The relationship between hospital infection surveillance and control activities and antibiotic-resistant pathogen rates.

BACKGROUND: Antibiotic-resistant pathogen rates are rising in Canada and the United States with significant health and economic costs. The examination of the relationship of surveillance and control activities in hospitals with rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile -associated diarrhea (CDAD), and vancomycin-resistant Enterococcus (VRE) may identify strategies for controlling this growing problem.

METHODS: Surveys were sent to infection control programs in hospitals that participated in an earlier survey of infection control practices in Canadian acute care hospitals.

RESULTS: One hundred twenty of 145 (82.8%) hospitals responded to the survey. The mean MRSA rate was 2.0 (SD 2.9) per 1000 admissions, the mean CDAD rate was 3.8 (SD 4.3), and the mean VRE rate was 0.4 (SD 1.5). Multiple stepwise regression analysis found that hospitals that reported infection rates by specific risk groups ( r = -0.27, P < .01) and that kept attendance records of infection control teaching activities ( r = -0.23, P < .01) were associated with lower MRSA rates. Multiple stepwise regression analysis found that larger hospitals ( r = 0.25, P < .01) and hospitals at which infection control committees or staff had the direct authority to close a ward or unit to further admissions because of outbreaks ( r = 0.22, P < .05) were associated with higher CDAD rates. Multiple logistic regression analysis found that larger hospitals (OR, 1.6; 95% CI, 1.2-2.0; P = .003) and teaching hospitals (OR, 3.7 95% CI, 1.2-11.8; P = .02) were associated with the presence of VRE. Hospitals were less likely to have VRE when infection control staff frequently contacted physicians and nurses for reports of new infections (OR, 0.5; 95% CI, 0.3-0.7; P = .02) and there were in-service programs for updating nursing and ancillary staff on current infection control practices (OR, 0.2; 95% CI, 0.1-0.7; P = .01).

CONCLUSION: Surveillance and control activities were associated with MRSA and CDAD rates and the presence of VRE. Surveillance and control activities might be especially beneficial in large and teaching hospitals.