Main Menu Browse by Day or Program Author Keywords

616 Blood Stream Infections Related to Hemodialysis Venous Access (BSI-HD) in the Province of Qu�bec (2007-2010)

Sunday, April 3, 2011: 2:15 PM
Cortez Ballroom (Hilton Anatole)
Elise Fortin, MSc , Institut National de Sante Publique du Quebec, Montreal, QC, Canada
Claude Tremblay, MD , CHUQ Hotel Dieu, Quebec, QC, Canada
Isabelle Rocher, BScN, MSc , Institut National de Sante Publique du Quebec, Montreal, QC, Canada
Caroline Quach, MD , Montreal Children's Hospital, Montreal, QC, Canada
Charles Frenette, MD , McGill University Health Centre, Montreal, QC, Canada
Background: Since 1998, a voluntary surveillance program of healthcare associated bloodstream infections (HA-BSI) is offered to all acute-care hospitals of the province of Qu�bec.  Since 16% of HA-BSI are acquired trough ambulatory care, and almost half of these are related to hemodialysis (HD), a specific BSI-HD surveillance was instituted in 2007.

 Objective: Document the  incidence, epidemiology and microbiology of BSI-HD in Qu�bec, to allow for provincial benchmarking.

Methods: The 39 HD units in Qu�bec were invited to participate (all hospital-based). Definitions of BSI-HD are those of NNIS/NHSN prior to the recent changes. The denominators are per 100 month-patients(mp).Numerators and denominators were stratified according to venous access types : temporary catheter (TC), permanent catheter (PT), synthetic fistula (SF) or native fistula (NF). Pooled mean rates were obtained with 95% CI and compared using square root transformation test. Proportion comparisons were done with chi-square test..

 Results: 26 units (66%) are now participating in the surveillance program  (up to 89% of total dialysis patients). The global rates were respectively 0.49, 0.50 and 0.56 BSI-HD per 100 mp in 2007-08, 2008-09 and 2009-10. In 2009-10, stratified rates were NF =0.17, SF= 0.50, PC= 0.73 and TC=7.64 BSI-HD per 100 mp.  BSI rate was 4 times higher with catheters (TC and PC) than fistulas (NF and SF) (p<0,0001). Proportion of venous access types varied: NF =40.6%, SF=5.8%, PC=52.8%  and TC=0.8%. The most frequent microorganisms were S. aureus (48%) and coagulase-negative Staphylococcus (24%). 18% of S.aureus were MRSA.

For the 20 units that participated since 2007, there was a significant BSI-HD increase between 2007-08 (0.48 / 100 mp) and 2009-10 (0.61 /100 mp) attributable to a significant increase in NF related BSI-HD going from 0.06 /100 mp to 0.20 /100 mp respectively. In 2009-10, 21 of 26 BSI-HD episodes related to NF, were associated with the newly applied « button hole » technique.

  Conclusions: This BSI-HD surveillance is useful for benchmarking and will provide hints to decrease the incidence of BSI-HD in the province of Qu�bec. NF remains the best choice for hemodialysis venous access. The proportion of NF should be increased and reasons for its lesser use in Qu�bec should be explored. Caution is advised with the « button  hole» technique.