Canadian Acute Care Hospitals Research Articles

Device and surgical procedure-related infections in Canadian acute care hospitals, 2018-2022.

Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2018 to 2022. Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2018, and December 31, 2022, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt (CSF) SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Between 2018 and 2022, 2,258 device-related infections and 987 surgical procedure-related infections were reported. A significant rate increase was observed in adult mixed intensive care unit CLABSIs (1.07-1.93 infections per 1,000 line days, p=0.05) and a non-significant rate increase was observed in SSIs following knee arthroplasty (0.31-0.42 infections per 100 surgeries, p=0.45). A fluctuating rate trend was observed in CSF shunt SSIs over the time period and a significant rate decrease in paediatric cardiac SSIs was observed (68%, from 7.5-2.4 infections per 100 surgeries, p=0.01). The most commonly identified pathogens were coagulase-negative staphylococci (22.8%) among CLABSIs and Staphylococcus aureus (42%) among SSIs. Epidemiological and microbiological trends among selected device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

The response of Canada's clinical health research ecosystem to the COVID-19 pandemic.

The response of Canada's research community to the COVID-19 pandemic provides a unique opportunity to examine the country's clinical health research ecosystem. We sought to describe patterns of enrolment across Canadian Institutes of Health Research (CIHR)-funded studies on COVID-19. We identified COVID-19 studies funded by the CIHR and that enrolled participants from Canadian acute care hospitals between January 2020 and April 2023. We collected information on study-and site-level variables from study leads, site investigators, and public domain sources. We described and evaluated factors associated with cumulative enrolment. We obtained information for 23 out of 26 (88%) eligible CIHR-funded studies (16 randomized controlled trials [RCTs] and 7 cohort studies). The 23 studies were managed by 12 Canadian and 3 international coordinating centres. Of 419 Canadian hospitals, 97 (23%) enrolled a total of 28 973 participants - 3876 in RCTs across 78 hospitals (median cumulative enrolment per hospital 30, interquartile range [IQR] 10-61), and 25 097 in cohort studies across 62 hospitals (median cumulative enrolment per hospital 158, IQR 6-348). Of 78 hospitals recruiting participants in RCTs, 13 (17%) enrolled 50% of all RCT participants, whereas 6 of 62 hospitals (9.7%) recruited 54% of participants in cohort studies. A minority of Canadian hospitals enrolled the majority of participants in CIHR-funded studies on COVID-19. This analysis sheds light on the Canadian health research ecosystem and provides information for multiple key partners to consider ways to realize the full research potential of Canada's health systems.

Nirmatrelvir-ritonavir use among adults hospitalized with COVID-19 during the Omicron phase of the COVID-19 pandemic, Canadian Nosocomial Infection Surveillance Program.

Recent studies have demonstrated the effectiveness of nirmatrelvir-ritonavir in reducing the risk of progression to severe disease among outpatients with mild to moderate coronavirus disease 2019 (COVID-19); however, data are limited regarding the use and role of nirmatrelvir-ritonavir among hospitalized patients. This study describes the use and outcomes of nirmatrelvir-ritonavir among adults hospitalized with COVID-19 in a sentinel network of Canadian acute care hospitals during the Omicron variant phase of the pandemic. The Canadian Nosocomial Infection Surveillance Program conducts surveillance of hospitalized patients with COVID-19 in acute care hospitals across Canada. Demographic, clinical, treatment and 30-day outcome data were collected by chart review by trained infection control professionals using standardized questionnaires. From January 1 to December 31, 2022, 13% (n=490/3,731) of adult patients (18 years of age and older) hospitalized with COVID-19 in 40 acute care hospitals received nirmatrelvir-ritonavir either at admission or during hospitalization. Most inpatients who received nirmatrelvir-ritonavir, 79% of whom were fully vaccinated, had at least one pre-existing comorbidity (97%) and were of advanced age (median=79 years). Few were admitted to an intensive care unit (2.3%) and among the 490 nirmatrelvir-ritonavir treated inpatients, there were 13 (2.7%) deaths attributable to COVID-19. These findings from a large sentinel network of Canadian acute-care hospitals suggest that nirmatrelvir-ritonavir is being used to treat adult COVID-19 patients at admission who are at risk of progression to severe disease or those who acquired COVID-19 in hospital. Additional research on the efficacy and indications for nirmatrelvir-ritonavir use in hospitalized patients is warranted to inform future policies and guidelines.

