Clostridium difficile–Associated Diarrhea (CDAD) : surveillance results 2013–2014

From April 1, 2013, to March 31, 2014, 95 healthcare facilities participated in the surveillance of Clostridium difficile–associated diarrhea (CDAD), for a combined total of 5,121,300 inpatient days (Table 1). The participating facilities reported 3,661 cases of healthcare-associated (HA) CDAD. The incidence rate of HA CDAD was 7.1 cases per 10,000 patient days. This incidence rate was stable compared to the rate of 2012–2013. The 10-day fatality rate was 9.1% (n = 322) while the 30-day rate was 15.1% (n = 534). In total, 46 (1.3%) colectomies were reported. Data was extracted on May 15th, 2014.

Updated : February 24,2016
Version française

Table 1 – Participation of Healthcare Facilities in the Surveillance of CDAD, Québec, 2009–2010 to 2013–2014*

	2009-2010	2010-2011	2011-2012	2012-2013	2013-2014
Participating facilities (N)	95	95	95	95	95
Admissions (N)	608,380	617,103	630,156	640,541	649,716
Inpatient days (N)	5,106,622	5,160,240	5,176,519	5,230,689	5,121,300
Healthcare-associated CDAD cases (cat. 1a + 1b) (N)	3,266	3,635	3,778	3,796	3,661

* These results are based on a surveillance year (April 1–March 31) that corresponds to the fiscal year for Québec healthcare facilities which is different from the surveillance results published by the Institut national de santé publique du Québec (INSPQ) in previous years.

Incidence Rates

In 2013–2014, the incidence rate for HA CDAD was 7.1 cases per 10,000 patient days (Table 2). According to number of beds and academic mission, incidence rates for CDAD remain significantly higher in facilities with a proportion of admitted patients aged 65 years or older equal of greater to 35%, except for teaching facilities. Teaching facilities have a higher incidence rate of CDAD compared to non-teaching or less than 100 beds facilities, and this, regardless of the proportion of admitted patient aged 65 years or older (Figure 1 and Table 2).

Figure 1 – Healthcare-associated CDAD Incidence Rate, by Healthcare Facility Category, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

p65: Proportion of admitted patients aged 65 years or older.
95% CI: 95% confidence interval.
In 2013–2014, the healthcare facility categories (Table 2) associated with a CDAD incidence rate higher than that of the reference facilities (facilities ˂ 100 beds and p65 < 35%) were:

Facilities ˂ 100 beds and p65 ≥ 35% (univariate rate ratio = 2.0);
Non-teaching facilities ≥ 100 beds and p65 ≥ 35% (univariate rate ratio = 2.5);
Teaching facilities ≥ 100 beds and p65 ˂ 35% (univariate rate ratio = 2.6);
Teaching facilities ≥ 100 beds and p65 ≥ 35% (univariate rate ratio = 3.1).

Table 2 – Percentile, Incidence Rate and Univariate Rate Ratio of Healthcare-Associated CDAD by Healthcare Facility Category, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Healthcare Facility Category	Distribution Indicator						Incidence Rate [95% CI]	Univariate Rate Ratio [95% CI]
Healthcare Facility Category	Min.	25%	50%	75%	90%	Max.	Incidence Rate [95% CI]	Univariate Rate Ratio [95% CI]
Facilities < 100 beds and p65 < 35% (N = 4)	1.6	2.4	3.2	3.5	3.6	3.6	2.9 [1.8-4.2]	(ref)
Facilities < 100 beds and p65 ≥ 35% (N = 29)	1.0	2.8	3.9	7.1	10.1	14.2	5.6 [4.9-6.3]	2.0 [1.3-3.1]*
Non-teaching ≥ 100 beds and p65 < 35% (N = 4)	0.7	2.0	3.6	6.7	9.4	9.4	3.8 [2.9-4.9]	1.4 [0.8-2.2]
Non- teaching ≥ 100 beds and p65 ≥ 35% (N = 28)	1.6	3.8	6.7	9.7	13.3	17.1	7.1 [6.7-7.5]	2.5 [1.6-3.8]*
Teaching ≥ 100 beds and p65 < 35% (N = 6)	3.3	4.3	7.0	10.9	14.3	14.3	7.8 [7.1-8.5]	2.6 [1.7-4.0]*
Teaching ≥ 100 beds and p65 ≥ 35% (N = 16)	4.5	6	8.3	10.8	13.7	14.0	8.7 [8.3-9.2]	3.1 [2.0-4.7]*
Rehabilitation (N = 6)	0	1.7	2.8	3.5	4.6	4.6	2.9 [2.3-3.6]	1.1 [0.7-1.7]
Pediatric (N = 2)	2.2	2.2	4.1	5.9	5.9	5.9	3.2 [2.2-4.5]	1.2 [0.7-2.1]
Total (N = 95)	0	3.2	5.1	8.9	11.4	17.1	7.1 [6.9-7.4]

There are two teaching facilities included in the healthcare facilities with the fewer than 100 beds category.
* Significant statistical difference (p < 0.05) between univariate rate ratio of the heatlcare facility category and reference (ref).

