Kathryn Bush

Mapping the Core: Chlamydia and Gonorrhea Infections in Calgary, Alberta

Objectives: To examine the spatial patterning of the individuals with gonorrhea or chlamydia infection in the Calgary Health Region (CHR) to target prevention and control activities. Methods: A Geographic Information System was used to map the prevalence rates of gonorrhea and chlamydia infection in the CHR to 2001 Census Tracts in the CHR. Data from the 2001 Canadian Census were used to describe the socioeconomic status (SES) of these areas. Results: Low SES indicators correlated with each other (low median household income, lower education, single mothers) as did high SES indicators (married, owning a dwelling, high median income, university education). A correlation was detected between areas of low SES and areas of high prevalence rates for gonorrhea and for chlamydia. These areas clustered primarily downtown and in the northeast part of the city. Conclusions: Nodes and corridors of activity in Calgary were detected in correlation studies of the 2001 Census variables used. The core (high prevalence) areas should be the areas targeted for sexually transmitted infection prevention and control. This can be done at the community level through measures such as more sexually transmitted infection clinics operating with longer hours in areas identified from this mapping.

Improving Surveillance for Surgical Site Infections Following Total Hip and Knee Arthroplasty Using Diagnosis and Procedure Codes in a Provincial Surveillance Network.

OBJECTIVE To evaluate hospital administrative data to identify potential surgical site infections (SSIs) following primary elective total hip or knee arthroplasty. DESIGN Retrospective cohort study. SETTING All acute care facilities in Alberta, Canada. METHODS Diagnosis and procedure codes for 6 months following total hip or knee arthroplasty were used to identify potential SSI cases. Medical charts of patients with potential SSIs were reviewed by an infection control professional at the acute care facility where the patient was identified with a diagnosis or procedure code. For SSI decision, infection control professionals used the National Healthcare Safety Network SSI definition. The performance of traditional surveillance methods and administrative data-triggered medical chart review was assessed. RESULTS Of the 162 patients identified by diagnosis or procedure code, 46 (28%) were confirmed as an SSI by an infection control professional. More SSIs were identified following total hip vs total knee arthroplasty (42% vs16%). Of 46 confirmed SSI cases, 20 (43%) were identified at an acute care facility different than their procedure facility. Administrative data-triggered medical chart review with infection control professional confirmation resulted in a 1.1- to 1.7-fold increase in SSI rate compared with traditional surveillance. SSIs identified by administrative data resulted in sensitivity of 90% and specificity of 99%. CONCLUSION Medical chart review for cases identified through administrative data is an efficient supplemental SSI surveillance strategy. It improves case-finding by increasing SSI identification and making identification consistent across facilities, and in a provincial surveillance network it identifies SSIs presenting at nonprocedure facilities. Infect Control Hosp Epidemiol 2016;37:699-703.

Epidemiology of meticillin-resistant Staphylococcus aureus bloodstream infections in Alberta, Canada

Most studies of meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) reflect a convenience sample from a single hospital or a small group of hospitals. From April 2011 to March 2013, cases of MRSA BSI diagnosed in all hospitals in Alberta, Canada were captured prospectively. Isolates were spa typed. In total, there were 299 cases of MRSA BSI, equating to 3.95 cases per 100,000 population. Community-acquired BSI accounted for 66.9% of cases, and 33.1% of cases were hospital acquired. Cases were predominantly seen in tertiary care (36.4%) and large urban hospitals (34.3%), but were also common in regional and rural hospitals. Paediatric hospitals had very few cases (3.0%). Two clones, CMRSA 10 (USA 300; 40.2%) and CMRSA 2 (USA 100/800; 38.0%), predominated.

Prevalence of Antimicrobial Use in a Network of Canadian Hospitals in 2002 and 2009

The Canadian Nosocomial Infection Surveillance Program has been performing surveillance of antibiotic-resistant organisms in Canada since 1994. The authors of this study compared two point-prevalence surveys of antimicrobial use that were conducted in hospitals that were participating in the program in 2002 and 2009. The authors compared the use of antimicrobials between these two surveys. The changes in antimicrobial use over time are presented, in addition to potential reasons for and consequences of these changes.

