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

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 device-associated 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 line-associated bloodstream infections (CLABSIs). Counts, rates, patient and hospital characteristics, as well as pathogen distributions and antimicrobial susceptibilities are presented. 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.