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Infection control and antimicrobial restriction practices for antimicrobial-resistant organisms in Canadian tertiary
Marianna Ofner-Agostini1, Monali Varia, Lynn Johnston
1Nosocomial and Occupational Infections Section, Public Health Agency of Canada, Ottawa, Ontario, Canada. m.ofner@utoronto.ca
Abstract:
In 2003, a survey examining infection control and antimicrobial restriction policies and practices for preventing the emergence and transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and extended spectrum beta-lactamase (ESBL) was performed within Canadian teaching hospitals as part of the Canadian Nosocomial Infection Surveillance Program. Twenty-eight of 29 questionnaires were returned. The majority of facilities conducted admission screening for MRSA (96.4%) and VRE (89.3%) but only 1 site screened for ESBL/AmpC. Rates of MRSA, VRE, and ESBL remain low in Canada. It is believed that these lower rates may be due to intense admission screening protocols and stringent infection control policies for antimicrobial-resistant organisms (AROs) within Canadian institutions. Few (MRSA: 14.8%; VRE: 12.0%) recorded the number of patients screened. Regular prevalence surveys were done for MRSA (21.4%), VRE (35.7%), and ESBL/AmpC (3.8%). Pre-emptive precautions were applied for MRSA by 60.7% and for VRE by 75.0% of facilities. All facilities flagged patients previously identified with MRSA and VRE but only 46.2% flagged ESBL and 15.4% flagged AmpC patients. Barrier precautions varied by ARO and patient-care setting. In the inpatient non-ICU setting, more than 90% wore gowns and gloves for MRSA and VRE but only 50% for ESBL; and 57.1% wore masks for MRSA. Attempts to decolonize MRSA patients had been made by 82.1%, largely in order to place them in another facility. Policies restricting antimicrobial prescribing were reported by 21 facilities (75.0%). Further studies examining hospital infection control policies and corresponding rates of ARO infections would help in identifying and refining best practice guidelines within Canadian institutions.
Insights
Canadian hospitals employ robust screening and infection control for antimicrobial-resistant organisms (AROs) like MRSA and VRE, contributing to low infection rates. Further research is needed to refine best practices.
Area of Science:
- Healthcare epidemiology
- Infectious disease control
- Public health surveillance
Background:
- Antimicrobial-resistant organisms (AROs) pose a significant threat to healthcare settings globally.
- Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and extended-spectrum beta-lactamase (ESBL)-producing organisms are key AROs of concern.
- Understanding current infection control and antimicrobial restriction policies is crucial for preventing ARO transmission.
Purpose of the Study:
- To assess infection control and antimicrobial restriction policies and practices in Canadian teaching hospitals.
- To examine the prevention strategies for MRSA, VRE, and ESBL/AmpC.
- To correlate policies with observed rates of AROs in Canadian healthcare facilities.
Main Methods:
- A survey was conducted in Canadian teaching hospitals as part of the Canadian Nosocomial Infection Surveillance Program in 2003.
- Twenty-eight out of 29 hospitals returned questionnaires regarding their ARO policies and practices.
- Data collected included screening protocols, prevalence surveys, isolation precautions, decolonization attempts, and antimicrobial prescribing restrictions.
Main Results:
- High rates of admission screening for MRSA (96.4%) and VRE (89.3%) were reported, contrasting with low screening for ESBL/AmpC (1 site).
- Canada reported low rates of MRSA, VRE, and ESBL, potentially linked to stringent screening and infection control measures.
- Barrier precautions varied by ARO and setting; most facilities used gowns and gloves for MRSA/VRE, but less consistently for ESBL. Antimicrobial prescribing restriction policies were reported by 75.0% of facilities.
Conclusions:
- Stringent admission screening and infection control policies are likely contributing factors to the low prevalence of MRSA, VRE, and ESBL in Canadian teaching hospitals.
- Variations in barrier precautions and limited screening for ESBL/AmpC highlight areas for potential improvement.
- Further research correlating specific hospital policies with ARO infection rates is recommended to refine best practice guidelines.
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