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Background: Health care-associated infections are a common cause of patient morbidity and mortality. We sought to describe the trends in these infections in acute care hospitals, using data from 3 national point-prevalence surveys.Methods: The Canadian Nosocomial Infection Surveillance Program (CNISP) conducted descriptive point-prevalence surveys to assess the burden of health care-associated infections on a single day in February of 2002, 2009 and 2017. Surveyed infections included urinary tract infection, pneumonia, Clostridioides difficile infection, infection at surgical sites and bloodstream infections. We compared the prevalence of infection across the survey years and considered the contribution of antimicrobial-resistant organisms as a cause of these infections.Results: We surveyed 28 of 33 (response rate 84.8%) CNISP hospitals (6747 patients) in 2002, 39 of 55 (response rate 71.0%) hospitals (8902 patients) in 2009 and 47 of 66 (response rate 71.2%) hospitals (9929 patients) in 2017. The prevalence of patients with at least 1 health care-associated infection increased from 9.9% in 2002 (95% confidence interval [CI] 8.4%-11.5%) to 11.3% in 2009 (95% CI 9.4%-13.5%), and then declined to 7.9% in 2017 (95% CI 6.8%-9.0%). In 2017, device-associated infections accounted for 35.6% of all health care-associated infections. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 3.9% of all organisms identified from 2002 to 2017; other antibiotic-resistant organisms were uncommon causes of infection for all survey years.Interpretation: In CNISP hospitals, there was a decline in the prevalence of health care-associated infection in 2017 compared with previous surveys. However, strategies to prevent infections associated with medical devices should be developed. Apart from MRSA, few infections were caused by antibiotic-resistant organisms. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of a symptomatic urinary tract infection (UTI) can be challenging among elderly patients, resulting in an increased risk for specimen collection and treatment of asymptomatic patients. The Vancouver Coastal Health Authority's Antimicrobial Stewardship Guidelines provide a systematic approach to support clinicians in the assessment and treatment of UTIs. The purpose of this quality review was to evaluate if urine collection practices were in alignment with the guidelines. Methods: The review involved a retrospective examination of all urine specimens collected from medical and surgical patients of a small rural hospital from September 1, 2015 to August 31, 2016. A survey of staff was also conducted to evaluate the interdisciplinary team's knowledge of urine collection and interpretation and to assess concordance with the guidelines. Results: 318 urine cultures were reviewed, of which only 78 (24.5%) met microbiologic criteria and were considered to be positive cultures. A large proportion of samples resulted in mixed organisms. There was a highly statistically significant relationship between urinalysis and a positive culture (Fisher's exact test p < 0.0001). A positive urine culture (> 100 million CFU/L) was statistically significantly more likely to be observed when there was a positive urinalysis. Conclusions: Older adults represent a large and growing population of hospitalized patients. Diagnosis of a symptomatic UTI in the elderly can pose challenges. Urine cultures are frequently obtained and a high proportion sent for culturing with missing or negative urinalysis. Urinalysis results are pertinent in the diagnosis of a UTI as there is correlation between a positive urinalysis and a positive urine culture. Adoption of a systematic approach in the management of UTIs would result in consistent and appropriate assessment and treatment of UTIs for elderly patients. [ABSTRACT FROM AUTHOR]