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Indicator Metadata

NameIn-Hospital Infections Due to Methicillin-Resistant Staphylococcus aureus (MRSA)
Short/Other Names

In-Hospital MRSA Infections

DescriptionRisk-adjusted rate of methicillin-resistant Staphylococcus aureus (MRSA) infections identified during a hospital stay
InterpretationA lower rate for this indicator is desirable. However, higher rates should be interpreted with caution, as they may indicate better surveillance.
HSP Framework Dimension

Health System Outputs: Safe

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameIn-Hospital Infections Due to Methicillin-Resistant Staphylococcus aureus (MRSA)
Short/Other Names

In-Hospital MRSA Infections

Indicator Description and Calculation
DescriptionRisk-adjusted rate of methicillin-resistant Staphylococcus aureus (MRSA) infections identified during a hospital stay
Calculation: Description

The risk-adjusted in-hospital MRSA infection rate is calculated by dividing the observed number of discharges with in-hospital MRSA infections in each hospital by the expected number of discharges with in-hospital MRSA infections in the hospital and multiplying by the Canadian average in-hospital MRSA infection rate.

The indicator is expressed as the number of hospital discharges with a post-admission diagnosis of MRSA infection per 10,000 patient days.

The unit of analysis is a hospital discharge.

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Rate - Rate — per 10,000 patient days

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
Age, sex, immunocompromised states, comorbidity score, transfer from acute care hospitals

For detailed descriptions of the above covariates and the risk-adjustment method, please refer to the In-Hospital Infections Appendices.

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Number of patient days in an acute care institution within a fiscal year
Inclusions:
1. Admission to an acute care institution (Facility Type Code = 1)
2. Sex recorded as male or female
3. Length of stay of 2 days and longer
Exclusions:
1. Abstracts with an invalid age
2. Abstracts with invalid admission or discharge dates
3. Abstracts with admission category of stillbirths and cadaveric donors (Admission Category Code = R or S)
4. Abstracts with selected mental health diagnoses (i.e., most responsible diagnosis ICD-10-CA code of F10–F99)

Numerator

Description:
Discharges with an MRSA infection identified during a hospital stay
Inclusions:
Non-Quebec abstracts

1. Staphylococcus aureus as the cause of diseases (ICD-10-CA: B95.6) as type (3) and resistance to methicillin (ICD-10-CA: U82.1) as type (1) or (2) and an infection code (see In-Hospital Infections Appendices) as type (2) in the same cluster

OR

2. Staphylococcal infections (ICD-10-CA: A49.0, J15.2, G00.3, L00, M00.0–) as type (2) and resistance to methicillin (ICD-10-CA: U82.1) as type (1) or (2) in the same cluster

OR

3. Sepsis due to Staphylococcus aureus (ICD-10-CA: A41.0) as type (2) and resistance to methicillin (ICD-10-CA: U82.1) as type (1) or (2) in the same cluster

OR

4. Sepsis due to Staphylococcus aureus (ICD-10-CA: A41.0) as type (3) and infection following a procedure (ICD-10-CA: T80.2, T81.4, T82.6, T82.7–, T83.5, T83.6, T84.5–, T84.6–, T84.7, T85.7 or T88.0) as type (2) and complications of medical or surgical care (ICD-10-CA: Y60–Y84) and resistance to methicillin (ICD-10-CA: U82.1) as type (1) or (2) in the same cluster

OR

5. Sepsis due to Staphylococcus aureus (ICD-10-CA: A41.0) as type (3) and

a. Abortive outcome complicated by infection (ICD-10-CA: O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3, O08.0–) as type (2) and resistance to methicillin (ICD-10-CA: U82.1) as type (1) or (2) in the same cluster

OR

b. Other obstetric infections (ICD-10-CA: O98.502, O98.802) as type (M), (1), ( 2), (W), (X), (Y) and resistance to methicillin (ICD-10-CA: U82.1) as type (1) or (2) in the same cluster

Quebec abstracts

1. Staphylococcus aureus as the cause of diseases (ICD-10-CA: B95.6) as type (3) or (C) and resistance to methicillin (ICD-10-CA: U82.1) as type (1), (2) or (C) and an infection code (see In-Hospital Infections Appendices) as type (2) on the same abstract

OR

2. Staphylococcal infections (ICD-10-CA: A49.0, J15.2, G00.3, L00, M00.0–) as type (2) and resistance to methicillin (ICD-10-CA: U82.1) as type (1) or (2) on the same abstract

OR

3. Sepsis due to Staphylococcus aureus (ICD-10-CA: A41.0) as type (2) and resistance to methicillin (ICD-10-CA: U82.1) as type (1), (2) or (C) on the same abstract

OR

4. Sepsis due to Staphylococcus aureus (ICD-10-CA: A41.0) as type (3) and infection following a procedure (ICD-10-CA: T80.2, T81.4, T82.6, T82.7–, T83.5, T83.6, T84.5–, T84.6–, T84.7, T85.7 or T88.0) as type (2) and complications of medical or surgical care (ICD-10-CA: Y60–Y84) and resistance to methicillin (ICD-10-CA: U82.1) as type (1), (2) or (C) on the same abstract

