Secure surveillance of antimicrobial resistant organism colonization or infection in Ontario long term care homes.
BACKGROUND
There is stigma attached to the identification of residents carrying antimicrobial resistant organisms (ARO) in long term care homes, yet there is a need to collect data about their prevalence for public health surveillance and intervention purposes.


OBJECTIVE
We conducted a point prevalence study to assess ARO rates in long term care homes in Ontario using a secure data collection system.


METHODS
All long term care homes in the province were asked to provide colonization or infection counts for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) as recorded in their electronic medical records, and the number of current residents. Data was collected online during the October-November 2011 period using a Paillier cryptosystem that allows computation on encrypted data.


RESULTS
A provably secure data collection system was implemented. Overall, 82% of the homes in the province responded. MRSA was the most frequent ARO identified at 3 cases per 100 residents, followed by ESBL at 0.83 per 100 residents, and VRE at 0.56 per 100 residents. The microbiological findings and their distribution were consistent with available provincial laboratory data reporting test results for AROs in hospitals.


CONCLUSIONS
We describe an ARO point prevalence study which demonstrated the feasibility of collecting data from long term care homes securely across the province and providing strong privacy and confidentiality assurances, while obtaining high response rates.
Electronic Health Information Laboratory, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Paediatrics, University of Ottawa, Ottawa, Ontario, Canada.
Khaled
K
El Emam
Electronic Health Information Laboratory, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Luk
L
Arbuckle
Electrical and Computer Engineering, Western University, London, Ontario, Canada.
Aleksander
A
Essex
Family Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Saeed
S
Samet
Privacy Analytics Inc., Ottawa, Ontario, Canada.
Benjamin
B
Eze
Privacy Analytics Inc., Ottawa, Ontario, Canada.
Grant
G
Middleton
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
David
D
Buckeridge
Electronic Health Information Laboratory, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Elizabeth
E
Jonker
Electronic Health Information Laboratory, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Ester
E
Moher
Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Craig
C
Earle
D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D017053:Infection Control; D008134:Long-Term Care; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D009735:Nursing Homes; D009864:Ontario; D013203:Staphylococcal Infections / Q000453:epidemiology*; D020713:Vancomycin Resistance; D018440:beta-Lactam Resistance