Surveillance provinciale des infections nosocomiales

Entre le 1^er avril 2015 et le 31 mars 2016, 66 unités de soins intensifs ont participé à la surveillance des bactériémies sur cathéters centraux, pour un cumul de 128 035 jours-cathéters. Ces unités ont rapporté 150 bactériémies, survenues chez 139 patients. Le taux d’incidence est de 0,70 dans les unités universitaires adultes, de 0,42 dans les unités non universitaires adultes, de 1,95 dans les unités pédiatriques et de 4,15 dans les unités néonatales (incluant les cas de bris de barrière muqueuse). Aucun cas n’a été observé en unité coronarienne. Par rapport à 2014-2015, une unité coronarienne et une unité universitaire mixte n’ont pas participé alors qu’une unité néonatale s’est rajoutée à la surveillance. Une unité universitaire mixte et une unité non universitaire mixte présentes l’année passée ont saisi des données pour moins de 11 périodes en 2015-2016. Le critère d’un minimum de 11 périodes de participation a été établi chaque année pour que les données soient incluses dans ce rapport de surveillance. Les données ont été extraites le 31 mai 2016.

L’Institut national de santé publique du Québec (INSPQ) a été mandaté par le ministère de la Santé et des Services sociaux (MSSS) pour exercer les activités de surveillance provinciale des infections nosocomiales. Les résultats de surveillance sont disponibles sur le site de l’INSPQ à l’adresse suivante : https://www.inspq.qc.ca/infections-nosocomiales/spin.

Les faits saillants, discussions et orientations du programme découlant des résultats de surveillance pour l’année 2014-2015 ont été rendus publics à la suite de leur approbation par le Comité sur les infections nosocomiales du Québec (CINQ) et le MSSS. Ils sont disponibles sur le site de l’INSPQ à l’adresse suivante : https://www.inspq.qc.ca/publications/2079.

Le présent document découle des résultats de surveillance et de l’analyse des faits saillants. Il reprend les…

From April 1st, 2014, to March 31st, 2015, 45 hemodialysis units took part in the surveillance of vascular access–related bloodstream infections (VARBSIs) in hemodialysis (HD) patients, for a combined total of 55,640 patient-periods (Table 1). Participating units reported 156 VARBSIs in 142 patients. The proportion of patient-periods involving a fistula accounted for 43.4%. The VARBSI incidence rate was 0.09 cases per 100 patient-periods for patients with an arteriovenous (AV) fistula, 0.20 for patients with a synthetic fistula (graft), 0.37 for patients with a permanent catheter and 6.73 for patients with a temporary catheter. In 2014–2015, incidence rates per type of vascular access were stable compared to 2010–2014, except for patients with a permanent catheter, which has significantly decreased (p < 0.01). Since 2013-2014, four HD units joined the program and one HD unit stopped participating. Data was extracted on May 20, 2015.

From April 1st, 2014, to March 31st, 2015, 67 intensive care units (ICUs) took part in surveillance of central line–associated bloodstream infections (CLABSIs), for a combined total of 130,776 catheter-days. Participating ICUs reported 115 CLABSIs in 112 patients. Incidence rates were 0.34 per 1,000 catheter-days in coronary ICUs, 0.52 in teaching adult ICUs, 0.76 in non-teaching adult ICUs, 2.06 in pediatric ICUs and 2.20 in neonatal ICUs. The incidence rates in 2014–2015 were lower compared to 2010–2014 in teaching adult as well as in neonatal ICUs while non-teaching adult, pediatric and coronary ICUs pooled mean rates remained stable. Compared to 2013-2014, two adult non-teaching ICUs with less than 10 beds and a neonatal ICU are not considered anymore in the results, having provided less than 11 periods of data. Data were extracted on May 20, 2015.

From April 1st, 2014, to March 31st, 2015, 88 healthcare facilities took part in the hospital-wide surveillance of bloodstream infections (BSIs), for a combined total of 4,733,772 patient-days. Participating facilities reported 3,035 BSIs in 2,832 patients. The total incidence rate was 5.3 cases per 10,000 patient-days. The incidence rate in 2014–2015 was significantly lower compared to the average rate for 2010–2014 in facilities that took part in both surveillance periods. Two teaching and 10 non-teaching facilities joined the program in 2014–2015 and one stopped participating; in addition, four facilities are not counted anymore in the 2013-2014 surveillance results, having provided data for less than 11 periods for this surveillance year. Data was extracted on May 20th, 2015.

From April 1, 2014, to March 31, 2015, 67 healthcare facilities (participation rate: 75.2%) took part in the surveillance of carbapenemase-producing Gram negative bacilli (CPGNB) infections, for a total of 3,225,934 patient-days (Table 1).

In total, 9 CPGNB infections were reported among patients who acquired their strain during a current or previous hospital stay in the reporting facility (categories 1a + 1b). The incidence rate of healthcare-associated CPGNB infection (cat. 1a + 1b) was 0.028 / 10,000 patient days. The acquisition rate of healthcare-associated CPGNB colonization (cat. 1a + 1b) was 0.16 / 10,000 patient days. Data was extracted on May 20th, 2015 and updated on June 1, 2015 for complications. 

Updated : March 24, 2016

Table 1 – Participation of Healthcare Facilities in the Surveillance of CPGNB Infections, Québec, 2014-…

From April 1, 2014, to March 31, 2015, 95 healthcare facilities participated in the surveillance of Clostridium difficile–associated diarrhea (CDAD), for a combined total of 5,076,655 inpatient days. The participating facilities reported 3,453 cases of healthcare-associated (HA) CDAD. The incidence rate of HA CDAD was 6.8 cases per 10,000 patient days. This incidence rate was significantly lower compared to the rate of 2013–2014. The 10-day fatality rate was 9.8% (n = 285) while the 30-day fatality rate was 18.6% (n = 543). In total, 36 (1.2%) colectomies were reported. Data was extracted on May 20th, 2015 and updated on June 1st 2015.  

From April 1, 2014, to March 31, 2015, 89 healthcare facilities took part in the surveillance of healthcare-associated vancomycin-resistant enterococci (VRE) infections, for a combined total of 4,839,578 patient days (Table 1). In total, 87 VRE infections were reported among patients who contracted strain during a current or previous hospital stay in the reporting facility (categories 1a + 1b). The incidence rate of healthcare-associated VRE infections (cat. 1a + 1b) was 0.18 / 10,000 patient days. This incidence rate was stable since 2013-2014. The acquisition rate of healthcare-associated VRE colonization (cat. 1a + 1b) was 10.99 / 10,000 patient days. Data was extracted on May 20th, 2015 and updated on June 1, 2015 for complications.

From April 1, 2013, to March 31, 2014, 89 healthcare facilities took part in the surveillance of healthcare-associated vancomycin-resistant enterococci (VRE) infections, for a combined total of 4,948,058 patient days (Table 1). In total, 92 VRE infections were reported among patients who contracted strain during a current or previous hospital stay in the reporting facility (categories 1a + 1b). The incidence rate of healthcare-associated VRE infections (cat. 1a + 1b) was 0.19 / 10,000 patient days. This incidence rate was two times higher than 2012-2013. The acquisition rate of healthcare-associated VRE colonization (cat. 1a + 1b) was 9.77 / 10,000 patient days. Data was extracted on May 15th, 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. 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.