Vancomycin Therapeutic Drug Monitoring: A Cross-Sectional Survey of Canadian Hospitals.

Little is known about the current landscape of vancomycin therapeutic drug monitoring (TDM) in Canadian hospitals, which operate within publicly funded health care systems. To determine current TDM practices for vancomycin and associated challenges and to gather perceptions about TDM based on area under the concentration-time curve (AUC) in Canadian hospitals. An electronic survey was distributed to hospital pharmacists in spring 2021 through multiple national and provincial antimicrobial stewardship, public health, and pharmacy organizations. The survey gathered data about hospital characteristics, TDM methods, inclusion criteria for patient selection, pharmacokinetic and pharmacodynamic targets, vancomycin susceptibility testing and reporting, and perceived barriers and challenges. In total, 120 pharmacists from 10 of the 13 provincial and territorial jurisdictions in Canada, representing 12.5% of Canadian acute care hospitals (n = 962), completed at least 90% of survey questions. The predominant TDM method was trough-based (107/119, 89.9%); another 10.1% of respondents (12/119) reported performing AUC-based TDM (with or without trough-based TDM), and 17.9% (19/106) of those not already using AUC-based TDM were considering implementing it within 1 to 2 years. Among hospitals performing trough-based TDM, 60.5% (66/109) targeted trough levels between 15 and 20 mg/L for serious infections with methicillin-resistant Staphylococcus aureus. One-quarter of the respondents using this method (27/109, 24.8%) agreed that trough-based TDM was of uncertain benefit, and about one-third (33/109, 30.3%) were neutral on this question. Multiple challenges were identified for trough-based TDM, including sub- or supra-therapeutic concentrations and collection of specimens at inappropriate times. Overall, 40.5% (47/116) of respondents agreed that AUC-based TDM was likely safer than trough-based TDM, whereas 23.3% (27/116) agreed that AUC-based TDM was likely more effective. This survey represents a first step in developing evidence-based, standardized best practices for vancomycin TDM that are uniquely suited to the Canadian health care system.

Impact of COVID-19 on healthcare-associated infections in Canadian acute-care hospitals: Interrupted time series (2018–2021)

Background: Data regarding the effects of the SARS-COV-2 (COVID-19) pandemic on healthcare-associated infections (HAIs) in Canadian acute-care hospitals are limited. We examined the impact of the COVID-19 pandemic on HAIs and antimicrobial resistant organisms in hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Methods: We analyzed 13,406 HAIs including adult mixed intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs), and healthcare-associated (HA) Clostridioides difficile infection (CDI), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), vancomycin-resistant Enterococcus (VRE) BSI, and carbapenemase-producing Enterobacterales (CPE) infections collected using standardized case definitions and questionnaires from 29–64 hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) from January 2018 to December 2021. We used a generalized linear mixed model with quasi-Poisson distribution to assess step and slope changes in monthly HAI rates between the pre–COVID-19 pandemic period (January 1, 2018–February 29, 2020; 26 time points) and the COVID-19 pandemic period (March 1, 2020–December 31, 2021; 22 time points). Results were reported as incidence rate ratios (IRRs) with 95% confidence intervals (CIs) and adjusted for seasonality, hospital clustering, and hospital characteristics of interest. Results: In the CNISP network, 7,352 (55%) HAIs were reported in the prepandemic period and 6,054 (45%) in the pandemic period. Median age was significantly younger during the pandemic period compared to the prepandemic period among patients with HA-CDI, HA-MRSA BSI, and adult mixed ICU CLABSIs, and more than half of cases among all reported HAIs were male (range, 52%–65%). The 30-day all-cause in-hospital mortality rate did not significantly change between the prepandemic and pandemic periods for all reported HAIs and was highest among HA-VRE BSIs (34%). Modeling results indicated that the COVID-19 pandemic was associated with an immediate increase in HA-CDI and adult mixed ICU CLABSI rates whereas HA-MRSA BSI, HA-CPE and HA-VRE BSI rates immediately decreased. However, pandemic status did not have a statistically significant lasting impact on monthly rate trends for all reported HAIs after adjusting for seasonality, clustering, and hospital covariates (Fig. 1 and 2). Adjusted IRRs for all HAIs ranged from 1.00 to 1.01 (95% CI, 0.94–0.99 to 1.01–1.05).Conclusions: Although the COVID-19 pandemic placed a significant burden on the Canadian healthcare system, the immediate impact on monthly rates of HAIs in Canadian acute-care hospitals was not sustained over time. Understanding the epidemiological effects of the COVID-19 pandemic in the context of changing patient populations, and clinical and infection control practices, are essential to inform the continued management and prevention of HAIs in Canadian acute-care settings.Disclosures: None

Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2017-2021.

