Quarterly Surveillance Report

Quarter four (Q4) of 2025/26 (December 05, 2025 - March 31, 2026)

CDI

Clostridioides difficile Infection (CDI) is the most common health care-associated infection. CDI typically causes diarrhea and mostly occurs during or soon after treatment with antibiotics or among people who are immunocompromised. New cases and relapses identified among inpatients in acute care facilities are under provincial surveillance.

Direct comparisons across health authorities should be avoided due to differences in testing, screening, case-finding, and application of the surveillance protocol. Methodological differences are detailed in the CDI section of the technical notes.

Provincial Highlights

• Rate of new CDI cases associated with the reporting facility in BC:
  2.7 per 10,000 inpatient days
• Provincial trend compared to the same quarter last year:
  Rates have decreased from 2.8 to 2.7 per 10,000 inpatient days
• Proportion of new CDI episodes associated with the reporting facility in BC:
  51.4%

^a For LOESS curve methodology see Technical Note 8

*Provincial Health Services Authority serves patients from
across the province and is not displayed as a geographic region on the map.

MRSA

Methicillin-Resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to many antibiotics. MRSA often lives on the skin or in the nose of healthy people without causing symptoms (colonization). It can, however, cause pneumonia, bloodstream infections, surgical site infections, and other infections associated with invasive medical procedures and devices. MRSA cases (colonization or infection) identified for the first time from inpatients in acute care facilities are under provincial surveillance.

Direct comparisons between health authorities should be avoided, as differences may reflect variation in population characteristics, hospital services, and potential differences in screening, case-finding strategies, and application of the provincial surveillance protocol. Methodological differences are detailed in the MRSA section of the technical notes.

Provincial Highlights

• Rate of new MRSA cases associated with the reporting facility in BC:
  4.4 per 10,000 inpatient days
• Provincial trend compared to the same quarter last year:
  Rates have increased from 3.5 to 4.4 per 10,000 inpatient days
• Proportion of new MRSA cases associated with the reporting facility in BC:
  52.0%

^a For LOESS curve methodology see Technical Note 8

*Provincial Health Services Authority serves patients from
across the province and is not displayed as a geographic region on the map.

CPO

Carbapenemase-Producing Organisms (CPO) are bacteria often naturally found in the gut that have become resistant to carbapenems, a class of broad spectrum antibiotics usually reserved to treat serious infections when other antibiotics have not worked. When spread from the gut to other parts of the body such as the blood, lungs, or bladder, these multi-drug-resistant bacteria can cause infections that are difficult to treat. Each carbapenemase gene newly identified from a given patient with CPO colonization or infection is considered a new case. CPO cases are reportable to public health in B.C.

Comparisons across health authorities should be avoided due to variations in applying the provincial surveillance protocol, case finding strategies, patient demographics and risk profile and services provided. Methodological differences are detailed in the CPO section of the technical notes.

Provincial Highlights

• 214 new cases identified in BC
  • Identified from 156 patients
    • 120 patients harboured 1 gene
    • 19 patients harboured 2 genes
    • 14 patients harboured 3 genes
    • 1 patients harboured 4 genes
    • 2 patients harboured 5 genes
  • 139 new cases had surveillance information
• Provincial acute care trend compared to the same quarter last year:
  Rates increased from 6.0 to 8.1 cases per 10,000 admissions
• Most identified gene:
  NDM
• Proportion of cases with prior BC health-care exposure (past 12 months):
  30.2%

^a See Technical Note 27 for why FH and VCH are the only HAs reported separately

^b For LOESS curve methodology see Technical Note 8

^a Based on cases with available surveillance information. Denominators for percentages are all cases (with available surveillance information) within that particular region.

^a Based on cases with available surveillance information. Categories represent reported risk factors, not confirmed exposures. Individuals may report more than one risk factor.

^b Surveillance information is missing for a higher proportion of cases this quarter due to delays in data submission. Reported results may change as additional information is received.

HHC

Improving hand hygiene compliance (HHC) among health care workers is key to reducing health care-associated infections. Reporting on compliance provides transparency to the public and assists health care facilities in quality improvement.

Direct comparisons across health authorities should be avoided because differences and changes in rates may reflect methodological shifts rather than true differences in performance. Methodological differences are detailed in the HHC section of the technical notes.