The univariate analysis of Table 3 reveals that:

Facilities with 250 beds or more have a higher annual CDAD incidence rate than facilities with fewer than 100 beds (univariate rate ratio of 1.7);
Teaching facilities have a higher incidence rate than non-teaching facilities (univariate rate ratio of 1.3);
Facilities with a proportion of admitted patients aged 65 years or older equal of greater to 35% have a higher incidence rate than facilities with a proportion of admitted patients aged 65 years or older lower than 35% (univariate rate ratio of 1.2);
Rehabilitation facilities have a lower incidence rate than non-teaching facilities (univariate rate ratio of 0.4);
Pediatric facilities have a lower incidence rate than non-teaching facilities (univariate rate ratio of 0.5).

Table 3 – Healthcare-associated CDAD Incidence Rate and Univariate Rate Ratio Stratified by Number of Beds, Proportion of Admitted Patients Aged 65 Years or Older and Type of Healthcare Facility, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Facility Characteristics	Incidence Rate [95% CI]	Univariate Rate Ratio [95% CI]
Number of Beds*
< 100 beds (N = 33)	5.2 [4.6-5.8]	(ref)
100–249 beds (N = 30)	5.9 [5.5-6.2]	1.1 [1.0-1.3]
≥ 250 beds (N = 26)	8.6 [8.3-9.0]	1.7 [1.5-1.9]***

Proportion of Admitted Patients Aged 65 Years or Older**
p65 < 35% (N = 14)	6.6 [6.1-7.2]	(ref)
p65 ≥ 35% (N = 73)	7.6 [7.4-7.9]	1.2 [1.1-1.3]***

Type of Healthcare Facility
Non-teaching (N = 63)	6.5 [6.2-6.8]	(ref)
Teaching (N = 24)	8.5 [8.1-8.8]	1.3 [1.2-1.4]***
Rehabilitation (N = 6)	2.9 [2.3-3.6]	0.4 [0.4-0.6]***
Pediatric (N = 2)	3.2 [2.2-4.5]	0.5 [0.4-0.7]***

* The six rehabilitation facilities are excluded from the analysis.
** The six rehabilitation facilities and two pediatric facilities are excluded from the analysis.
*** Significant statistical difference (p < 0.05) between univariate rate ratio of the heatlcare facility category and reference (ref).

Incidence Rate Trends

HA CDAD incidence rates in 2013–2014 were stable compared to 2012–2013 (Table 4, Figures 2 and 3).

Figure 2 – Healthcare-associated CDAD Incidence Rate for Participating Healthcare Facilities, Québec, 2004–2005 to 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI]) (N = 88)

Note: data analyzed are those from healthcare facilities that participated in the surveillance from 2004-2005 to 2013-2014.

Figure 3 – Healthcare-associated CDAD Incidence Rate and 75th percentile Threshold Value (for Participating Facilities, Québec, 2009–2010 to 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI]) (N = 95)

Compared to 2012-2013, non-teaching healthcare facilities with 100 or more beds and 35% or more admitted patients aged 65 years or older (p65 ≥ 35%) demonstrated a significant increase in their CDAD incidence rate from 6.1 to 7.1 healthcare-associated CDAD / 10 000 patient days. In contrast, teaching facilities with 100 or more beds and 35% or more admitted patients aged 65 years or older (p65 ≥ 35%) demonstrated a significant drop in their CDAD incidence rate from 9.9 to 8.7 healthcare-associated CDAD / 10 000 patient days (Table 4).

Table 4 – Healthcare-associated CDAD Incidence Rate by Healthcare Facility Category, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Healthcare Facility Category	2009–2010	2010–2011	2011–2012	2012–2013	2013–2014
Facilities ˂ 100 beds, p65 ˂ 35% (N = 4)	1.8 [1.0-2.8]	3.1 [2.0-4.4]	5.3 [3.8-7.0]	3.5 [2.3-4.9]	2.9 [1.8-4.2]
Facilities ˂ 100 beds, p65 ≥ 35% (N = 29)	4.2 [3.6-4.8]	6.4 [5.7-7.2]	5.0 [4.4-5.7]	5.4 [4.7-6.1]	5.6 [4.9-6.3]
Non-teaching ≥ 100 beds, p65 ˂ 35% (N = 4)	7.8 [6.4-9.3]	7.6 [6.2-9.1]	6.0 [4.8-7.4]	4.7 [3.6-5.9]	3.8 [2.9-4.9]
Non-teaching ≥ 100 beds, p65 ≥ 35% (N = 28)	5.7 [5.4-6.1]	6.4 [6.0-6.8]	6.6 [6.2-7.0]	6.0 [5.7-6.4]	7.1 [6.7-7.5]*
Teaching ≥ 100 beds, p65 ˂ 35% (N = 6)	7.0 [6.3-7.7]	7.4 [6.7-8.1]	8.0 [7.3-8.7]	8.6 [7.9-9.4]	7.8 [7.1-8.5]
Teaching ≥ 100 beds, p65 ≥ 35% (N = 16)	8.6 [8.2-9.0]	8.7 [8.3-9.1]	9.6 [9.1-10.1]	9.9 [9.4-10.4]	8.7 [8.3-9.2]*
Rehabilitation facilities (N = 6)	2.4 [1.8-3.0]	3.3 [2.7-4.0]	3.0 [2.4-3.7]	3.4 [2.8-4.1]	2.9 [2.3-3.6]
Pediatric facilities (N = 2)	1.7 [1.0-2.6]	3.2 [2.2-4.4]	2.5 [1.6-3.5]	3.9 [2.8-5.2]	3.2 [2.2-4.4]
Total	6.4 [6.2-6.6]	7.0 [6.8-7.2]	7.3 [7.1-7.5]	7.3 [7.1-7.5]	7.1 [6.9-7.3]

* Significant statistical difference (p < 0.05) between healthcare-associated CDAD of 2012-2013 and 2013-2014.

