A comparison of infection control program resources, activities, and antibiotic resistant organism rates in Canadian acute care hospitals in 1999 and 2005: pre- and post-severe acute respiratory syndrome.

INTRODUCTION: The Resources for Infection Control in Hospitals (RICH) project assessed infection control programs and rates of antibiotic-resistant organisms (AROs) in Canadian acute care hospitals in 1999. In the meantime, the Severe Acute Respiratory Syndrome (SARS) outbreak and the concern over pandemic influenza have stimulated considerable government and healthcare institutional efforts to improve infection control systems in Canada.

METHODS: In 2006, a version of the RICH survey similar to the original RICH instrument was mailed to infection control programs in all Canadian acute care hospitals with 80 or more beds. Chi-square, ANOVA, and analysis of covariance analyses tested for differences between the 1999 and 2005 samples for infection control program components and ARO rates.

RESULTS: 72.3% of Canadian acute care hospitals completed the RICH survey for 1999 and 60.1% for 2005. Hospital size was controlled for in analyses involving AROs and surveillance and control intensity levels. Methicillin-resistant Staphylococcus aureus (MRSA) rates increased from 1999 to 2005 (F = 9.4, P = 0.003). In 2005, the MRSA rate was 5.2 (SD 6.1) per 1,000 admissions and in 1999 was 2.0 (SD 2.9). Clostridium difficile-associated diarrhea (CDAD) rates, trended up from 1999 to 2005 (F = 2.9, P = 0.09). In 2005, the mean CDAD rate was 4.7 (SD 4.3) and in 1999 it was 3.8 (SD 4.3). The proportion of hospitals that reported having new nosocomial Vancomycin-resistant Enterococcus (VRE) cases was greater in 2005 than in 1999 (X = 10.5, P = 0.001). In 1999, 34.5% (40 of 116) hospitals reported having new nosocomial VRE cases and in 2005, 61.0% (64 of 105) reported new cases. Surveillance intensity index scores increased from 61.7 (SD 18.5) in 1999 to 68.1 (SD 15.4) in 2005 (F = 4.1, P = 0.04). Control intensity index scores, trended upwards slightly from 60.8 (SD 14.6) in 1999 to 64.1 (12.2) in 2005 (F = 3.2, P = 0.07). ICP full time equivalents (FTEs) per 100 beds increased from 0.5 (SD 0.2) in 1999 to 0.8 (SD 0.3) in 2005 (F = 90.8, P < 0.0001). However, the proportion of ICPs in hospitals certified by the Certification Board of Infection Control (CBIC) decreased from 53% (SD 46) in 1999 to 38% (SD 36) in 2005 (F = 8.7, P = 0.004).

CONCLUSIONS: Canadian infection control programs in 2005 continued to fall short of expert recommendations for human resources and surveillance and control activities. Meanwhile, Nosocomial MRSA rates more than doubled between 1999 and 2005 and hospitals reporting new nosocomial VRE cases increased 77% over the same period. While investments have been made towards infection control programs in Canadian acute hospitals, the rapid rise in ICP positions has not yet translated into marked improvements in surveillance and control activities. In the face of substantial increases in ARO rates in Canada, continued efforts to train ICPs and support hospital infection control programs are necessary.