Provincial Highlights

• Overall HHC in BC:
  80% in acute care facilities (ACF)
  82% in long-term care facilities (LTCF)
• HHC by moments of contact in BC:
  74% before contact
  85% after contact
HHC by health care worker (HCW) group in BC:
Lowest for Physicians at 73%
Highest for Nursing staff at 81%

For confidence interval methodology see Technical Note 5.
ACF = Acute care facilities
LTCF = Long-term care facilities

For confidence interval methodology see Technical Note 5.

*Provincial Health Services Authority serves patients from
across the province and is not displayed as a geographic region on the map.

Technical Notes

General

1. The provincial surveillance program for IPC is a collaboration between PICNet and B.C. health authorities. Provincial surveillance protocols for CDI, MRSA and CPOs are available on the PICNet website: www.picnet.ca
   

2. Standard provincial surveillance protocols were developed at the beginning of each program and are typically reviewed annually to reflect advances in scientific research and surveillance practice, however there are noted variations in how case definitions and inclusion/exclusion criteria are applied by HAs and health-care facilities, which can affect the findings in this report.

3. Provincial surveillance data for CDI, MRSA and HHC are collected by health authorities, aggregated by health-care facility and quarter, and reported to PICNet. Provincial surveillance data for CPO are submitted to PICNet at the case level by health authorities or care providers in community care settings.

4. Data are presented by fiscal quarter, as defined by financial departments across health authorities. The exceptions are CDI, MRSA and HHC data from Provincial Health Services Authority, which are aggregated by calendar quarter. The time frame of each fiscal quarter varies by fiscal year. Generally, the fourth fiscal quarter (Q4) is longer than the other three quarters (Q1, Q2, and Q3).

5. Rates and 95% Confidence Interval Methodology

   • The rate of HCA CDI or MRSA was calculated using the total number of new cases of HCA CDI or MRSA associated with the reporting facility as numerators divided by the total inpatient days during the same period as denominators, then multiplying by 10,000 to calculate a rate per 10,000 inpatient days.
   • The rate of CPO was calculated using the total number of new cases of CPO identified in acute care facilities as numerators divided by the total admissions during the same period as denominators, then multiplying by 10,000 to calculate a rate per 10,000 admissions.
   • For HHC percentages in acute care facilities, the Mid-P Binomial method was used to calculate 95% confidence intervals.

6. Rates and HHC percentages calculated in this report are crude and were not adjusted for any risk factors such as patient acuity, comorbidities, or length of stay. While adjusted rates could offer a more nuanced understanding of differences over time or between regions, these adjustments are not currently feasible due to limitations in available data across health authorities. As such, direct comparison of CDI, MRSA and CPO rates, or HHC percentages, between HAs are not recommended.

7. Acute Care Facility Types

   • Tertiary/referral hospitals: Large hospitals that care for patients from across the region or even the whole province. They offer many kinds of specialized care, like major surgeries or intensive care. Patients are often sent to these hospitals from smaller ones when they need expert treatment.
   • Regional hospitals: Serve people in a specific area and have more beds than community hospitals. They offer some specialist care, including surgeries and maternity care, and often have labs and intensive care units.
   • Community hospitals: Focus on the local population and provide basic medical care. Family doctors work with hospital doctors to care for patients. These hospitals don’t usually offer highly specialized treatments.

8. LOESS Smoothing Methodology

   • The LOESS (locally estimated scatterplot smoothing) method creates a smooth trend line through the data by fitting simple curves to small groups of nearby data points. This approach is particularly useful for revealing trends in data that may not follow a straight line.
   • LOESS looks at each point (in this case, each fiscal year) and fits a simple curve - usually basic lines or gently curved lines - to the data points that are closest in time. A key parameter (the span) controls how many data points (fiscal years) are used to fit each local line. The process is repeated along the time series so that each segment reflects the local trend. When fitting the curve for a specific fiscal year, data points that are closer in time to that fiscal year are considered more relevant than those further away. We also apply robust weighting to lessen the influence of outlier fiscal years.

CDI

9. CDI episodes are classified as HCA or community-associated according to patients’ encounters with a health-care facility in the previous four weeks.

10. HCA CDI episodes among inpatients in acute care facilities (ACFs) are further classified as new cases or relapses based on the time frame of the episodes. A relapse may include recurrence of a previous CDI, re-infection with the same strain, or infection with a different strain of C. difficile that occurs between two and eight weeks after a previous HCA CDI episode.

11. CDI episodes among inpatients in acute care facilities that are classified as community-associated include both new cases and relapses.

12. Health authorities have adopted a two-step testing approach for CDI, which includes an initial screening test followed by a confirmatory test, at different times: Fraser Health began in October 2023, Interior Health in February 2022, Island Health in October 2018, Northern Health in November 2023, Providence Health Care in January 2017, Provincial Health Services Authority in December 2023, and Vancouver Coastal Health in June 2023. This two-step testing method may lead to higher reported CDI cases due to its increased sensitivity.

13. Facilities in PHSA and PHC are unable to check patient health-care history outside their health authority and thus did not collect CDI cases that were associated with another facility (new and relapse).

14. VCH, PHC and IH do not collect community associated or unknown CDI data.

15. During the study period (FY 2018/19 to FY 2024/25), four health authorities: FH, VCH, ISLH and NH provided all quarters CDI complication data to PICNet. IH began submitting these data in Q3 of 2023/24.

MRSA

16. New MRSA cases are classified as HCA or community-associated according to patients’ encounters with a health-care facility in the previous 12 months.

17. A new MRSA case is defined as a colonization or infection identified for the first time in an inpatient in an acute care facility. MRSA infections identified in inpatients with previous MRSA colonization are not included.

18. PHC does not collect MRSA cases associated with another reporting facility and community-associated cases. IH does not collect unknown subtype data while VCH neither collect unknown or community cases data.

CPO

19. CPO Case Definition and Reporting

    • CPO surveillance is gene-based. A new case is defined as the first identification of a specific carbapenemase gene in a patient.
    • Repeat detection of the same gene in the same patient is not counted as a new case, regardless of organism or specimen type.
    • Detection of a different carbapenemase gene in the same patient is counted as a separate case.
    • Reporting pathways differ based on setting:
      • Cases identified in acute care facilities are reported to PICNet by health authority IPC teams.
      • Cases identified in community settings are reported to the local Medical Health Officer as a reportable condition, with public health coordination as appropriate.

20. CPO infections and colonizations are reportable to public health in B.C. All CPO-suspect isolates are required to be sent to BC Centre for Disease Control Public Health Laboratory (PHL) for molecular testing and genotyping. CPO testing results are then obtained from the PHL’s laboratory information system.

21. A new CPO case is defined as a carbapenemase gene that was identified for the first time from a given patient in the province. Different genes identified from the same patient are considered different cases.

22. Surveillance forms are required to be completed for new CPO cases (colonizations and infections) identified in both acute and community care settings and submitted to PICNet by health authorities or health-care providers in community care settings, such as outpatient clinics, emergency departments, long-term care or assisted living facilities and community clinics. Surveillance information is not available for a minority of CPO cases due to administrative challenges.

23. Exposure information collected on CPO surveillance forms includes: travel outside Canada, health-care encounters outside Canada and within B.C., ongoing CPO transmission investigation in a patient care unit, and contact with a known CPO case or CPO in the environment in the previous twelve months. These exposures are not mutually exclusive.

24. Exposure information is reported only for the cases where surveillance information is available.

25. New CPO cases are reported based on where they were identified and reported, i.e. acute care facility in a health authority or community care setting.

26. IPC practices vary across health authorities and health-care facilities which affect identification of CPO cases. For example, FH has a robust screening program which captures patients reporting any health-care encounter outside of Canada as well as travelers returning from India, Pakistan, Bangladesh or Vietnam.

27. FH and VCH are reported separately in the trend line figure below because their case counts are high enough to produce stable rates. FH serves the largest patient population in the province and is highly diverse. In addition, FH implements broader screening practices than those required by the provincial protocol. VCH serves the second-largest patient population and is also characterized by a very diverse demographic profile.

HHC

28. HHC is audited by health authorities. The percentage compliance reports how often, during an audit, health-care workers clean their hands before and after contact with a patient or the patient environment (e.g. changing bed linen, touching a bed rail or clearing a bedside table).

29. The goal for hand hygiene compliance is 100% for both before and after contact with the patient and patients’ environment for each health-care worker group. The provincial target of 80%, established by the Provincial Hand Hygiene Working Group, is a minimum standard health authorities should meet while striving for continuous quality improvement.

30. In acute care facilities, trained auditors observe a sample of health-care workers and record whether they clean their hands at the appropriate times.