Description of Cases

In total, 5,251 cases of CDAD were reported, of which 3,661 (69.7%) were healthcare-associated (cat. 1a and 1b) and 265 (5.0%) were healthcare-associated with ambulatory care in the reporting facility (cat. 1c) (Table 5).

Table 5 – Distribution of CDAD Cases by Presumed Origin of Acquisition, Québec, 2013–2014 (N, %)

Category	Origin of Acquisition	N	%
1a	Healthcare-associated with a current hospitalisation in the reporting facility	2,608	49.7
1b	Healthcare-associated with a previous hospitalisation in the reporting facility	1,053	20.0
1c	Healthcare-associated with ambulatory care in the reporting facility	265	5.0
1d	Healthcare-associated with long term care unit in the reporting facility	26	0.5
2	Healthcare-associated with another facility	259	4.9
3	Community-associated	751	14.3
4	Unknown origin of acquisition	289	5.5
	Total	5,251	100.0

Data related to complications were available in 3,525 of the 3,661 cases of HA CDAD (96.3%). The 10-day case fatality rate (n = 322) was 9.1% whereas the 11- to 30-day case fatality rate (n = 212) was 6.0%. In addition to the 534 (15.1%) deaths that occurred within 30 days, 46 colectomies (1.3%), 223 readmissions (6.3%) and 110 admissions to an intensive care unit (ICU) (3.1%) were reported (Table 6). As of 2009-2010, the percentage of deaths within 30 days has remained stable, ranging from 15.1% to 17.3%.

Table 6 – Number of Deaths, Case Fatality Rate and Complications Related to Healthcare-associated CDAD, Québec, 2009–2010 to 2013–2014 [N (%)]

	2009–2010	2010–2011	2011–2012	2012–2013	2013–2014
Number and percentage of CDAD cases with documented complications	2,978 (91.2)	3,343 (92)	3,550 (94)	3,481 (91.7)	3,525 (96.3)
Number of facilities reporting complications	87	89	91	88	89
Deaths
Death within 10 days	258 (8.7)	318 (9.5)	305 (8.6)	304 (8.7)	322 (9.1)
Death within 30 days*	478 (16.1)	580 (17.3)	545 (15.4)	561 (16.1)	534 (15.1)
Other complications
Colectomy	50 (1.7)	59 (1.8)	53 (1.5)	33 (0.9)	46 (1.3)
Readmission	130 (4.4)	170 (5.1)	155 (4.4)	182 (5.2)	223 (6.3)
Admission to ICU	85 (2.9)	94 (2.8)	98 (2.8)	97 (2.8)	110 (3.1)

* : The number of deaths within 30 days includes the number of deaths within 10 days.

Microbiology

A laboratory surveillance of C. difficile strains was performed by the Laboratoire de santé publique du Québec every year. This surveillance took place in 2013-2014 and results will be incorporated into this report shortly.

Data per Healthcare Facility

The HA CDAD incidence rates by healthcare facility and healthcare facility category are shown in Figures 4 through 11.

Figure 4 – Healthcare-associated CDAD Incidence Rate, Among Facilities with Fewer than 100 Beds and a Proportion of Admitted Patients Aged 65 Years or Older Below 35% , Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Figure 5 – Healthcare-associated CDAD Incidence Rate Among Facilities with Fewer than 100 Beds and a Proportion of Admitted Patients Aged 65 Years or Older of 35% or More, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Figure 6 – Healthcare-associated CDAD Incidence Rate Among Non-Teaching Facilities with 100 Beds or More and a Proportion of Admitted Patients Aged 65 Years or Older Below 35%, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Figure 7 – Healthcare-associated CDAD Incidence Rate Among Non-Teaching Facilities with 100 Beds or More and a Proportion of Admitted Patients Aged 65 Years or Older of 35% or More, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Figure 8 – Healthcare-associated CDAD Incidence Rate Among Teaching Facilities with 100 Beds or More and a Proportion of Admitted Patients Aged 65 Years or Older Below 35%, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Figure 9 – Healthcare-associated CDAD Incidence Rate Among Teaching Facilities with 100 Beds or More and a Proportion of Admitted Patients Aged 65 Years or Older of 35% or More, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Figure 10 – Healthcare-associated CDAD Incidence Rate Among Rehabilitation Facilities, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

Figure 11 – Healthcare-associated CDAD Incidence Rate Among Pediatric Facilities, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

The HA CDAD incidence rate ranged from 0 to 17.1/10,000 patient days in 2013–2014 among the healthcare facilities in Québec. The incidence rates for the past five years of surveillance are shown in Table 7. Overall, 11 healthcare facilities (11.6%) saw a significant increase in their HA CDAD incidence rate compared to 2012–2013, whereas 11 facilities (11.6%) experienced a significant decrease.