A Comparison of Administrative Data Versus Surveillance Data for Hospital-Associated Methicillin-Resistant Staphylococcus aureus Infections in Canadian Hospitals.

BACKGROUND In Canadian hospitals, clinical information is coded according to national coding standards and is routinely collected as administrative data. Administrative data may complement active surveillance programs by providing in-hospital MRSA infection data in a standardized and efficient manner, but only if infections are accurately captured. OBJECTIVE To assess the accuracy of administrative data regarding in-hospital bloodstream infections (BSIs) and all-body-site infections due to MRSA. METHODS A retrospective study of all (adult and pediatric) in-hospital MRSA infections was conducted by comparing administrative data against surveillance data from 217 acute Canadian hospitals (124 in Ontario, 93 in Alberta) over a 12-month period. Hospital-associated MRSA BSI cases in Ontario, and for all-body-site MRSA infections in Alberta were identified. Pearson correlation coefficients were used to compare the number of hospital-level MRSA cases within administrative versus surveillance datasets. The correlation of all-body-site MRSA infections versus MRSA BSIs was also assessed using the Ontario administrative data. RESULTS Strong correlations between hospital-level MRSA cases in administrative and surveillance datasets were identified for Ontario (r=0.79; 95% CI, 0.72-0.85) and Alberta (r=0.92; 95% CI, 0.88-0.94). A strong correlation between all-body-site and bloodstream-only MRSA infection rates was identified across Ontario hospitals (r=0.95; P<.0001; 95% CI, 0.93-0.96). CONCLUSIONS This study provides good evidence of the comparability of administrative and surveillance datasets in identifying in-hospital MRSA infections. With standard definitions, administrative data can provide estimates of in-hospital infections for monitoring and/or comparisons across hospitals. Infect Control Hosp Epidemiol 2017;38:436-443.

Validity of administrative data in identifying complex surgical site infections from a population-based cohort after primary hip and knee arthroplasty in Alberta, Canada

HighlightsComprehensive Infection Prevention and Control prospective surveillance is used at many hospitals to track surgical site infections after hip and knee arthroplasty. ICD‐9 and ICD‐10 codes are used as part of this surveillance.We followed a large population‐based cohort to determine the sensitivity, specificity, and positive and negative predictive values of ICD codes compared to comprehensive Infection Prevention and Control surveillance.The testing characteristics were reasonably accurate and may be useful in hospitals without prospective Infection Prevention and Control surveillance, but the surveillance is still more accurate at detecting surgical site infections. Background Surgical site infections (SSIs) are a substantial burden to healthcare systems in North America. Administrative data is one method though which these may be identified, but the accuracy of using such data is uncertain. Methods We followed a population‐based cohort of patients who received primary hip/knee arthroplasty in Alberta, Canada, for whom a comprehensive Infection Prevention and Control (IPC) prospective surveillance methodology was used to track SSIs. Patients were also followed using International Classification of Diseases, Tenth Revision (ICD‐10) codes. We assessed the sensitivity/specificity and positive/negative predictive values of ICD‐10 codes compared to IPC surveillance. Results Between April 1, 2012, and March 31, 2015, 24,512 people received hip/knee arthroplasty. Of these, 258 (1.05%) had a complex SSI found by IPC surveillance. Sensitivity and specificity of ICD‐10 codes in identifying complex SSIs after hip/knee arthroplasty were 85.3% (95% confidence interval [CI] 80.3%‐89.4%) and 99.5% (95% CI 99.4%‐99.6%), respectively. Positive and negative predictive values were 63.6% (95% CI 58.3%‐68.7%) and 99.8% (95% CI 99.8%‐99.9%), respectively. Discussion Administrative data have reasonable testing characteristics for identifying complex SSIs after arthroplasty. For centers without prospective surveillance programs, this could be useful in identifying hospitals with frequent complex SSIs after arthroplasty. Conclusions A comprehensive IPC surveillance program is superior at detecting SSIs after arthroplasty.