Nosocomial infection

Measures to Prevent and Control Transmission of Multidrug-Resistant Gram-Negative Bacilli (Excluding Carbapenemase-Producing Enterobacteriaceae) in Acute Care Settings in Québec

Gram-negative bacilli (GNB) are bacteria frequently encountered in clinical settings, both as normal flora and as pathogens in a variety of infections.

The use of antibiotics has led to the emergence of various resistance mechanisms and some of these bacteria are now resistant to several classes of antibiotics.

This document was created to help healthcare-associated infection prevention and control (IPC) teams identify major multidrug-resistant. Gram-negative bacilli (MDR-GNB) and implement IPC measures to prevent them from being transmitted to acute care settings in Québec. This document replaces the document published in 2015 and discusses all GNB excluding carbapenemase-producing Enterobacteriaceae (CPE). Since the latter are important, a separate document has been created containing the information that pertains to them (CINQ 2017).

This document is primarily intended to be used as a basic reference for centres that are not dealing with an outbreak.…

Comité sur les infections nosocomiales du Québec

Prevention and control measures for Clostridium difficile in residential and long-term care facilities

  • Since August 2004, Clostridium difficile associated diarrhea (CDAD) has undergone ongoing surveillance in all Quebec hospitals with more than 1,000 admissions annually. The surveillance has monitored the evolution of CDAD levels in health care facilities and confirmed their decrease. From an average of 9.1 cases/10,000 patient days in 2005-2006, the average rate has dropped to 4.6 cases/10,000 patient days in 2016-2017 (SPIN, 2017).
  • Clostridium difficile (C. difficile) infection is nonetheless one of the main causes of nosocomial infectious diarrhea in Quebec health care facilities. Although the majority of cases occur in hospitals, some cases have been identified in residential and long-term care facilities and, based on epidemiological data available, outbreaks have also been reported there. Complications and deaths are more common in the older population.
  • In 2005, the Comité sur les infections nosocomiales du Québec (CIN…
Comité sur les infections nosocomiales du Québec

Prevention and control measures for Candida auris in health care facilities

  • Candida auris is an emerging microorganism that belongs to the yeast category. Increasingly, it is being found as a pathogen causing nosocomial fungal infections.
  • First identified in Japan in 2009 in a sample from a patient’s auditory canal (Satoh et al., 2009; ECDC, 2016; Rock, 2017), it has since been identified in up to 17 countries, spread across at least 5 continents: Asia, Europe, Africa and the Americas (CDC, 2017a; Schwartz and Hammond, 2017).
  • C. auris, with a clonal strain, has caused outbreaks in many health care facilities, including some involving a large number of colonized or infected patients.
  • Some particular characteristics of Candida auris are making world experts concerned about its propagation. As well as its ability to be transmitted at health care facilities and cause outbreaks, many strains demonstrate or quickly develop resistance to most antifungal agents commonly used to trea…
Comité sur les infections nosocomiales du Québec

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

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, incidenc…

Surveillance provinciale des infections nosocomiales

Central Line–Associated Bloodstream Infections in Intensive Care Units Surveillance results: 2016-2017

Central Line–Associated Bloodstream Infections in Intensive Care Units
Surveillance results: 2016-2017

From April 1st, 2016, to March 31st, 2017, 69 intensive care units (ICUs) took part in surveillance of central line–associated bloodstream infections (CLABSIs), for a combined total of 135,114 catheter days (Table 1). Participating ICUs report 133 CLABSIs in 125 patients. Incidence rates are 0.91 per 1,000 catheter days in coronary ICUs, 0.62 in teaching adult ICUs, 0.46 in non-teaching adult ICUs, 2.16 in pediatric ICUs and 2.78 in neonatal ICUs. The incidence rates in 2016–2017 are lower compared to 2012–2016 in neonatal ICUs while they remain statistically stable in other ICU types. Compared to 2015-2016, one adult non-teaching ICUs with less than 10 beds has stopped…

Surveillance provinciale des infections nosocomiales

Hospital-Wide Healthcare-associated Bloodstream Infections Surveillance results: 2016-2017

Hospital-Wide Healthcare-associated Bloodstream Infections
Surveillance results: 2016-2017

From April 1st, 2016, to March 31st, 2017, 89 healthcare facilities took part in the hospital-wide surveillance of bloodstream infections (BSIs), for a combined total of 4,830,348 patient days (Table 1). Participating facilities reported 3,167 BSIs in 2,982 patients. The total incidence rate was 5.43 cases per 10,000 patient days. The incidence rate in 2016–2017 is stable compared with the average rate for 2012–2016. Two non-teaching facilities joined the program in 2016–2017. Data were extracted on May 5th, 2017.