Table 7 – Healthcare-associated CDAD Incidence Rate per Healthcare Facility, Québec, 2009–2010 to 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

HR	Facility		Incidence rate of healthcare-associated CDAD / 10,000 patient days [95% CI]
HR	Number	Name	2009-2010	2010-2011	2011-2012	2012-2013	2013-2014
01	16	HÔPITAL RÉGIONAL DE RIMOUSKI	10.1 [7.7-12.9]	9.8 [7.4-12.6]	16.0 [12.8-19.6]	7.0 [5.0-9.4]	5.1 [3.3-7.2]
	32	CENTRE HOSPITALIER RÉGIONAL DU GRAND-PORTAGE	2.1 [0.8-4.0]	4.6 [2.6-7.2]	3.1 [1.5-5.3]	2.6 [1.1-4.7]	2.7 [1.2-4.9]
	61	CENTRE NOTRE-DAME-DE-FATIMA	0	9.7 [4.4-17.1]	8.2 [3.5-14.9]	9.8 [4.4-17.2]	7.8 [2.8-15.3]
	71	HÔPITAL DE MATANE	0.7 [0-2.8]	3.0 [0.8-6.7]	3.7 [1.2-7.7]	1.6 [0.1-4.6]	3.1 [0.8-6.9]
	77	HÔPITAL D’AMQUI	6.0 [2.2-11.8]	16.8 [9.6-26]	17.8 [10.2-27.6]	9.7 [4.2-17.6]	6.2 [2.0-12.8]
	84	HÔPITAL DE NOTRE-DAME-DU-LAC	6.4 [2.3-12.5]	0	7.1 [2.6-13.9]	0	2.4 [0.2-6.9]
		BAS-SAINT-LAURENT	5.8 [4.6-7.2]	7.6 [6.2-9.2]	10.3 [8.6-12.2]	5.3 [4.1-6.7]	4.3 [3.2-5.6]
02	20	HÔPITAL DE CHICOUTIMI	3.9 [2.7-5.3]	3.2 [2.1-4.5]	3.5 [2.4-4.8]	6.4 [4.8-8.2]	8.0 [6.3-9.9]
	67	HÔPITAL ET CENTRE DE RÉADAPTATION DE JONQUIÈRE	1.0 [0.3-2.2]	3.9 [2.2-6.1]	3.6 [2.0-5.7]	3.0 [1.5-4.9]	10.1 [7.2-13.5]*
	74	HÔPITAL DE DOLBEAU-MISTASSINI	0	3.6 [1.4-6.8]	2.9 [1.0-5.7]	4.7 [2.0-8.5]	3.2 [1.0-6.6]
	88	HÔPITAL, CLSC ET CENTRE D’HÉBERGEMENT DE ROBERVAL	0.9 [0.2-2.2]	2.3 [0.9-4.3]	1.2 [0.3-2.6]	3.0 [1.4-5.1]	2.0 [0.7-3.9]
	112	HÔPITAL D’ALMA	0.9 [0.2-2.2]	14.6 [10.7-19.1]	8.8 [5.8-12.4]	3.2 [1.5-5.5]	8.1 [5.3-11.5]*
		SAGUENAY–LAC-SAINT-JEAN	2.2 [1.6-2.9]	5.0 [4.1-6.0]	3.8 [3.0-4.7]	4.6 [3.7-5.6]	7.2 [6.1-8.4]*
03	2	HÔPITAL DE L’ENFANT-JÉSUS	8.3 [6.8-9.9]	3.5 [2.6-4.6]	6.9 [5.6-8.4]	6.8 [5.5-8.3]	5.0 [3.9-6.3]
	7	PAVILLON L’HÔTEL-DIEU DE QUÉBEC	10.1 [8.1-12.3]	13.4 [11.1-15.9]	9.9 [7.9-12.1]	7.7 [5.9-9.7]	13.7 [11.3-16.3]*
	24	HÔPITAL DU SAINT-SACREMENT	4.2 [2.6-6.2]	4.7 [3.0-6.8]	5.3 [3.6-7.4]	7.9 [5.8-10.4]	5.7 [3.9-7.9]
	27	PAVILLON CENTRE HOSPITALIER DE L’UNIVERSITÉ LAVAL	7.5 [5.9-9.3]	7.1 [5.6-8.8]	5.0 [3.7-6.5]	3.2 [2.2-4.4]	4.3 [3.1-5.7]
	28	PAVILLON SAINT-FRANÇOIS D’ASSISE	12.0 [9.9-14.4]	12.8 [10.6-15.2]	11.3 [9.2-13.6]	16.1 [13.6-18.8]	14.3 [11.9-16.9]
	33	INSTITUT UNIVERSITAIRE DE CARDIOLOGIE ET DE PNEUMOLOGIE DE QUÉBEC	9.0 [7.2-11.0]	6.2 [4.7-7.9]	8.7 [6.9-10.7]	6.1 [4.7-7.7]	5.2 [3.9-6.7]
	59	HÔPITAL DE BAIE-SAINT-PAUL	2.4 [0.2-6.9]	1.1 [0-4.3]	5.5 [1.4-12.2]	1.4 [0-5.5]	1.2 [0-4.7]
