Device-associated infections in Canadian acute-care hospitals from 2009 to 2018.

OVERVIEW Device-associated infections in Canadian acute-care hospitals from 2009 to 2018 Canadian Nosocomial Infection Surveillance Program1* This work is licensed under a Creative Commons Attribution 4.0 International License. Abstract Background: Healthcare-associated infections (HAIs) pose a serious risk to patient safety and quality of care. The Canadian Nosocomial Infection Surveillance Program (CNISP) conducts national surveillance of HAIs at sentinel acute-care hospitals across Canada. This report provides an overview of 10 years of Canadian data on the epidemiology of select deviceassociated HAIs. Methods: Over 40 hospitals submitted data between 2009 and 2018 for hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs, paediatric cardiac SSIs and/or central lineassociated bloodstream infections (CLABSIs). Counts, rates, patient and hospital characteristics, as well as pathogen distributions and antimicrobial susceptibilities are presented. Affiliation Public Health Agency of Canada, Ottawa, ON 1 *Correspondence: Results: A total of 4,300 device-associated infections were reported. Central line-associated bloodstream infections were the most common device-associated HAI reported (n=2,973, 69%) and hip and knee arthroplasty infections were the most common SSIs reported (66% of SSIs). Our findings show decreasing CLABSI rates in neonatal intensive care units (4.2 to 1.9 per 1,000 line-days, p<0.0001) and decreasing knee SSI rates (0.69 to 0.30 infections per 100 surgeries, p=0.007). Rates of device-associated HAIs have remained relatively consistent over the 10-year surveillance period. Overall, 4,599 pathogens were identified from device-associated HAI; 70% of these were related to CLABSIs. Coagulase-negative staphylococci (29%) and Staphylococcus aureus (14%) were the most frequently reported pathogens. Gram-positive pathogens represented 68% of identified pathogens, gram-negative pathogens represented 22% and fungi represented 9%. Conclusion: Understanding the national burden of device-associated HAIs is essential for developing and maintaining benchmark rates for informing infection and prevention control and antimicrobial stewardship policies and programs. Suggested citation: Canadian Nosocomial Infection Surveillance Program. Device-associated infections in Canadian acute-care hospitals from 2009 to 2018. Can Commun Dis Rep 2020;46(11/12):387–97. https://doi.org/10.14745/ccdr.v46i1112a05 Keywords: hospital-associated infection, acute-care, surveillance, antimicrobial resistance, device-associated, surgical site infections, Canada Introduction Healthcare-associated infections (HAIs) pose a serious risk to patient safety and quality of care and contribute to prolonged hospital stays, increased antimicrobial resistance, costs to the health system and unnecessary deaths (1). Risk factors for HAIs include the use of invasive devices, surgical procedures and inappropriate antibiotic use (2). In Canada, surgical site infections (SSIs) affect an estimated 26,000 to 65,000 patients annually (3). In a 2017 Canadian point prevalence study at sentinel hospitals, device-associated infections accounted for 35.6% of all HAIs reported. Of the device-associated infections, SSIs associated with a prosthetic implant accounted for 19.4% and central line-associated bloodstream infections (CLABSIs) accounted for 21.2% (4). Device-associated HAI antimicrobial susceptibility information has important implications for antibiotic resistance (5); impacting length of stay and healthcare costs (6). Cumulative antibiograms are a valuable resource for clinical decision-making while sensitivity results are pending (7). The risk of device-associated HAIs varies among patient populations and hospital types; patients admitted to the intensive care unit (ICU) are at higher risk of developing an HAI (8). CCDR • November 5, 2020 • Vol. 46 No. 11/12 Page 387 OVERVIEW Understanding the trends in device-associated HAIs is essential to effective infection prevention and control. Drawing on a decade of HAI data (2009−2018) from over 40 sentinel acute-care hospitals across Canada participating in the Canadian Nosocomial Infection Surveillance Program (CNISP), this report provides an epidemiological overview of select device-associated HAIs. Methods Design Established in 1994, the CNISP, a collaboration between the Public Health Agency of Canada, the Association of Medical Microbiology and Infectious Disease Canada and sentinel hospitals across Canada, conducts national HAI surveillance at sentinel acute-care hospitals across Canada. This report presents data on device-associated HAIs for the following infections: hip and knee SSIs; cerebrospinal fluid shunt SSIs (CSF-shunt-SSIs); paediatric cardiac surgical site infections (paediatric-cardiac-SSIs); and CLABSIs. Case definitions Device-associated HAIs were defined according to standardized protocols and expert-reviewed case definitions (Appendix 1). Only CLABSIs identified in ICU settings were included in surveillance. Only complex infections, defined as deep incisional and organ space, were included in hip and knee SSI surveillance. Results Between 2009 and 2018, over 40 hospitals contributed deviceassociated HAI data to CNISP, most of which were medium (201−499 bed) adult hospitals (Table 1). Overall, 4,300 deviceassociated infections were reported. CLABSIs were the most common device-associated HAI (n=2,973, 69%). Hip and knee SSI were the most common type of SSI reported (66% of SSIs, n=871/1,327). Table 1: Characteristics of acute-care hospitals participating in device-associated HAI surveillance and frequency of device-associated hospital-acquired infections, 2009–2018 CSF Characteristic shunt of hospitals SSI Years of surveillance Number of HAIs reported Total participating hospitals 2009– 2018 Paediatric cardiac SSI Hip and knee SSI 2010– 2018 2011– 2018 CLABSICLABSICLABSI- CLABSIadult adult PICU NICU mixed CVICU ICU 2009– 2018 2009– 2018 2009– 2018 2009– 2018 266 190 871 1,331 192 348 1,102 8–14 3–4 12–25 22–41 5–8 5–10 9–17 Hospital type Adulta 2–5 NA 8–16 12–27 3–7 NA 2–3 Mixed 2–4 NA 4–9 4–14 1–2 0–4 1–6 Paediatric 4–7 3–4 NA NA NA 4–6 4–8 Hospital size Data source Small (1–200 beds) 3–7 2–4 1–2 1–4 0–1 3–5 4–7 Participating hospitals submitted epidemiological data on CSF-shunt-SSIs and CLABSIs occurring between January 1, 2009 and December 31, 2018. Paediatric-cardiac-SSI surveillance started in January 2010. Hip and knee SSI surveillance started in January 2011. Data submission and case identification were supported by annual training sessions and continuous evaluations of data quality. Medium (201–499 beds) 4–8 1 7–15 10–27 2–4 1–5 1–7 Large (500+ beds) 0–1 NA 5–8 5–10 2–3 0 1–3 3,558 693 9,973 16,701 ICU beds 3,570 ICU beds 2,209 ICU beds 5,500 ICU beds Statistical analysis CLABSI rates were calculated by dividing t (...truncated)