Update: October 5, 2017

Surveillance provinciale des infections nosocomiales

Clostridium difficile–Associated Diarrhea Surveillance results: 2016-2017

Clostridium difficile–Associated Diarrhea
Surveillance results: 2016-2017

From April 1st, 2016 to March 31st, 2017, 95 healthcare facilities participated in the Clostridium difficile–associated diarrhea (CDAD) surveillance program, for a combined total of 5,022,104 patient days (Table 1). These participating facilities reported 2,330 healthcare-associated CDAD (HA-CDAD), either acquired during a current or previous hospitalization (categories 1a and 1b). The HA-CDAD incidence rate was 4.64 cases per 10,000 patient days. This incidence rate has declined for a third consecutive year and this decline was statistically and significantly lower than the 2015–2016 rate. The 10-day fatality rate was 6.3% (n = 130) while the 30-day fatality rate was 12.4% (n…

Surveillance provinciale des infections nosocomiales

Carbapenemase-Producing Gram Negative Bacilli Infections Surveillance results: 2016-2017

Carbapenemase-Producing Gram Negative Bacilli Infections
Surveillance results: 2016-2017

From April 1st, 2016, to March 31st, 2017, 82 healthcare facilities took part in the surveillance of carbapenemase-producing Gram negative bacilli (CPGNB) infections, for a total of 4,448,999 patient days (Table 1). These facilities reported 17 healthcare-associated CPGNB (HA-CPGNB) infections among patients who acquired their strain during a current or previous hospitalization (categories 1a and 1b). The incidence rate of HA-CPGNB infection was 0.04 per 10,000 patient days. The acquisition rate of HA-CPGNB colonization was 0.57 per 10,000 patient days. Eight infections were observed among healthcare facilities that joined the surveillance this year. Two teaching and one non-teaching facilities discontinued their participation this y…

Surveillance provinciale des infections nosocomiales

Vancomycin-Resistant Enterococci Infections Surveillance results: 2016-2017

Vancomycin-Resistant Enterococci Infections
Surveillance results: 2016-2017

From April 1st, 2016 to March 31st, 2017, 89 healthcare facilities took part in the surveillance of vancomycin-resistant enterococci (VRE) infections, for a combined total of 4,827,659 patient days (Table 1). These facilities reported 44 healthcare-associated VRE (HA-VRE) infections, either acquired during a current or previous hospitalization (categories 1a and 1b). The HA-VRE infection rate was 0.09 per 10,000 patient days. This incidence rate was down from 2015-2016. The acquisition rate of HA-VRE colonization (cat. 1a and 1b) in 2016-2017 was 7.43 per 10,000 patient days and was lower compared to 2015-2016. For all results, analyses include facilities that participated for a minimum of 11 periods. Data were extracted on June 1s…

Surveillance provinciale des infections nosocomiales

Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Surveillance results: 2016-2017

Methicillin-Resistant Staphylococcus aureus Bloodstream Infections
Surveillance results: 2016-2017

From April 1st, 2016 to March 31st, 2017, 89 healthcare facilities participated in the surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, for a combined total of 4,835,605 patient days (Table 1). Together, these facilities reported 66 cases of healthcare-associated MRSA bloodstream infections (HA-MRSA-BSI) acquired during a current or previous hospitalization (categories 1a and 1b). The HA-MRSA-BSI incidence rate was 0.14 per 10,000 patient days. While this incidence rate has been declining for the past five years, this year was comparable to the last one. The proportion of methicillin resistance in healthcare-associated S. aur…

Surveillance provinciale des infections nosocomiales