 ; 52]

776

38 [35 ; 41]

decrease

21

HÔPITAL SAINT-LUC DU CHUM

5,396

59 [58 ; 60]

3,359

58 [56 ; 59]

 

23

HÔTEL-DIEU D'ARTHABASKA

1,140

29 [27 ; 32]

365

24 [19 ; 28]

decrease

25

HÔPITAL DU SACRÉ-COEUR DE MONTRÉAL

9,837

32 [31 ; 33]

2,639

37 [35 ; 39]

increase

26

HÔPITAL DE VERDUN

6,700

42 [41 ; 43]

1,610

39 [37 ; 41]

decrease

29

HÔPITAL GÉNÉRAL DE MONTRÉAL

5,786

33 [32 ; 34]

1,667

33 [31 ; 35]

 

31

PAVILLON SAINTE-MARIE

8,353

28 [27 ; 29]

2,320

24 [23 ; 26]

decrease

35

HÔPITAL HONORÉ-MERCIER

4,700

53 [51 ; 54]

1,580

48 [46 ; 51]

decrease

36

HÔPITAL GÉNÉRAL DU LAKESHORE

5,846

34 [33 ; 35]

1,708

35 [33 ; 37]

 

37

HÔTEL-DIEU DE SOREL

2,650

57 [55 ; 59]

705

57 [54 ; 61]

 

40

HÔPITAL DE HULL

8,824

29 [28 ; 30]

2,021

26 [24 ; 28]

decrease

42

CENTRE HOSPITALIER ANNA-LABERGE

-

-

724

38 [34 ; 42]

 

44

HÔPITAL SAINTE-CROIX

1,986

39 [37 ; 41]

517

34 [30 ; 38]

decrease

45

HÔPITAL DE SAINT-EUSTACHE

-

-

1,118

47 [44 ; 50]

 

46

HÔPITAL DE GRANBY

2,690

51 [49 ; 53]

858

50 [47 ; 53]

 

47

HÔPITAL DE ROUYN-NORANDA

611

74 [71 ; 78]

181

67 [61 ; 74]

 

48

CENTRE HOSPITALIER DE ST. MARY

4,575

43 [41 ; 44]

1,270

40 [37 ; 43]

 

49

CSSS DE MEMPHREMAGOG 

766

46 [42 ; 49]

200

48 [41 ; 55]

 

51

HÔPITAL DE MANIWAKI

873

33 [30 ; 37]

238

28 [22 ; 34]

 

53

HÔPITAL DE CHANDLER

236

55 [49 ; 61]

147

68 [60 ; 76]

increase

58

HÔPITAL DU SUROÎT

4,172

51 [49 ; 52]

1,224

33 [31 ; 36]

decrease

63

HÔPITAL DE SAINT-GEORGES

862

54 [51 ; 57]

278

58 [52 ; 64]

 

65

HÔPITAL ET CLSC DE VAL-D'OR

1,551

44 [41 ; 46]

348

54 [49 ; 60]

increase

70

CENTRE DE SOINS DE COURTE DURÉE LA SARRE

429

55 [50 ; 60]

143

60 [52 ; 68]

 

72

HÔPITAL ET CENTRE D'HÉBERGEMENT DE SEPT-ÎLES

540

63 [59 ; 67]

153

59 [51 ; 67]

 

74

HÔPITAL DE DOLBEAU-MISTASSINI

399

37 [32 ; 42]

128

55 [47 ; 64]

increase

76

HÔPITAL DE LACHINE

-

-

1,009

36 [33 ; 39]

 

81

HÔPITAL DE MONT-LAURIER

1,701

49 [47 ; 52]

457

46 [41 ; 50]

 

89

HÔPITAL DE MONTMAGNY

349

41 [36 ; 46]

199

39 [32 ; 45]

 

96

CENTRE DE SANTÉ DE CHIBOUGAMAU

953

32 [29 ; 35]

225

28 [22 ; 34]

 

101

HÔPITAL RÉGIONAL DE SAINT-JÉRÔME

9,267

44 [43 ; 45]

1,688

43 [40 ; 45]

 

111

HÔPITAL DE PAPINEAU

468

37 [32 ; 41]

223

42 [36 ; 49]

 

113

HÔPITAL DE THETFORD MINES

783

59 [56 ; 63]