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2017 to 2021 (Candida auris 2012-2021) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial laboratories to the National Microbiology Laboratory (NML). Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for Clostridioides difficile infections (CDI), carbapenemase-producing Enterobacterales (CPE), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and vancomycin-resistant Enterococcus (VRE) BSIs. Candida auris (C. auris) surveillance was initiated in 2019 by CNISP and in 2012 by the NML. Case counts, rates, outcomes, molecular characterization and antimicrobial resistance profiles are presented. From 2017 to 2021, increased rates per 10,000 patient days were observed for MRSA BSIs (35%; 0.84-1.13), VRE BSIs (43%; 0.23-0.33) and CPE infections (166%, 0.03-0.08). CDI rates decreased 11% (5.68-5.05). Thirty-one C. auris isolates were identified in Canada from 2012 to 2021, with the majority from Western Canada (68%). From 2017 to 2021, the incidence of MRSA and VRE BSIs, and CPE infections increased in Canadian acute care hospitals participating in a national sentinel network (CNISP) while CDI decreased. Few C. auris isolates were identified from 2012 to 2021. Reporting standardized surveillance data and the consistent application of infection prevention and control practises in acute care hospitals are critical to help decrease the burden of HAIs and AMR in Canada.

Device and surgical procedure-related infections in Canadian acute care hospitals, 2017-2021.

Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2017 to 2021. Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Between 2017 and 2021, 2,898 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units representing 69% (n=2,002) of all reported infections under surveillance. Significant rate increases were observed in adult mixed intensive care unit CLABSIs (1.08-2.11 infections per 1,000 line days, p=0.014) while decreases were observed in SSIs following knee arthroplasty (0.34-0.27 infections per 100 surgeries, p=0.05). No changes in trends were observed in the other reported HAIs. Of the 3,089 pathogens identified, the majority were gram-positive (66%), followed by gram negative (23%) and fungi (11%). Coagulase-negative staphylococci (22%) and Staphylococcus aureus (17%) were the most frequently isolated pathogens. Epidemiological and microbiological trends among select device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

1784. Appropriateness of Intravenous Vancomycin in a Canadian Acute Care Hospital

Abstract Background Intravenous (IV) vancomycin is a commonly prescribed antimicrobial. However, there is limited literature assessing IV vancomycin appropriateness. The objective of the study was to assess the appropriateness of IV vancomycin prescriptions in a Canadian acute care hospital. Methods Prospective audit and feedback (PAF) was conducted on all new IV vancomycin prescriptions in hospitalized adults (age ≥ 18 years) at the University of Alberta Hospital from January 17 to February 11, 2022. Appropriateness was assessed against institutional prescribing guidelines (Bugs & Drugs® and Alberta Health Services Formulary Prescribing Guidelines). Verbal and written feedback were provided to the attending teams. Results A total of 109 prescriptions were audited. Median age was 57 (IQR 43-72) years and 42% were female. 65 (60%) were admitted to Medicine, 18 (17%) to Surgery, and 26 (24%) to Intensive Care units. MRSA colonization was present in 32 (29%) patients, β-lactam allergy recorded in 21 (19%), and acute kidney injury (AKI) in 21 (19%). Infectious Diseases consultation (IDC) occurred in 29 (27%). The top indications were skin and soft tissue, pulmonary, and bloodstream infections (Table 1); 70% of prescriptions were empiric in nature. Overall, 43 (39%) prescriptions were assessed to be suboptimal. Antimicrobial Stewardship program (ASP) recommendations were made in 56 prescriptions, totaling 63 unique recommendations. Vancomycin was recommended to be discontinued in 24 (43%) cases or changed to a different agent in 15 (27%). Regimen optimization (duration or frequency change) was recommended in 4 (7%). ASP recommended investigations in 8 cases and IDC in 12. Full or partial acceptance was achieved in 49 cases (88%). IDC was associated with greater appropriateness (83% vs 53%, p=0.004) as was MRSA colonization (75% vs 55%, p=0.047), but AKI was not (62% vs 60%, p=0.888). Adjusting for age, AKI, and MRSA colonization, IDC remained a significant predictor of vancomycin appropriateness (OR=4.27, [95%CI 1.44-12.70]; p=0.009). Conclusion IV vancomycin prescriptions were suboptimal in 39% of cases. IDC was associated with increased appropriateness. This pilot informs the need for antimicrobial stewardship intervention and the importance of IDC at our center. Disclosures Dima Kabbani, MD, MSc, AVIR Pharma: Grant/Research Support|AVIR Pharma: Honoraria|GSK: Honoraria|Merck: Grant/Research Support.