	86	HÔPITAL DE LA MALBAIE	12.4 [6.8-19.7]	21.5 [14.2-30.4]	14.4 [8.2-22.3]	4.2 [1.1-9.4]	8.0 [3.2-15.0]
		CAPITALE-NATIONALE	8.8 [8.1-9.6]	7.9 [7.2-8.6]	7.9 [7.2-8.6]	7.6 [6.9-8.3]	7.7 [7.0-8.4]
04	23	HÔTEL-DIEU D’ARTHABASKA	4.1 [2.5-6.0]	4.1 [2.6-6.0]	6.9 [4.9-9.3]	6.4 [4.5-8.7]	3.4 [2.0-5.2]*
	31	PAVILLON SAINT-JOSEPH	7.7 [6.2-9.4]	10.6 [8.8-12.5]	11.9 [10.0-13.9]	14.9 [12.9-17.1]	8.8 [7.2-10.5]*
	41	HÔPITAL DU CENTRE-DE-LA-MAURICIE	6.4 [4.2-9.0]	5.4 [3.5-7.7]	4.0 [2.4-6.0]	3.0 [1.6-4.8]	4.1 [2.5-6.1]
	44	HÔPITAL SAINTE-CROIX	11.5 [8.9-14.4]	11.3 [8.8-14.2]	10.6 [8.1-13.4]	4.4 [2.9-6.3]	4.3 [2.8-6.1]
	85	CENTRE DE SANTÉ ET DE SERVICES SOCIAUX DU HAUT-SAINT-MAURICE	0	6.4 [2.0-13.2]	4.0 [0.8-9.8]	8.5 [3.1-16.7]	4.3 [0.8-10.5]
		MAURICIE ET CENTRE-DU-QUÉBEC	7.4 [6.4-8.4]	8.6 [7.6-9.7]	9.2 [8.1-10.3]	9.2 [8.1-10.3]	6.1 [5.2-7.0]*
05	15	HÔPITAL FLEURIMONT	2.7 [1.8-3.7]	3.1 [2.2-4.2]	2.4 [1.6-3.4]	2.5 [1.7-3.5]	3.3 [2.3-4.5]
	30	HÔTEL-DIEU DE SHERBROOKE	3.3 [2.1-4.8]	4.2 [2.8-5.9]	3.7 [2.4-5.3]	3.0 [1.8-4.4]	4.5 [3.0-6.3]
	49	CENTRE DE SANTÉ ET DE SERVICES SOCIAUX MEMPHRÉMAGOG	2.7 [0.5-6.6]	4.3 [1.3-8.9]	4.4 [1.4-9.1]	6.1 [2.4-11.5]	2.8 [0.7-6.3]
	75	CENTRE DE SANTÉ ET DE SERVICES SOCIAUX DU GRANIT	0	4.7 [1.2-10.4]	0	3.1 [0.8-6.9]	1.0 [0-4.0]
		ESTRIE	2.8 [2.1-3.6]	3.6 [2.8-4.5]	2.9 [2.2-3.7]	2.9 [2.2-3.7]	3.6 [2.8-4.5]
06	3	HÔPITAL ROYAL VICTORIA	8.0 [6.5-9.7]	10.4 [8.6-12.4]	14.6 [12.5-16.9]	13.9 [11.8-16.2]	10.9 [9.0-13.0]*
	4	HÔPITAL NOTRE-DAME DU CHUM	5.9 [4.6-7.4]	5.7 [4.4-7.2]	6.4 [5.0-7.9]	6.7 [5.3-8.3]	9.8 [8.1-11.7]*
	5	HÔPITAL GÉNÉRAL JUIF	8.3 [7.0-9.8]	12.4 [10.8-14.1]	15.7 [13.9-17.6]	16.4 [14.5-18.4]	8.3 [7.0-9.8]*
	6	HÔPITAL DE MONTRÉAL POUR ENFANTS	1.4 [0.4-3.1]	5.1 [2.9-8.0]	3.3 [1.6-5.6]	3.2 [1.4-5.6]	5.9 [3.4-9.2]
	8	PAV. MAISONNEUVE / PAV. MARCEL-LAMOUREUX	15.9 [14.0-17.9]	12.2 [10.6-13.9]	11.3 [9.8-12.9]	10.7 [9.2-12.3]	10.7 [9.2-12.3]
	12	CENTRE HOSPITALIER UNIVERSITAIRE SAINTE-JUSTINE	1.8 [1.0-2.9]	2.5 [1.5-3.8]	2.1 [1.2-3.3]	4.2 [2.8-5.8]	2.2 [1.2-3.4]*
	13	INSTITUT DE CARDIOLOGIE DE MONTRÉAL	6.1 [3.9-8.7]	6.5 [4.3-9.2]	7.2 [4.9-10.0]	7.2 [4.9-10.0]	6.3 [4.1-8.9]
	21	HÔPITAL SAINT-LUC DU CHUM	7.0 [5.4-8.8]	6.5 [5.0-8.2]	9.8 [7.9-11.9]	8.5 [6.8-10.4]	9.2 [7.4-11.2]
	22	HÔTEL-DIEU DU CHUM	8.1 [6.2-10.3]	9.5 [7.4-11.8]	15.4 [12.8-18.3]	11.2 [9.0-13.6]	14 [11.5-16.7]
	25	HÔPITAL DU SACRÉ-CœUR DE MONTRÉAL	7.3 [6.0-8.7]	7.2 [5.9-8.6]	8.7 [7.3-10.2]	9.0 [7.6-10.6]	7.7 [6.4-9.2]
	26	HÔPITAL DE VERDUN	9.9 [7.7-12.4]	9.0 [7.0-11.3]	8.1 [6.2-10.2]	8.9 [6.9-11.2]	6.6 [4.9-8.6]