178

69 [62 ; 76]

increase

Table 7 – Evolution of the Number of VARBSI Cases and Incidence Rate by Healthcare Facility, Québec,
2012–2016 and 2016–2017 (Incidence Rate per 100 Patient-periods [95% CI])

Facility

2012-2016*

2016-2017

Cases (N)

Cases per year (N)

Rate /100 pp

Cases (N)

Rate /100 pp

1

HÔPITAL CHARLES LEMOYNE

38

9.5

0.23 [0.16 ; 0.31]

9

0.20 [0.09 ; 0.36]

3

GLEN - ROYAL VICTORIA

36

9

0.57 [0.40 ; 0.77]

3

0.95 [0.18 ; 2.33]

4

HÔPITAL NOTRE-DAME DU CHUM

47

11.8

0.51 [0.38 ; 0.67]

4

0.61 [0.16 ; 1.34]

5

HÔPITAL GÉNÉRAL JUIF

16

4

0.15 [0.09 ; 0.23]

3

0.11 [0.02 ; 0.26]

6

GLEN - ENFANTS

0

0

0.00 [0.57 ; 0.57]

0

0

7

PAVILLON L'HÔTEL-DIEU DE QUÉBEC

46

11.5

0.30 [0.22 ; 0.40]

8

0.21 [0.09 ; 0.38]

8

PAVILLON MAISONNEUVE/PAVILLON MARCEL-LAMOUREUX

63

15.8

0.32 [0.25 ; 0.40]

9

0.18 [0.08 ; 0.31]

9

HÔPITAL DU HAUT-RICHELIEU

16

4

0.26 [0.15 ; 0.40]

5

0.32 [0.10 ; 0.67]

11

HÔPITAL PIERRE-LE GARDEUR

18

4.5

0.40 [0.24 ; 0.61]

3

0.22 [0.04 ; 0.53]

12

CENTRE HOSPITALIER UNIVERSITAIRE SAINTE-JUSTINE

8

2

3.25 [1.39 ; 5.90]

0

0

14

CENTRE HOSPITALIER RÉGIONAL DE LANAUDIÈRE

12

3

0.24 [0.12 ; 0.40]

6

0.42 [0.15 ; 0.83]

15

HÔPITAL FLEURIMONT

22

5.5

0.47 [0.29 ; 0.68]

3

0.30 [0.06 ; 0.73]

16

HÔPITAL RÉGIONAL DE RIMOUSKI

4

1

0.14 [0.04 ; 0.32]

0

0

18

HÔTEL-DIEU DE LÉVIS

4

1

0.09 [0.02 ; 0.21]

3

0.30 [0.06 ; 0.74]

19

HÔPITAL CITÉ DE LA SANTÉ

23

5.8

0.19 [0.12 ; 0.28]

11

0.36 [0.18 ; 0.60]

20

HÔPITAL DE CHICOUTIMI

10

2.5

0.25 [0.12 ; 0.43]

0

0

21

HÔPITAL SAINT-LUC DU CHUM

20

6.7

0.37 [0.23 ; 0.55]

7

0.21 [0.08 ; 0.39]

23

HÔTEL-DIEU D'ARTHABASKA

1

0.3

0.09 [0.00 ; 0.34]

0

0

25

HÔPITAL DU SACRÉ-COEUR DE MONTRÉAL

39

9.8

0.40 [0.28 ; 0.53]

5

0.19 [0.06 ; 0.39]

26

HÔPITAL DE VERDUN

19

4.8

0.28 [0.17 ; 0.43]

5

0.31 [0.10 ; 0.64]

29

HÔPITAL GÉNÉRAL DE MONTRÉAL

21

5.3

0.36 [0.22 ; 0.53]

8

0.48 [0.20 ; 0.87]

31

PAVILLON SAINTE-MARIE

22

5.5

0.26 [0.16 ; 0.38]

9

0.39 [0.18 ; 0.68]

35

HÔPITAL HONORÉ-MERCIER

16

4

0.34 [0.19 ; 0.53]

2

0.13 [0.01 ; 0.36]

36

HÔPITAL GÉNÉRAL DU LAKESHORE

11

2.8

0.19 [0.09 ; 0.32]

1

0.06 [0.00 ; 0.23]