THE STATE OF HEART FAILURE SERVICES IN CANADA: FINDINGS OF THE HEART & STROKE NATIONAL HEART FAILURE RESOURCES AND SERVICES INVENTORY

THE STATE OF HEART FAILURE SERVICES IN CANADA: FINDINGS OF THE HEART & STROKE NATIONAL HEART FAILURE RESOURCES AND SERVICES INVENTORY

Infections liées aux instruments médicaux et aux interventions chirurgicales dans les hôpitaux de soins aigus du Canada de 2011 à 2020

Infections liées aux instruments médicaux et aux interventions chirurgicales dans les hôpitaux de soins aigus du Canada de 2011 à 2020

Les infections associées aux soins de santé et la résistance aux antimicrobiens dans les hôpitaux canadiens de soins aigus, 2016 à 2020

Caractéristiques épidémiologiques et de laboratoire des infections associées aux soins de santé et de la résistance aux antimicrobiens de 2016 à 2020 à l’aide des données de surveillance fournies par les hôpitaux canadiens participant au Programme canadien de surveillance des infections nosocomiales.

Device and surgical procedure-related infections in Canadian acute care hospitals from 2011 to 2020.

Healthcare-associated infections (HAIs) continue to place a burden on patient health and safety as well as on the healthcare system. In Canada, national surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes ten years of device and surgical procedure-related HAI epidemiology in Canada from 2011 to 2020. Data were collected from over 40 Canadian sentinel acute care hospitals between January 1, 2011, and December 31, 2020, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions, and antimicrobial resistance are presented. Between 2011 and 2020, 4,751 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units (ICUs) representing 67% (n=3,185) of all reported infections. Over the surveillance period, significant rate increases were observed in adult mixed ICU CLABSIs (0.8 to 1.6 per 1,000 line days, p=0.004) while decreases were observed in neonatal ICU CLABSIs (4.0 to 1.6 per 1,000 line days, p=0.002) and SSIs following knee arthroplasty (0.69 to 0.29 infections per 100 surgeries, p=0.002). No trends were observed in the other reported HAIs.Of the 5,071 pathogens identified, the majority were gram-positive (68%), followed by gram-negative (23%) and fungi (9%). Coagulase-negative staphylococci (27%) and Staphylococcus aureus (16%) were the most frequently isolated pathogens. This report describes epidemiological and microbiological trends among select device and surgical procedure-related HAIs, essential for benchmarking infection rates nationally and internationally, to identify any changes in infection rates or antimicrobial resistance patterns and to help inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2016–2020

Epidemiologic and laboratory characteristics of healthcare-associated infections and antimicrobial resistance from 2016 to 2020 using surveillance data provided by Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program.

Assessing the maturity and performance of the IT function in acute-care hospitals: a configurational view

ABSTRACT This study aims to characterises the maturity of IT management in hospitals, to identify the IT management configurations needed to achieve greater performance and to characterise the organisational and strategic IT contexts in which these configurations evolve. Drawing on survey data from 72 Canadian acute-care hospitals with the CIO as the main respondent, we used a configurational approach to assess the maturity of their IT functions. We classified participating hospitals in two distinct groups, each related to different levels of performance. Hospitals in the first group are characterised by a rather “immature” IT management model and presented low levels of IT performance. Hospitals in the second group showed more maturity in their IT management model and high levels of IT performance. Importantly, both the strategic influence of the CIO and the centrality of IT to the hospital’s strategic goals were found to be significantly greater in the mature group.

