The Relationship between Hospital Infection Surveillance and Control Activities and Antibiotic Resistant Pathogen Rates

Objective: The purpose of the study was to examine the relationship of surveillance and control activities in Canadian hospitals with rates of nosocomial methicillin-resistant S. aureus (MRSA), C. difficile associated diarrhea (CDAD), and vancomycin-resistant Enterococcus (VRE). Methods: Surveys were sent to Infection Control programs in hospitals that participated in an earlier survey of infection control practices in Canadian acute care hospitals. Results: One hundred and twenty of 145 (82.8%) hospitals responded to the survey. The mean MRSA rate was 2.0 (SD 2.9) per 1,000 admissions, the mean CDAD rate was 3.8 (SD 4.3), and the mean VRE rate was 0.4 (SD 1.5). Multiple stepwise regression analysis found hospitals that reported infection rates by specific risk groups (r = - 0.27, p < 0.01) and that kept attendance records of infection control teaching activities (r = - 0.23, p < 0.01) were associated with lower MRSA rates. Multiple stepwise regression analysis found larger hospitals (r = 0.25, p < 0.01) and hospitals where infection control committees or staff had the direct authority to close a ward or unit to further admissions due to outbreaks (r = 0.22, p < 0.05) were associated with higher CDAD rates. Multiple logistic regression analysis found larger hospitals (OR = 1.6, CI 1.2 - 2.0, p = 0.003) and teaching hospitals (OR = 3.7, CI 1.2 - 11.8, p = 0.02) were associated with the presence of VRE. Hospitals were less likely to have VRE when infection control staff frequently contacted physicians and nurses for reports of new infections (OR = 0.5, CI 0.3 - 0.7, p = 0.02) and there were in-service programs for updating nursing and ancillary staff on current infection control practices (OR = 0.2, CI 0.1 - 0.7, p = 0.01). Conclusions: Surveillance and control activities were associated with MRSA and CDAD rates and the presence of VRE. Surveillance and control activities might be especially beneficial in large and teaching hospitals.

Gross and net nitrogen transformation rates and availability in late summer in tall shrub and birch hummock ecosystems of the Canadian low Arctic

Climate change is occurring most rapidly in the Arctic where warming has been twice as fast as the rest of the globe over the last few decades. Arctic soils contain a vast store of carbon and warmer arctic soils may mediate current atmospheric CO2 concentrations and global warming trends. Warmer soils could increase nutrient availability to plants, leading to increased primary production and sequestration of CO2. Presumably because of these effects of warming on shrub ecosystems, shrubs have been expanding across the arctic over the last 50 years, Arctic shrub expansion may track or cause changes in nutrient cycling and availability that favour growth of larger, denser shrubs. This study aimed at measuring gross and net nitrogen cycling rates, major soil nitrogen and carbon pool sizes, and elucidating controls on nutrient cycling and availability between a mesic birch (Betula nana) hummock tundra ecosystem and an ecosystem of dense, tall, birch (B. nana) shrubs. Nitrogen cycling and availability was enhanced at the tall shrub ecosystem compared to the birch hummock ecosystem. Net nitrogen immobilization by microbes was approximately threefold greater at the tall shrub ecosystem. This was in part because of larger microbial biomass nitrogen and carbon (interpreted as a larger microbial community) at the tall shrub ecosystem. Nitrogen inputs via litter were significantly larger at the tall shrub ecosystem and were hypothesized to be the major contributor to the higher dissolved organic and inorganic nitrogen pools in the soil at the tall shrub ecosystem. The results from this study suggest a positive feedback mechanism between litter nitrogen inputs and the enhancement of nitrogen cycling and availability as a driver of shrub expansion across the Arctic.