OR

5. Sepsis due to Staphylococcus aureus (ICD-10-CA: A41.0) as type (3) and

a. Abortive outcome complicated by infection (ICD-10-CA: O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3, O08.0–) as type (2) and resistance to methicillin (ICD-10-CA: U82.1) as type (1), (2) or (C) in the same abstract

OR

b. Other obstetric infections (ICD-10-CA: O98.502, O98.802) as type (M), (1), (2), (W), (X), (Y), (C) and resistance to methicillin (ICD-10-CA: U82.1) as type (1), (2) or (C) in the same abstract

Background, Interpretation and Benchmarks
Rationale

In recent years, there have been increasing rates of resistance to commonly used antimicrobials within the hospital setting, leading to longer patient lengths of stay, higher mortality rates and increasing health care costs. MRSA microorganisms pose a great challenge to patient care in acute care hospitals.

This indicator measures the risk-adjusted rate of infections due to MRSA identified during a hospital stay in all acute care hospitals across Canada. CIHI engaged with clinical expert advisors across the country to develop definitions and risk-adjustment methodologies that will ensure comparability of the indicator results across acute care facilities.

The Canadian Nosocomial Infection Surveillance Program (CNISP) network provides crude rates and trends of health care–associated infections from 60 sentinel Canadian facilities using standardized definitions. Many jurisdictions have surveillance programs to capture MRSA infections, and some submit the data to their ministries; however, each jurisdiction has its own set of case definitions, thus hampering comparability across jurisdictions. Where possible, case definitions for CIHI’s in-hospital indicators were aligned to definitions developed and revised by the CNISP.

CIHI’s suite of in-hospital infections indicators is not a replacement for surveillance programs because of the different purposes of both data sets. Rather, these indicators will complement existing surveillance programs by
–Enabling pan-Canadian reporting at the national, provincial, regional and facility levels;
–Helping facilities and jurisdictions monitor their in-hospital infections rates and allowing them to compare against the Canadian average (for jurisdictions) or against the national peer group average (for facilities);
–Enabling facilities/jurisdictions to track changes over time and measure the effectiveness of their improvement strategies to reduce in-hospital infections; and
–Enabling facilities and jurisdictions with limited capacity to monitor and report on in-hospital infections and to learn from others in a more efficient and less resource-intensive manner.

Interpretation

A lower rate for this indicator is desirable. However, higher rates should be interpreted with caution, as they may indicate better surveillance.

HSP Framework Dimension

Health System Outputs: Safe

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

Agency for Healthcare Research and Quality. Technical Specifications: Patient Safety Indicators, Appendices — Version 4.5 (PDF 5.42 MB). 2013.

Canadian Institute for Health Information. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada, Version 2015. 2015.

Canadian Institute for Health Information. Canadian Coding Standards for Version 2015 ICD-10-CA and CCI. 2015.

Conly J. Antimicrobial resistance in Canada. CMAJ. October 2002.

Drosler S. Health Care Quality Indicators Project, Patient Safety Indicators Report 2009: Annex (PDF 748.20 KB). 2009.

Mulvey MR, Simor AE. Antimicrobial resistance in hospitals: how concerned should we be? CMAJ. February 2009.

Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology. March 2011.

Ramirez Mendoza JY, Daneman N, Elias MN, Amuah JE, Bush K, Couris CM, Leeb K. A comparison of administrative data versus surveillance data for hospital-associated methicillin-resistant Staphylococcus aureus infections in Canadian hospitals. Infection Control and Hospital Epidemiology. 2017 (in press).

Availability of Data Sources and Results
Data Sources

DAD, HMDB

Available Data Years

Type of Year:
Fiscal
First Available Year:
2015
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable

Quality Statement
Caveats and Limitations

There may be inconsistencies in the data that could limit interpretation of the indicator; these inconsistencies may be the result of differences in facility MRSA testing/screening procedures and how the information is recorded on patient charts. In collaboration with clinical expert advisors and representatives from provincial surveillance programs, CIHI undertook a series of correlation studies between provincial surveillance programs and the administrative database. A good correlation was found between MRSA cases reported by the Ontario surveillance program and those identified by the administrative database. A stronger correlation was observed between MRSA cases reported by the Alberta surveillance program and in-hospital MRSA infection cases identified in the administrative database (Ramirez Mendoza et al., 2017).

This indicator does not measure the number of patients who tested positive for MRSA, but rather the infections that resulted during admission. This indicator also does not distinguish between MRSA acquired in hospital versus in the community, but rather measures the overall rate of infections due to MRSA that were recorded as a post-admit diagnosis. To limit the capture of community-acquired cases, hospital stays shorter than 2 days were not considered in the case selection. Due to lack of timing of diagnosis, it is also not possible to distinguish newly diagnosed infections from recurrent infections.

Although we acknowledge the data limitations of administrative data to report on in-hospital infections, results of this indicator can be viewed as a starting point for tracking progress on patient safety and data quality of both surveillance and administrative databases.

Trending Issues

Not applicable

Comments

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