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. 2014 Apr 8;9(4):e93285.
doi: 10.1371/journal.pone.0093285. eCollection 2014.

Secure surveillance of antimicrobial resistant organism colonization or infection in Ontario long term care homes

Khaled El Emam  1 , Luk Arbuckle  2 , Aleksander Essex  3 , Saeed Samet  4 , Benjamin Eze  5 , Grant Middleton  5 , David Buckeridge  6 , Elizabeth Jonker  2 , Ester Moher  2 , Craig Earle  7
Affiliations

Secure surveillance of antimicrobial resistant organism colonization or infection in Ontario long term care homes

Khaled El Emam et al. PLoS One. .

Abstract

Background: There is stigma attached to the identification of residents carrying antimicrobial resistant organisms (ARO) in long term care homes, yet there is a need to collect data about their prevalence for public health surveillance and intervention purposes.

Objective: We conducted a point prevalence study to assess ARO rates in long term care homes in Ontario using a secure data collection system.

Methods: All long term care homes in the province were asked to provide colonization or infection counts for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) as recorded in their electronic medical records, and the number of current residents. Data was collected online during the October-November 2011 period using a Paillier cryptosystem that allows computation on encrypted data.

Results: A provably secure data collection system was implemented. