Description:
<jats:sec id="S0899823X17000812_abs1" sec-type="general"><jats:title>OBJECTIVE</jats:title><jats:p>We examined the impact of methicillin-resistant <jats:italic>Staphylococcus aureus</jats:italic> (MRSA) guidelines in Québec adult hospitals from January 1, 2006, to March 31, 2015, by examining the incidence rate reduction (IRR) in healthcare-associated MRSA bloodstream infections (HA-MRSA), using central-line associated bloodstream infections (CLABSIs) as a comparator.</jats:p></jats:sec><jats:sec id="S0899823X17000812_abs2" sec-type="methods"><jats:title>METHODS</jats:title><jats:p>In this study, we utilized a quasi-experimental design with Poisson segmented regression to model HA-MRSA and CLABSI incidence for successive 4-week surveillance segments, stratified by teaching status. We used 3 distinct periods with 2 break points (April 1, 2007, and January 3, 2010) corresponding to major MRSA guideline publications and updates.</jats:p></jats:sec><jats:sec id="S0899823X17000812_abs3" sec-type="results"><jats:title>RESULTS</jats:title><jats:p>Over the study period, HA-MRSA incidence decreased significantly in adult teaching facilities but not in nonteaching facilities. Prior to MRSA guideline publication (2006–2007), HA-MRSA incidence decrease was not significant (<jats:italic>P</jats:italic>=.89), while CLABSI incidence decreased by 4% per 4-week period (<jats:italic>P</jats:italic>=.05). After the publication of guidelines (2007–2009), HA-MRSA incidence decreased significantly by 1% (<jats:italic>P</jats:italic>=.04), while no significant decrease in CLABSI incidence was observed (<jats:italic>P</jats:italic>=.75). HA-MRSA and CLABSI decreases were both significant at 1% for 2010–2015 (<jats:italic>P</jats:italic><.001 and <jats:italic>P</jats:italic>=.01, respectively). These decreases were gradual rather than sudden; break points were not significant. Teaching facilities drove these decreases.</jats:p></jats:sec><jats:sec id="S0899823X17000812_abs4" sec-type="conclusion"><jats:title>CONCLUSION</jats:title><jats:p>During the study period, HA-MRSA and CLABSI rates decreased significantly. In 2007–2009, the significant decrease in HA-MRSA rates with stable CLABSI rates suggests an impact from MRSA-specific guidelines. In 2010–2015, significant and equal IRRs for HA-MRSA and CLABSI may be due to the continuing impact of MRSA guidelines, to the impact of new interventions targeting device-associated infections in general by the 2010–2015 Action Plan, or to a combination of factors.</jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol</jats:italic> 2017;38:840–847</jats:p></jats:sec>