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MRSA Surveillance: to report or not to report

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Presentation on theme: "MRSA Surveillance: to report or not to report"— Presentation transcript:

1 MRSA Surveillance: to report or not to report
Dr Bonnie Henry BC Centre for Disease Control

2 Surveillance Definition
Surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know. The final link in the surveillance chain is the application of these data to prevention and control.

3 Elements of a Surveillance System
Data collection: pertinent, regular, frequent, timely - i.e. ongoing and systematic Consolidation and interpretation: orderly, descriptive, evaluative, timely Dissemination: prompt, to all who need to know (data providers and action takers) Action to control and prevent WHO, 2000

4 Surveillance: A Classical Model
Health Care System Public Health Authority Reporting Event Data Analysis & Interpretation Decision Intervention Information (Feedback)

5 Surveillance is NOT the same as:
Disease reporting - reporting provides a foundation for surveillance Monitoring or Screening - monitoring and screening do not involve planning, implementation and evaluation

6 Objectives of Surveillance Systems:
Monitor trends Understanding of diseases and their determinants Identify and predict clusters, outbreaks, threats to health and emerging issues Detect changes in health practices 1. Monitor trends systematically in health, disease, DOH, and health practices 2. Improve understanding of diseases and their determinants · describe disease natural history · estimate prevalence and burden of illness · provide details re patterns of occurrence and diseases and their determinants · detect rare, but significant causes of disease 3. Identify and predict clusters, outbreaks, threats to health and emerging issues - Operational purposes 4. Detect changes in health practices

7 Objectives of Surveillance Systems cont.:
Facilitate epidemiological research To assist with planning and policy Empower individuals, health providers, governments and communities with the information necessary for them to take action to protect and improve health 5. Facilitate epidemiological research To assist with: Evidence-based policy, planning and evaluation Planning health services Setting priorities and developing policies and programs to manage health risks Deciding upon resource allocation Enabling the evaluation of health policies, programs and services, including control and prevention measures 7. Empower individuals, health providers, governments and communities with the information necessary for them to take action to protect and improve health i.e. providing the information needed for people to increase control over, and improve their health

8 Types of Surveillance Active Passive Enhanced Sentinel
Passive surveillance Active surveillance Sentinel surveillance Laboratory-based surveillance Notifiable disease reporting Registries Surveys Record linkages Special (intense)

9 Rationale for Surveillance System Development
 Disease Importance Impact – burden of disease, PAR of risk factor, severity, societal impact Communicability – for infectious diseases  Intervention Prevention / Control - ability to intervene effectively Immediacy of response – needed to control spread or severity  System Requirement for reporting – legislated or international interest Public perception – concern about risk

10 Why conduct healthcare surveillance?
Determine baseline rates of HAIs Detect time/space clustering (ie, outbreaks) Detect changes in rates and/or their distribution Identify areas for targeted investigation and/or research Determine the effectiveness of IC measures Monitor compliance with established hospital policies and practices In the era of patient safety, healthcare associated infections are in the public and legislative spotlight. That said, healthcare associated infection surveillance has become increasingly important. Conducting or establishing surveillance allows an infection control program to do the following: Determine baseline rates of adverse events including healthcare associated infections (both contagious as well as noninfectious complications of healthcare) Detect outbreaks Identify areas for targeted intervention and research Evaluate the effectiveness of infection prevention and control measures Monitor compliance with hospital guidelines and protocols

11 Why conduct healthcare surveillance cont’d?
Evaluate changes in practice Meet regulatory and other reporting requirements Generate hypotheses concerning risk factors Guide treatment and/or prevention strategies Reduce healthcare associated infections Support evidence-based resource allocation Evaluate changes in practice Address regulatory and other reporting requirements (accrediting agencies, hospital administrators, etc) Generate hypotheses concerning risk factors for infection Guide treatment and prevention strategies (eg, antibiotic utilization) Reduce healthcare associated infections Support evidence-based resource allocation

12 Targeting your surveillance
Focus on: Preventable infections Frequently occurring infections or events Infections that cause significant morbidity or mortality Infections that are costly to treat Infections caused by organisms resistant to multiple antimicrobial agents Lautenbach E & Woeltje K. eds. Practical Handbook for Healthcare Epidemiologists. Thorofare, NJ: SLACK Incorporated; 2004.