31. Health care workers in ACFs are grouped into four categories:

    • Nursing staff, including registered nurse, midwife, licensed practical nurse, care aide, and nursing/midwife student.
    • Physicians, including medical doctor, resident, fellow, medical student, and nurse practitioner.
    • Clinical support services, including occupational therapist, physiotherapist, respiratory therapist, speech therapist, social worker, dietician, psychologist, audiologist, porter, pastoral care, radiologist, and technician (e.g., ECG, EEG, phlebotomy).
    • Other support services, including housekeeping, food services, and clerk.

32. Audits of HHC in acute care facilities are administrated by each health authority, and the number of observed opportunities varies across authorities and over time. To account for the impact of this variation, provincial acute care compliance rates are also calculated using a weighting factor based on acute care inpatient days. In this method, each health authority’s compliance rate is multiplied by its proportion of total provincial inpatient days, and these weighted values are summed to produce the provincial rate. This approach ensures that results from facilities or regions with higher patient volumes have a proportionally greater influence on the provincial estimate.

33. Due to the COVID-19 pandemic, compliance data from some health authorities acute care facilities were not available during the following periods: FH (Q4 of 2019/20 to Q2 of 2020/21), IH (Q1 of 2020/21), PHC (Q4 of 2019/20), and VCH (Q4 of 2019/20 to Q3 of 2020/21).

34. HHC is audited in long-term care facilities that are owned or operated by a health authority. Audit data are voluntarily reported by health authorities to PICNet for public reporting.

35. There are no long-term care facilities owned or operated by Provincial Health Services Authority. Provincial Health Services Authority’s HHC audit methods were modified during Q1 of 2021/22.

36. From Q2 of 2018/19 through Q4 of 2022/23, Fraser Health only reported observations performed by regional hand hygiene auditors in acute care facilities to PICNet. As a result, compliance data are unavailable for all long-term care facilities in Fraser Health for that time period, except for Q1 of 2018/19 data, and Q3 of 2019/20.

37. HHC audits were suspended in some health authorities long-term care facilities due to the COVID-19 pandemic response and diversion of resources to other priorities.

    • Compliance data in all long-term care facilities in Interior Health are not available from Q1 of 2020/21 to Q2 of 2021/22.
    • No HHC audits were done in PHC’s long-term care facilities from Q4 of 2019/20 Q4 to Q1 of 2021/22; HHC audits resumed in Q2 of 2021/22.

38. HHC is audited through direct observation in both acute care facilities and long-term care facilities; however, audit strategies and methods vary across health authorities and over time. Auditors are trained by health authorities and include dedicated hand hygiene auditors or coordinators, IPC professionals, university co-op students, and staff within health-care facilities (self-auditing). Observer bias and Hawthorne effect (i.e. behaviour changes due to awareness of being observed) may occur during auditing.

Abbreviations

Abbreviation	Definition
ACF	Acute Care Facilities
BC	British Columbia
CDI	Clostridioides difficile infection
CPO	Carbapenemase-producing organisms
FH	Fraser Health
HCA	Health care-associated
HHC	Hand hygiene compliance
IH	Interior Health
IPC	Infection prevention and control
ISLH	Island Health
LOESS	Locally estimated scatterplot smoothing
LTCF	Long-term care facilities
MRSA	Methicillin-resistant Staphylococcus aureus
NH	Northern Health
PHC	Providence Health Care
PHL	Public Health Laboratory
PHSA	Provincial Health Services Authority
PICNet	Provincial Infection Control Network of British Columbia
VCH	Vancouver Coastal Health

Acknowledgements

PICNet acknowledges and thanks our colleagues in each of the health authorities, including Fraser Health (FH), Interior Health (IH), Island Health (ISLH), Northern Health (NH), Providence Health Care (PHC), Provincial Health Services Authority (PHSA), and Vancouver Coastal Health (VCH) for their collaboration in providing their health authority’s data, which supports building a provincial view of the indicators. We also recognize the contributions of IPC professionals, laboratory teams, and epidemiology partners who support this work locally.

First Nations Land Acknowledgement

We respectfully acknowledge that we work and live on the traditional, ancestral, and unceded territories of many BC First Nations. PICNet’s office is on the traditional territories of the xʷməθkʷəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) Nations. We also acknowledge the Métis Chartered Communities and Inuit who reside on these lands.

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