	29	HÔPITAL GÉNÉRAL DE MONTRÉAL	10.6 [8.8-12.6]	14.4 [12.3-16.7]	14.8 [12.6-17.2]	12.5 [10.4-14.7]	11.8 [9.7-14.2]
	34	HÔPITAL SANTA CABRINI	8.6 [6.8-10.6]	5.1 [3.8-6.6]	9.1 [7.3-11.0]	7.7 [6.1-9.5]	9.5 [7.7-11.4]
	36	HÔPITAL GÉNÉRAL DU LAKESHORE	8.7 [6.6-11.1]	10.1 [7.8-12.7]	5.8 [4.1-7.8]	8.4 [6.4-10.7]	10.2 [7.9-12.7]
	38	HÔPITAL JEAN-TALON	8.5 [6.6-10.7]	8.8 [6.5-11.4]	7.5 [5.4-9.9]	5.3 [3.5-7.4]	7.9 [5.7-10.5]
	48	CENTRE HOSPITALIER DE ST. MARY	5.5 [4.0-7.3]	4.8 [3.4-6.4]	4.4 [3.1-6.0]	8.2 [6.3-10.3]	4.7 [3.3-6.3]*
	76	HÔPITAL DE LACHINE	2.8 [1.1-5.3]	4.9 [2.4-8.2]	8.4 [5.0-12.7]	8.8 [5.3-13.2]	9.8 [5.9-14.7]
	80	HÔPITAL FLEURY	7.2 [4.8-10.1]	4.7 [2.8-7.1]	7.4 [5.1-10.2]	5.5 [3.5-7.9]	13.3 [10.1-16.9]*
	83	HÔPITAL DE LASALLE	8.5 [5.4-12.3]	7.6 [4.6-11.3]	12.0 [8.0-16.8]	7.9 [4.7-11.9]	9.4 [5.9-13.7]
	114	VILLA MÉDICA	2.9 [1.5-4.7]	4.8 [3.0-7.0]	3.1 [1.7-4.9]	5.9 [3.9-8.3]	3.5 [2.0-5.4]
	116	INSTITUT THORACIQUE DE MONTRÉAL	6.0 [3.3-9.6]	5.7 [3.0-9.2]	4.9 [2.4-8.2]	8.5 [5.1-12.8]	8.9 [5.3-13.5]
	118	HÔPITAL NEUROLOGIQUE DE MONTRÉAL	0.4 [0-1.6]	1.2 [0.2-3.0]	4.0 [1.9-6.9]	4.7 [2.4-7.7]	3.6 [1.6-6.3]
	120	HÔPITAL RICHARDSON	0.9 [0.1-2.6]	0	0	0	0
	121	HÔPITAL CATHERINE BOOTH DE L’ARMÉE DU SALUT	2.6 [1.1-4.7]	12.0 [8.4-16.2]	7.4 [4.6-10.8]	5.9 [3.5-9.0]	1.7 [0.5-3.5]*
	122	HÔPITAL MARIE-CLARAC	3.4 [2.1-5.0]	2.4 [1.4-3.7]	2.9 [1.8-4.3]	3.4 [2.1-4.9]	2.6 [1.5-4.0]
	137	INSTITUT DE RÉADAPTATION DE MONTRÉAL^a	0.6 [0.1-1.5]	1.3 [0.6-2.3]	2.4 [1.3-3.8]	3.8 [2.4-5.6]	4.6 [3.0-6.6]
		MONTRÉAL	7.4 [7.0-7.8]	7.9 [7.5-8.3]	9.0 [8.6-9.4]	8.9 [8.5-9.3]	8.2 [7.8-8.6]*
07	39	HÔPITAL DE GATINEAU	6.8 [4.9-9.0]	6.2 [4.4-8.4]	4.8 [3.2-6.7]	5.6 [3.9-7.6]	3.2 [2.0-4.7]*
	40	HÔPITAL DE HULL	10.2 [7.9-12.8]	3.8 [2.5-5.4]	2.1 [1.2-3.3]	11.1 [8.8-13.7]	10.2 [7.9-12.8]
	51	HÔPITAL DE MANIWAKI	5.3 [2.1-9.9]	17.6 [11.3-25.4]	4.1 [1.5-8.0]	7.4 [3.7-12.4]	5.3 [2.3-9.6]
	95	CENTRE HOSPITALIER DU PONTIAC	3.7 [1.2-7.7]	2.1 [0.4-5.1]	1.5 [0.2-4.2]	10.1 [5.5-16.1]	5.2 [2.1-9.8]
	111	HÔPITAL DE PAPINEAU	6.9 [3.8-11.0]	4.5 [2.0-7.9]	3.1 [1.1-6.1]	1.0 [0.1-2.9]	2.5 [0.8-5.1]
		OUTAOUAIS	7.8 [6.5-9.2]	5.6 [4.6-6.7]	3.2 [2.4-4.1]	7.7 [6.5-9.0]	5.9 [4.8-7.1]*
08	47	HÔPITAL DE ROUYN-NORANDA	2.1 [0.7-4.4]	6.4 [3.5-10.2]	3.4 [1.5-6.1]	2.0 [0.6-4.1]	3.9 [1.8-6.8]
	52	CENTRE HOSPITALIER HÔTEL-DIEU D’AMOS	3.1 [1.3-5.6]	3.1 [1.3-5.6]	8.8 [5.5-12.9]	2.9 [1.1-5.5]	3.3 [1.3-6.2]
