Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals☆,☆☆
Introduction
Surveillance of healthcare-associated infections (HAIs) is an important component of comprehensive infection prevention and control programme.1 The gold standard for surveillance is prospective active surveillance. Although not as accurate as the traditional prospective method, prevalence surveys can provide baseline information about the occurrence and distribution of HAI within a healthcare institution and help to establish priorities for infection prevention and control departments.
Repeated prevalence surveys have been used for the evaluation of infection control programmes, to follow trends in HAI rates, determine rates of device utilization and antibiotic usage, for intra-hospital comparisons, to measure adverse effects of HAI, and to measure the costs associated with these infections.2, 3, 4, 5, 6, 7 Large multicentre prevalence surveys have been conducted in Europe during the past decade and have shown an overall prevalence of HAI infections of 4–10%.7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 To date, there have been no published reports of prevalence surveys for HAI in adults hospitalised in Canadian acute care facilities.
We conducted a cross-sectional population survey of adult patients 19 years of age and older admitted to hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) to determine the prevalence of HAIs within these institutions.
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Methods
CNISP is a collaborative effort of the Canadian Hospital Epidemiology Committee, a subcommittee of the Association of Medical Microbiology and Infectious Disease Canada and the Public Health Agency of Canada (PHAC). Twenty-five acute-care CNISP member hospitals in eight provinces participated in a one-day HAI point prevalence survey occurring on any day between 5 and 8 February 2002. We have previously reported the results in paediatric age-group patients.20
Eligible patients were those 19 years
Results
A total of 5750 adults 19 years of age and older were surveyed. The mean age of the patients was 65 ± 17 years (range 19–99 years); 2938 (51%) patients were men. There were 2619 (46%) patients on medical units, 2112 (37%) on surgical units, 462 (8%) in critical care units including intensive care and coronary care, 250 (4%) on oncology/haematology units and 311 (5%) on other units including transplant, trauma and gynaecology. Of these, 1803 (31%) had at least one indwelling device; 1253 (22%) had
Discussion
This paper represents the first reported hospital-wide prevalence survey for HAI in adults hospitalised at large, university-affiliated acute-care hospitals across Canada. Since this study represents more than 85% of such hospitals, it provides a robust estimate of HAI in hospitals of this type in Canada. We found an overall prevalence of patients with HAI of 10.5%, with infections most common in patients on surgical wards. These results are in the range reported in large European multicentre
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Presented in part at the Fifth International Conference of the Hospital Infection Society, Edinburgh, Scotland, September 2002.
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This study was conducted without financial assistance.
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Members of the Canadian Nosocomial Infection Surveillance Program who participated in the Point Prevalence Survey for Healthcare-Acquired Infections: Dr Elizabeth Bryce, Vancouver General Hospital, Vancouver, BC; Dr Gordon Dow, The Moncton Hospital, Moncton, NB; Dr John Embil, Health Sciences Centre, Winnipeg, Manitoba; Dr Joanne Embree, Health Sciences Centre, Winnipeg, Manitoba; Dr Michael Gardam, University Health Network, Toronto, Ontario; Denise Gravel, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada; Dr Elizabeth Henderson, Peter Lougheed Centre, Calgary, Alberta; Dr James Hutchinson, Health Sciences Centre, St John's, Newfoundland; Dr Michael John, London Health Sciences Centre, London, Ontario; Dr Lynn Johnston, Queen Elizabeth II Health Sciences Centre, Halifax, NS; Dr Pamela Kibsey, Victoria General Hospital, Victoria, BC; Dr Joanne Langley, IWK Health Science Centre, Halifax, NS; Dr Mark Loeb, Hamilton Health Sciences Corporation and St Joseph's Healthcare, Hamilton, Ontario; Dr Anne Matlow, Hospital for Sick Children, Toronto, Ontario; Dr Allison McGeer, Mount Sinai Hospital, Toronto, Ontario; Dr Sophie Michaud, CHUS-Hôpital Fleurimont, Sherbrooke, Quebec; Dr Mark Miller, SMBD–Jewish General Hospital, Montreal, Quebec; Dr Dorothy Moore, Montreal Children's Hospital, Montreal, Quebec; Dr Michael Mulvey, National Microbiology Laboratory, Public Health Agency of Canada; Marianna Ofner, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada; Ms Shirley Paton, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada; Dr Virginia Roth, The Ottawa Hospital, Ottawa, Ontario; Jacob Stegenga, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada; Dr Geoffrey Taylor, University of Alberta Hospital, Edmonton, Alberta; Dr Karl Weiss, Maisonneuve–Rosemont Hospital, Montreal, Quebec; Dr Alice Wong, Royal University Hospital, Saskatoon, Saskatchewan; Dr Dick Zoutman, Kingston General Hospital, Kingston, Ontario.