This report by the California Department of Public Health (CDPH) on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) Bloodstream Infections (BSIs) is the fifth by the California Department of Public Health (CDPH) and the fourth using information submitted by California hospitals to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). The data were reported from January 1, 2013 through December 31, 2013, through NHSN laboratory-based identification of cases. The data presented in this report are based on laboratory identification of hospital-onset (HO) BSI cases. Hospital-onset (HO) cases are those for which the positive blood sample for MRSA or VRE was obtained on day four or later during the hospital stay.
In this report, we present hospital-specific HO MRSA BSI standardized infection ratios (SIRs) for general acute care hospitals, other than long-term and rehabilitation acute care hospitals. The MRSA BSI SIR adjusts for significant risk factors, including hospital bed size, affiliation with a medical school, and the community burden of MRSA BSI as observed in patients admitted to the hospital. Adjusting for these factors provides for a more accurate comparison of hospitals’ infections. We labeled each SIR as indicating either: N (no difference in number of observed and predicted infections), high (H, more infections than predicted), or low (L, fewer infections than predicted). As in prior reports, for long term acute care (LTAC) and rehabilitation acute care hospitals, we present MRSA BSI rates, because LTAC and rehabilitation hospitals are currently excluded from NHSN SIR analyses.
As in prior reports we present hospital specific HO VRE BSI incidence rates, and sort hospitals into categories that reflect their patients’ severity of illness and other factors that can affect their risk of infection such as age and length of hospitalization, and the type of care that they receive. These categories are: community, major teaching (excluding pediatric), LTAC, pediatric, critical access, rehabilitation, and prison hospitals. Separation of hospitals into such categories allows comparisons according to type of hospital and, with caution, between hospitals within these categories. There are no other reports of VRE BSI incidence rates from NHSN data for comparison with this report, so it is not possible to compare these rates from California hospitals with national or other state data. Hospitals are compared within each category to the average rate for all hospitals in that category. Hospitals with significantly higher or lower rates or those not different than the average for that category are indicated with an H, L, or N. Hospitals could have higher or lower rates of BSIs for a number of reasons, including differences in the severity of illness in their patient populations or in their infection prevention efforts. These data serve as a basis to evaluate BSI rates in California hospitals over time.
What is in key findings? This document summarizes the key findings including important results, key public health actions and messages for the prevention of MRSA and VRE BSI.
To view the tables for the MRSA BSI SIRs, MRSA BSI and VRE BSI incidence rates, and cases of MRSA and VRE BSIs reported by hospitals reporting twelve months of data see Tables 1-12, and less than twelve months of data see Table 13
What is in the technical notes? The Technical Notes contain information on the data sources, definitions, quality assurance and control, data presentation and statistical analyses associated with this report.
For more information on MRSA BSI and VRE BSI prevention, see MRSA BSI or VRE BSI Information