	65	HÔPITAL ET CLSC DE VAL-D’OR	13.4 [9.6-17.8]	11 [7.6-15.1]	5.3 [3.0-8.3]	2.5 [1.0-4.7]	0.7 [0.1-2.0]
	70	CENTRE DE SOINS DE COURTE DURÉE LA SARRE	10.2 [4.6-18]	1.0 [0-3.9]	4.7 [1.5-9.7]	1.9 [0.2-5.5]	6.1 [2.4-11.4]
	82	PAVILLON SAINTE-FAMILLE	0	3.2 [0.6-7.9]	0	1.3 [0-5.2]	2.8 [0.3-8.0]
		ABITIBI-TÉMISCAMINGUE	6.4 [4.9-8.1]	6.1 [4.6-7.8]	5.2 [3.9-6.7]	2.3 [1.4-3.4]	2.9 [1.9-4.1]
09	64	HÔPITAL LE ROYER	3.7 [1.8-6.2]	2.3 [0.9-4.3]	2.8 [1.2-5.1]	4.0 [2.0-6.7]	3.5 [1.6-6.1]
	72	HÔPITAL ET CENTRE D’HÉBERGEMENT DE SEPT-ÎLES	2.7 [1.0-5.3]	5.3 [2.7-8.7]	4.6 [2.2-7.9]	3.7 [1.6-6.7]	1.6 [0.4-3.6]
		CÔTE-NORD	3.3 [1.9-5.0]	3.6 [2.2-5.4]	3.5 [2.1-5.3]	3.8 [2.3-5.7]	2.6 [1.4-4.2]
10	96	CENTRE DE SANTÉ DE CHIBOUGAMAU	0	2.6 [0.2-7.5]	0	0	3.1 [0.3-8.9]*
		NORD-DU-QUÉBEC	0	2.6 [0.2-7.5]	0	0	3.1 [0.3-8.9]*
11	53	HÔPITAL DE CHANDLER	2.0 [0.4-4.9]	2.5 [0.7-5.5]	2.7 [0.7-6.0]	0.7 [0-2.8]	3.6 [1.1-7.4]
	91	HÔPITAL HÔTEL-DIEU DE GASPÉ	5.1 [1.8-10.0]	11.3 [6.2-18.0]	4.1 [1.3-8.5]	7.7 [3.3-14.0]	3.9 [1.0-8.6]
	97	HÔPITAL DE MARIA	1.0 [0.1-2.9]	2.5 [0.8-5.2]	1.5 [0.3-3.7]	7.6 [4.3-11.8]	10.0 [5.9-15.2]
	107	HÔPITAL DE L’ARCHIPEL	4.8 [1.3-10.6]	5.7 [1.8-11.8]	3.8 [0.7-9.3]	1.5 [0-5.8]	4.3 [0.8-10.5]
	109	HÔPITAL DE SAINTE-ANNE-DES-MONTS	3.4 [0.7-8.3]	6.7 [2.4-13.1]	2.4 [0.2-6.9]	2.8 [0.3-8.0]	1.2 [0-4.8]
		GASPÉSIE–ÎLES-DE-LA-MADELEINE	2.8 [1.7-4.2]	5.1 [3.5-7.0]	2.7 [1.6-4.1]	4.7 [3.1-6.6]	5.4 [3.7-7.5]
12	18	HÔTEL-DIEU DE LÉVIS	10.3 [8.1-12.7]	12.7 [10.3-15.3]	8.7 [6.8-10.9]	13.1 [10.7-15.7]	10.9 [8.7-13.3]
	63	HÔPITAL DE SAINT-GEORGES	3.1 [1.7-4.9]	5.7 [3.7-8.1]	8.5 [6.1-11.3]	5.4 [3.4-7.8]	12.3 [9.1-16.0]*
	89	HÔPITAL DE MONTMAGNY	6.2 [3.3-10.0]	16.2 [11.3-21.9]	7.4 [4.3-11.3]	9.9 [6.1-14.6]	11.4 [7.1-16.8]
	113	HÔPITAL DE THETFORD MINES	6.2 [3.5-9.7]	4.9 [2.6-7.9]	4.9 [2.6-7.9]	5.1 [2.8-8.1]	8.0 [4.9-11.9]
		CHAUDIÈRE-APPALACHES	7.2 [6.0-8.6]	10.1 [8.6-11.7]	7.9 [6.6-9.3]	9.5 [8.1-11.0]	10.9 [9.3-12.6]
13	19	HÔPITAL CITÉ DE LA SANTÉ	2.8 [2.0-3.7]	5.3 [4.2-6.5]	6.8 [5.6-8.1]	5.7 [4.6-6.9]	4.1 [3.2-5.1]*
	131	HÔPITAL JUIF DE RÉADAPTATION	2.7 [1.4-4.5]	2.0 [0.9-3.5]	2.5 [1.2-4.2]	1.5 [0.8-2.5]	2.9 [1.4-4.9]
		LAVAL	2.8 [2.1-3.6]	4.6 [3.7-5.6]	5.9 [4.9-7.0]	4.4 [3.6-5.3]	3.8 [3.0-4.7]
14	11	HÔPITAL PIERRE-LE GARDEUR	1.9 [1.1-2.8]	3.4 [2.4-4.6]	1.7 [1.0-2.6]	0.8 [0.3-1.4]	2.0 [1.2-2.9]*
	14	CENTRE HOSPITALIER RÉGIONAL DE LANAUDIÈRE	5.2 [3.8-6.8]	13.9 [11.5-16.5]	10.5 [8.5-12.8]	7.6 [5.9-9.5]	16.1 [13.6-18.9]*
		LANAUDIÈRE	3.4 [2.6-4.3]	8.3 [7.0-9.7]	5.8 [4.8-6.9]	4.0 [3.1-5.0]	8.4 [7.2-9.7]*