37

HÔTEL-DIEU DE SOREL

15

3.8

0.57 [0.32 ; 0.89]

3

0.43 [0.08 ; 1.04]

40

HÔPITAL DE HULL

28

7

0.32 [0.21 ; 0.45]

3

0.15 [0.03 ; 0.36]

42

CENTRE HOSPITALIER ANNA-LABERGE

-

-

-

0

0

44

HÔPITAL SAINTE-CROIX

6

1.5

0.30 [0.11 ; 0.59]

1

0.19 [0.00 ; 0.76]

45

HÔPITAL DE SAINT-EUSTACHE

-

-

-

2

0.18 [0.02 ; 0.51]

46

HÔPITAL DE GRANBY

6

1.5

0.22 [0.08 ; 0.44]

0

0

47

HÔPITAL DE ROUYN-NORANDA

1

0.3

0.16 [0.00 ; 0.64]

0

0

48

CENTRE HOSPITALIER DE ST. MARY

7

1.8

0.15 [0.06 ; 0.29]

4

0.31 [0.08 ; 0.70]

49

CSSS DE MEMPHREMAGOG 

0

0

0

0

0

51

HÔPITAL DE MANIWAKI

0

0

0

0

0

53

HÔPITAL DE CHANDLER

0

0

0

0

0

58

HÔPITAL DU SUROÎT

8

2

0.19 [0.08 ; 0.35]

0

0

63

HÔPITAL DE SAINT-GEORGES

1

0.3

0.12 [0.00 ; 0.45]

0

0

65

HÔPITAL ET CLSC DE VAL-D'OR

8

2

0.52 [0.22 ; 0.94]

0

0

70

CENTRE DE SOINS DE COURTE DURÉE LA SARRE

0

0

0

0

0

72

HÔPITAL ET CENTRE D'HÉBERGEMENT DE SEPT-ÎLES

2

0.5

0.37 [0.03 ; 1.06]

0

0

74

HÔPITAL DE DOLBEAU-MISTASSINI

2

0.7

0.50 [0.05 ; 1.44]

0

0

76

HÔPITAL DE LACHINE

-

-

-

5

0.50 [0.16 ; 1.03]

81

HÔPITAL DE MONT-LAURIER

4

1

0.24 [0.06 ; 0.52]

2

0.44 [0.04 ; 1.25]

89

HÔPITAL DE MONTMAGNY

2

1

0.57 [0.05 ; 1.64]

0

0

96

CENTRE DE SANTÉ DE CHIBOUGAMAU

0

0

0

0

0

101

HÔPITAL RÉGIONAL DE SAINT-JÉRÔME

35

8.8

0.38 [0.26 ; 0.51]

3

0.18 [0.03 ; 0.44]

111

HÔPITAL DE PAPINEAU

2

1

0.43 [0.04 ; 1.22]

0

0

113

HÔPITAL DE THETFORD MINES

3

0.8

0.38 [0.07 ; 0.94]

0

0

*Changes in rates within individual facilities were not subjected to statistical analysis, given the small number of cases involved.

  1. Fistula First. Graphs of Prevalent AV Fistula Use Rates, By Network [online]. http://www.fistulafirst.org/AboutFistulaFirst/FisultaFirstCatheterLastFFCLData.aspx (last consulted: 2013-08-06).
  2. Ayzac, L., Machut, A., Russell, I., et al. Rapport final pour l’année 2011 du réseau de surveillance des infections en hémodialyse – DIALIN. CClin Sud-Est and RAISIN [online]. http://cclin-sudest.chu-lyon.fr/Reseaux/DIALIN/Resultats/rapport_annuel_2011_V2.pdf (last consulted: 2013-08-06).
  3. Patel, P. R., Yi, S. H., Booth, S., et al. Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report. American Journal of Kidney Diseases, Vol. 62, No. 2 (August 2013), p. 322–330.

Comité de surveillance provinciale des infections nosocomiales (SPIN) – bactériémies associées aux accès vasculaires en hémodialyse

Editorial Committee 

Élise Fortin, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Charles Frenette, Centre universitaire de santé McGill

Muleka Ngenda-Muadi, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Isabelle Rocher, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Claude Tremblay, Centre hospitalier universitaire de Québec de Québec – Université Laval

Mélissa Trudeau, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Jasmin Villeneuve, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

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