Antimicrobial use in Canadian acute-care hospitals: Findings from three national point-prevalence surveys between 2002 and 2017.

The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use. Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%. In each survey, 28-47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%-37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%-41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%-40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60). The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.

The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults

Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs). To evaluate the effect of an electronic deprescribing decision support tool on ADEs after hospital discharge among older adults with polypharmacy. This was a cluster randomized clinical trial of older (≥65 years) hospitalized patients with an expected survival of more than 3 months who were admitted to 1 of 11 acute care hospitals in Canada from August 22, 2017, to January 13, 2020. At admission, participants were taking 5 or more medications per day. Data analyses were performed from January 3, 2021, to September 23, 2021. Personalized reports of deprescribing opportunities generated by MedSafer software to address usual home medications and measures of prognosis and frailty. Deprescribing reports provided to the treating team were compared with usual care (medication reconciliation). The primary outcome was a reduction of ADEs within the first 30 days postdischarge (including adverse drug withdrawal events) captured through structured telephone surveys and adjudicated blinded to intervention status. Secondary outcomes were the proportion of patients with 1 or more PIMs deprescribed at discharge and the proportion of patients with an adverse drug withdrawal event (ADWE). A total of 5698 participants (median [range] age, 78 [72-85] years; 2858 [50.2%] women; race and ethnicity data were not collected) were enrolled in 3 clusters and were adjudicated for the primary outcome (control, 3204; intervention, 2494). Despite cluster randomization, there were group imbalances, eg, the participants in the intervention arm were older and had more PIMS prescribed at baseline. After hospital discharge, 4989 (87.6%) participants completed an ADE interview. There was no significant difference in ADEs within 30 days of discharge (138 [5.0%] of 2742 control vs 111 [4.9%] of 2247 intervention participants; adjusted risk difference [aRD] -0.8%; 95% CI, -2.9% to 1.3%). Deprescribing increased from 795 (29.8%) of 2667 control to 1249 (55.4%) of 2256 intervention participants [aRD, 22.2%; 95% CI, 16.9% to 27.4%]. There was no difference in ADWEs between groups. Several post hoc sensitivity analyses, including the use of a nonparametric test to address the low cluster number, group imbalances, and potential biases, did not alter study conclusions. This cluster randomized clinical trial showed that providing deprescribing clinical decision support during acute hospitalization had no demonstrable impact on ADEs, although the intervention was safe and led to improvements in deprescribing. ClinicalTrials.gov Identifier: NCT03272607.

Deprescribing Opportunities for Hospitalized Patients With End-Stage Kidney Disease on Hemodialysis: A Secondary Analysis of the MedSafer Cluster Randomized Controlled Trial

Background:End-stage kidney disease patients on dialysis have a substantial risk of polypharmacy due their propensity for comorbidity and contact with the health care system. MedSafer is an electronic decision support tool that integrates patient comorbidity and medication lists to generate personalized deprescribing reports focused on identifying potentially inappropriate medications (PIMs).Objective:To conduct a secondary analysis of patients on regular hemodialysis included in the MedSafer randomized controlled trial to investigate the patterns of polypharmacy and evaluate the efficacy of the MedSafer deprescribing algorithms.Design:Secondary analysis of a cluster randomized clinical trial.Setting:Medical units in 11 acute care hospitals in Canada.Patients:The MedSafer trial enrolled 5698 participants with an expected prognosis of >3 months, age 65 years and older, and on 5 or more daily home medications; 140 participants were receiving chronic hemodialysis.Measurements:The primary outcome of the trial was 30-day adverse drug events (ADEs) post-hospital discharge, and a key secondary outcome was deprescribing.Methods:Control patients received usual care (medication reconciliation), whereas clinicians caring for intervention patients received a MedSafer report that highlighted individualized opportunities for deprescribing.Results:There were 70 patients in each of the control and intervention arms. The median number of home medications was 14 (compared with a median of 10 medications in the general trial population). The most frequent medications observed that were potentially inappropriate were proton pump inhibitors (potentially inappropriate in 55/76 users; 72.4%), diabetes medications in patients with a HBA1C <7.5% (36/65 users; 55.4%), docusate (27/27 users; 100%), gabapentinoids (27/36 users; 75%), and combination antiplatelet/anticoagulants (22/97 users; 22.7%). The proportion of PIMs deprescribed was higher during the intervention phase (28.8% vs 19.3%; absolute increase 9.4% [95% confidence interval 1.3%-17.6%]) compared with the control phase. There was no observed difference in ADEs at 30-day post-discharge between the control and the intervention groups. The most common ADE (n = 3) was gastrointestinal bleeding attributed to antiplatelet agents.Limitations:This was a post hoc exploratory analysis, the original trial did not stratify by hemodialysis status, and the small sample size precludes drawing any definitive conclusions.Conclusion:MedSafer facilitates deprescribing in hospitalized patients on hemodialysis. Larger-scale implementation of decision support software for deprescribing in dialysis and long-term follow-up are likely required to demonstrate an impact on ADEs.