15	45	HÔPITAL DE SAINT-EUSTACHE	5.8 [4.0-7.9]	6.6 [4.8-8.7]	7.3 [5.5-9.4]	4.8 [3.4-6.4]	5.7 [4.2-7.4]
	56	CENTRE DE SANTÉ ET DE SERVICES SOCIAUX D’ARGENTEUIL	12.1 [7.4-18.0]	14.3 [8.8-21.1]	13.8 [8.5-20.3]	16.5 [10.6-23.8]	14.2 [8.7-21.1]
	81	HÔPITAL DE MONT-LAURIER	3.1 [1.0-6.4]	8.2 [4.5-13.1]	5.7 [2.7-9.8]	3.9 [1.6-7.3]	3.5 [1.2-6.9]
	101	HÔPITAL RÉGIONAL DE SAINT-JÉRÔME	7.3 [5.7-9.1]	10.5 [8.6-12.6]	12.0 [9.9-14.2]	8.3 [6.6-10.1]	8.9 [7.2-10.8]
	103	HÔPITAL LAURENTIEN	4.8 [2.6-7.6]	8.1 [5.2-11.7]	4.9 [2.7-7.8]	3.2 [1.5-5.6]	3.7 [1.8-6.3]
		LAURENTIDES	6.6 [5.6-7.7]	9.2 [8.0-10.5]	9.3 [8.1-10.6]	6.7 [5.7-7.8]	7.1 [6.1-8.2]
16	1	HÔPITAL CHARLES-LEMOYNE	9.4 [7.8-11.1]	7.3 [5.9-8.8]	7.0 [5.6-8.5]	10.4 [8.7-12.2]	8.3 [6.8-10.0]
	9	HÔPITAL DU HAUT-RICHELIEU	5.2 [3.8-6.9]	6.5 [4.9-8.4]	6.9 [5.2-8.8]	10.7 [8.7-12.9]	17.1 [14.5-19.9]*
	10	HÔPITAL PIERRE-BOUCHER	1.9 [1.1-2.8]	2.3 [1.5-3.3]	5.3 [4.0-6.8]	3.7 [2.6-5.0]	4.4 [3.2-5.8]
	35	HÔPITAL HONORÉ-MERCIER	5.9 [4.2-7.8]	4.2 [2.8-5.9]	4.5 [3.0-6.3]	6.0 [4.3-8.0]	2.7 [1.6-4.1]*
	37	HÔTEL-DIEU DE SOREL	8.3 [6.0-11.0]	6.3 [4.3-8.7]	4.1 [2.5-6.1]	3.0 [1.7-4.7]	1.6 [0.7-2.9]
	42	HÔPITAL ANNA-LABERGE	4.6 [3.2-6.3]	2.8 [1.7-4.2]	2.8 [1.7-4.2]	2.1 [1.2-3.3]	7.5 [5.7-9.5]*
	46	HÔPITAL DE GRANBY	3.2 [1.7-5.1]	3.9 [2.3-6.0]	3.7 [2.1-5.7]	11.5 [8.5-15.0]	6.8 [4.6-9.5]*
	58	HÔPITAL DU SUROÎT	3.1 [1.8-4.7]	4.0 [2.5-5.8]	2.1 [1.1-3.4]	4.3 [2.8-6.1]	3.0 [1.8-4.5]
	99	HÔPITAL BROME-MISSISQUOI-PERKINS	5.4 [2.9-8.6]	1.5 [0.4-3.3]	6.3 [3.7-9.6]	5.6 [3.2-8.7]	2.8 [1.2-5.1]
	130	HÔPITAL BARRIE MEMORIAL	6.7 [2.9-12.2]	5.5 [2.0-10.8]	8.8 [4.2-15.1]	7.7 [3.7-13.2]	7.1 [3.2-12.5]
		MONTÉRÉGIE	5.5 [4.9-6.1]	4.7 [4.2-5.2]	5.1 [4.6-5.7]	6.7 [6.1-7.3]	6.9 [6.3-7.5]
		Total	6.4 [6.2-6.6]	7.0 [6.8-7.2]	7.3 [7.1-7.5]	7.3 [7.1-7.5]	7.1 [6.9-7.3]

* Significant statistical difference (p < 0.05) between incidence rates for Periods 1 through 13, 2012–2013 and 2013–2014.
When the incidence rate is 0, the confidence interval [CI] is not calculated.
^a Facility participating in the surveillance as of Period 6 of 2009–2010.

Author

Comité de surveillance provinciale des infections nosocomiales (SPIN)

Editorial committee

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

Yves Longtin, Hôpital général juif Sir Mortimer B. Davis

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

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

Epub Version

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