Impact of Québec MRSA guidelines on incidence rates of MRSA hospital-associated bloodstream infections
Bibliographic record
Abstract
Background: We described the CLABSI incidence rates in Québec and compared them to rates from other jurisdictions to determine trends. We then used CLABSI incidence rates as a comparator to examine impact of MRSA guidelines in Québec adult hospitals from January 1st, 2006 to March 31st, 2015 by looking at incidence rate reduction (IRR) in healthcare-associated MRSA bloodstream infections (HA-MRSA). Methods: CLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007-2014 data from the Québec Surveillance Provinciale des Infections Nosocomiales program (SPIN) and benchmarked to American and Canadian surveillance data, using standardized incidence ratios (SIRs). We used a quasi-experimental design and segmented Poisson regression to analyze SPIN surveillance data from 2006 to 2015 for HA-MRSA BSI and CLABSI for successive 4-week surveillance segments, stratified by facility type. Three distinct time intervals with 2 breakpoints were used (April 1st, 2007, and January 3rd, 2010), corresponding to major MRSA guideline and guideline updates. Results: For SPIN-BACC, 70 intensive care units (ICU) participated in CLABSI surveillance resulting in 1,474 cases, and 1,038,908 catheter-days. CLABSI rates had decreased significantly in ICUs except for pediatric ICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower, adult nonteaching ICUs had lower or comparable rates, while NICU and PICU rates were higher. For SPIN-SARM, 56 healthcare facilities participated, resulting in 1,854 HA-MRSA BSI cases and 43,728,219 patient-days. HA-MRSA BSI incidence decreased significantly for adult teaching facilities, but not for adult nonteaching facilities. Before MRSA guideline publication (2006-2007), HA-MRSA BSI incidence was stable (p=0.89), while CLABSI incidence declined by 4% per 4-week period, (p=0.05). After publication of guidelines (2007 - 2009), HA-MRSA incidence significantly declined at 1% (p=0.04), during which CLABSI incidence was stable (p=0.75). HA-MRSA and CLABSI declines were both significant at 1% in 2010-2015 (p<0.001, p=0.01, respectively). These declines were gradual rather than sudden as breakpoints were not significant. Teaching facilities drove these decreases. Conclusion: Significant HA-MRSA BSI rate decline in 2007-2009, with stable CLABSI rates, suggests an impact of MRSA-specific guidelines. In 2010-2015, significant and equal IRR for HA-MRSA and CLABSI may be due to continuing impact of MRSA guidelines, an impact of new interventions targeting device-associated infections in general of the 2010-2015 action plan, or of a combination of factors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".