Factors contributing to a coronavirus disease 2019 (COVID-19) outbreak on a mixed medical-surgical unit in a Canadian acute-care hospital.

To identify preventable factors that contribute to the cross transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to patients in healthcare facilities. A case-control study was conducted among inpatients on a coronavirus disease 2019 (COVID-19) outbreak unit. This study was conducted in a medical-surgical unit of a tertiary-care hospital in Nova Scotia in May 2021. Patients hospitalized on the unit for at least 12 hours and healthcare workers (HCW) working on the unit within 2 weeks of outbreak declaration were included. Risk factors for SARS-CoV-2 infection were analyzed using simple and multiple logistic regression. Whole-genome sequencing (WGS) was performed to identify SARS-CoV-2 strain relatedness. Network analysis was used to describe patient accommodation. SARS-CoV-2 infections were identified in 21 patients (29.6%) and 11 HCWs (6.6%). WGS data revealed 4 distinct clades of related sequences. Several factors likely contributed to the outbreak, including failure to identify SARS-CoV-2, a largely incomplete or unvaccinated population, and patient wandering behaviors. The most significant risk factor for SARS-CoV-2 infection was room sharing with an infectious patient, which was the only factor that remained statistically significant following multivariate analysis (odds ratio [OR], 9.2l; 95% confidence interval [CI], 2.04-41.67; P = .004). This outbreak likely resulted from admission of 2 patients with COVID-19, with subsequent transmissions to 17 patients and 11 staff. WGS and bioinformatics analyses were critical to identifying previously unrecognized nosocomial transmissions of SARS-CoV-2. This study supports strategies to reduce nosocomial transmissions of SARS-CoV-2, such as single-patient rooms, promotion of COVID-19 vaccination, and infection prevention and control measures including management of wandering behaviors.

Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home.

The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization. In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization. For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11-14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82-2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission. Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability. An early assessment of walking function within days of stroke admission can help to streamline discharge planning. Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.

Predicting Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infection Incidence Rates using Canadian Nosocomial Infection Surveillance Program (CNISP)

Methicillin-Resistant Staphylococcus aureus (MRSA) is among the most prevalent nosocomial pathogens globally, causing significant morbidity, mortality, and healthcare costs. MRSA bloodstream infection (BSI) incidence rates in Canadian hospitals have significantly risen by almost 60% and have a mortality of over 20% upon Intensive Care Unit admission. MRSA is believed to be spread through healthcare workers; thus, high hand hygiene compliancy in addition to environmental cleaning are the cornerstone countermeasures to disrupting its transmission. The Public Health Agency of Canada (PHAC), in collaboration with the Canadian Nosocomial Infection Surveillance Program (CNISP), conducts national, sentinel surveillance on healthcare-associated infections like MRSA. As a Student Epidemiologist, I developed a research proposal detailing two study objectives: 1) develop a regression model to predict all incident MRSA BSI rates among acute-care hospitals in Canada using CNISP MRSA BSI incident cases from 2000 to 2019, and 2) create a compartmental (Susceptible-Infected-Recovered-Deceased) model to determine the impact of various Infection Prevention and Control (IPC) measures on the risk of healthcare-associated MRSA BSI transmission specifically. This study hopes to demonstrate that proper IPC compliance is associated with lower incident MRSA BSI rates with the goal being to produce a manuscript draft by 2021. MRSA poses a serious threat to patient safety globally and is becoming a growing national public health concern in Canada; determining which IPC strategy is most effective at disrupting MRSA transmission is essential to reducing incidence and mortality rates.