Presentation on theme: "MRSA Surveillance: to report or not to report"— Presentation transcript:
1 MRSA Surveillance: to report or not to report Dr Bonnie HenryBC 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 systematicConsolidation and interpretation: orderly, descriptive, evaluative, timelyDissemination: prompt, to all who need to know (data providers and action takers)Action to control and preventWHO, 2000
4 Surveillance: A Classical Model Health Care SystemPublic Health AuthorityReportingEventDataAnalysis & InterpretationDecisionInterventionInformation(Feedback)
5 Surveillance is NOT the same as: Disease reporting - reporting provides a foundation for surveillanceMonitoring or Screening - monitoring and screening do not involve planning, implementation and evaluation
6 Objectives of Surveillance Systems: Monitor trendsUnderstanding of diseases and their determinantsIdentify and predict clusters, outbreaks, threats to health and emerging issuesDetect changes in health practices1. Monitor trends systematically in health, disease, DOH, and health practices2. 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 disease3. Identify and predict clusters, outbreaks, threats to health and emerging issues - Operational purposes4. Detect changes in health practices
7 Objectives of Surveillance Systems cont.: Facilitate epidemiological researchTo assist with planning and policyEmpower individuals, health providers, governments and communities with the information necessary for them to take action to protect and improve health5. Facilitate epidemiological researchTo assist with:Evidence-based policy, planning and evaluationPlanning health servicesSetting priorities and developing policies and programs to manage health risksDeciding upon resource allocationEnabling the evaluation of health policies, programs and services, including control and prevention measures7. 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 surveillanceActive surveillanceSentinel surveillanceLaboratory-based surveillanceNotifiable disease reportingRegistriesSurveysRecord linkagesSpecial (intense)
9 Rationale for Surveillance System Development Disease ImportanceImpact – burden of disease, PAR of risk factor, severity, societal impactCommunicability – for infectious diseases InterventionPrevention / Control - ability to intervene effectivelyImmediacy of response – needed to control spread or severity SystemRequirement for reporting – legislated or international interestPublic perception – concern about risk
10 Why conduct healthcare surveillance? Determine baseline rates of HAIsDetect time/space clustering (ie, outbreaks)Detect changes in rates and/or their distributionIdentify areas for targeted investigation and/or researchDetermine the effectiveness of IC measuresMonitor compliance with established hospital policies and practicesIn 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 outbreaksIdentify areas for targeted intervention and researchEvaluate the effectiveness of infection prevention and control measuresMonitor compliance with hospital guidelines and protocols
11 Why conduct healthcare surveillance cont’d? Evaluate changes in practiceMeet regulatory and other reporting requirementsGenerate hypotheses concerning risk factorsGuide treatment and/or prevention strategiesReduce healthcare associated infectionsSupport evidence-based resource allocationEvaluate changes in practiceAddress regulatory and other reporting requirements (accrediting agencies, hospital administrators, etc)Generate hypotheses concerning risk factors for infectionGuide treatment and prevention strategies (eg, antibiotic utilization)Reduce healthcare associated infectionsSupport evidence-based resource allocation
12 Targeting your surveillance Focus on:Preventable infectionsFrequently occurring infections or eventsInfections that cause significant morbidity or mortalityInfections that are costly to treatInfections caused by organisms resistant to multiple antimicrobial agentsLautenbach E & Woeltje K. eds. Practical Handbook for Healthcare Epidemiologists.Thorofare, NJ: SLACK Incorporated; 2004.
13 History of ReportingNationally Notifiable Diseases have been reviewed in 1988, and in 2006Framework and criteria developed for the 1997 processProvincial review in some provincesNumber of diseases added to or removed from BC list over time including MRSAHistorically 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 Programs5-Year Average IncidenceSeverityCommunicability/Potential Spread to the General PopulationPotential for OutbreaksSocioeconomic BurdenPreventabilityRisk PerceptionNecessity of Public Health ResponseIncreasing or Changing Patterns
16 MRSA in the USAApproximately 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 communities1995: Nationwide data available in CanadaNational MRSA surveillance started in sentinel hospitals2001: Canadian Nosocomial Infection Surveillance Program (CNISP) summary of first five years of surveillance
18 CNISP Surveillance GOALS AND OBJECTIVES 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
21 Regional MRSA rates in Canadian hospitals, 1995-2003
22 Cost of MRSADirect 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
26 Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Reports began in 1980s of MRSA occurring in the community in patients without established risk factorsYounger patientsIndigenous peoples and racial minoritiesSkin infections commonOutbreaks:Injection drug usersPlayers of close-contact sportsPrison/jail inmatesGroup Homes (developmentally disabled)Men who have sex with men
28 Reasons to ReportA growing community-based problem caused by a communicable disease with some family based clusteringNo other good mechanism to track the problemWhat 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 provincesLaboratory Reference Work - many provincesGuidelines (national and local)Prevention - e.g. Do Bugs Need DrugsStudies at various sitesCCHSA 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 ConclusionsDevelopment of surveillance systems for HAI a priority in BCNeed 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.