title: Infection control and antimicrobial restriction practices for antimicrobial-resistant organisms in Canadian tertiary care hospitals.
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.
authors.affiliation: Nosocomial and Occupational Infections Section, Public Health Agency of Canada, Ottawa, Ontario, Canada. m.ofner@utoronto.ca
authors.forename: Marianna
authors.initials: M
authors.lastname: Ofner-Agostini
authors.forename: Monali
authors.initials: M
authors.lastname: Varia
authors.forename: Lynn
authors.initials: L
authors.lastname: Johnston
authors.forename: Karen
authors.initials: K
authors.lastname: Green
authors.forename: Andrew
authors.initials: A
authors.lastname: Simor
authors.forename: Barbara
authors.initials: B
authors.lastname: Amihod
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bryce
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Henderson
authors.forename: Jacob
authors.initials: J
authors.lastname: Stegenga
authors.forename: Frederic
authors.initials: F
authors.lastname: Bergeron
authors.forename: Denise
authors.initials: D
authors.lastname: Gravel
mesh_terms: D000046:Academic Medical Centers; D002170:Canada; D002353:Carrier State / Q000382:microbiology*; D003428:Cross Infection / Q000517:prevention & control; D003625:Data Collection; D024901:Drug Resistance, Multiple, Bacterial; D005572:Formularies, Hospital as Topic; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D008403:Mass Screening / Q000379:methods*; D018571:Sentinel Surveillance