13 History of Reporting Nationally Notifiable Diseases have been reviewed in 1988, and in 2006 Framework and criteria developed for the 1997 process Provincial review in some provinces Number of diseases added to or removed from BC list over time including MRSA Historically there has been no formal framework or process for adding or removing from list in BC

14 Criteria for Reportability
Diseases of Interest to Organizations to Inform Prevention and Regulatory Programs 5-Year Average Incidence Severity Communicability/Potential Spread to the General Population Potential for Outbreaks Socioeconomic Burden Preventability Risk Perception Necessity of Public Health Response Increasing or Changing Patterns


16 MRSA in the USA Approximately 32% (89.4 million persons) and 0.8% (2.3 millions persons) of the U.S. population is colonized with S. aureus and MRSA respectively. (Kuehnert MJ et al. Journal of Infectious Diseases. 2006;193:172-9.) The proportion of healthcare-associated staphylococcal infections that are due to MRSA has been increasing: 2% of S. aureus infections in U.S. intensive-care units were MRSA in 1974, 22% in 1995, and 64% in (Klevens RM et al. Clinical Infectious Diseases 2006;42:389-91) There are an estimated 292,000 hospitalizations with a diagnosis of S. aureus infection annually in U.S. hospitals. Of these approximately 126,000 hospitalizations are related to MRSA. (Kuehnert MJ et al. Emerging Infectious Diseases. 2005;11: )

17 MRSA in Canada 1981: MRSA first reported in Canada
Subsequently MRSA identified in many Canadian health care facilities : CA-MRSA described in Aboriginal communities 1995: Nationwide data available in Canada National MRSA surveillance started in sentinel hospitals 2001: Canadian Nosocomial Infection Surveillance Program (CNISP) summary of first five years of surveillance

The objectives of this surveillance project are as follows: 1. To determine the incidence and burden of illness associated with MRSA in CNISP hospitals. 2. To describe the epidemiology of MRSA in Canada. 3. To characterize the molecular strains of MRSA in Canada.

19 CNISP MRSA Surveillance
Between 1995 and 2003, MRSA rates increased in CNISP hospitals from 0.46 cases per 1,000 admissions to 5.10 per 1,000 admissions (p = 0.002) Most of the increase in MRSA cases occurred in central Canada (Ontario and Quebec), although there were also increases elsewhere in the country

20 Ref: Simor, 2001: CMAJ

21 Regional MRSA rates in Canadian hospitals, 1995-2003

22 Cost of MRSA Direct health care cost attributable to MRSA in Canada, including cost for management of MRSA-infected and -colonized patients and MRSA infrastructure, averaged $82 million in 2004 and could reach $129 million in 2010. MRSA is a costly public health issue that needs to be tackled if the growing burden of this disease in Canadian hospitals and in the community is to be limited. Source: Canadian Journal of Infectious Diseases and Medical Microbiology, Volume 18, No. 1, January/February 2007

23 MRSA in BC (Hospital Separation data)

24 MRSA – As a Proportion of S. aureus Isolates (BC – AMM)

25 MRSA: Community vs Hospital

26 Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA)
Reports began in 1980s of MRSA occurring in the community in patients without established risk factors Younger patients Indigenous peoples and racial minorities Skin infections common Outbreaks: Injection drug users Players of close-contact sports Prison/jail inmates Group Homes (developmentally disabled) Men who have sex with men

27 CA-MRSA vs HA-MRSA isolates
Antimicrobial resistance Few Agents Multiple Agents SCCmec* Type IV Type II PGFE Types USA 300, 400 (CMRSA 10) USA 100, 200 PVL Toxin Common Rare *genetic element carrying mecA resistance gene Ref: CDC

28 Reasons to Report A growing community-based problem caused by a communicable disease with some family based clustering No other good mechanism to track the problem What is its magnitude? Distribution? Is it changing for the better or worse? Advice for patients, contacts, household members may benefit from systematic delivery

29 If yes, what case definition?
Epidemiological Definition? Phenotypic Definition (R Profile)? Genetic Definition?

30 What are We Actually Doing?
Surveillance - reportable in some provinces Laboratory Reference Work - many provinces Guidelines (national and local) Prevention - e.g. Do Bugs Need Drugs Studies at various sites CCHSA requirements

31 Issues Need to establish surveillance for HAIs BUT
Will making it reportable help? What about public reporting of rates? How do we distinguish CA and HA-MRSA? What about reporting of invasive disease only or reporting of aggregate rates?

32 Conclusions Development of surveillance systems for HAI a priority in BC Need to have connections with Public Health to address the spectrum of illness (we are all in this together!) Work together to address both needs and to protect patients, HCWs and our community.

33 Thank you!
Discussion! Thank you!

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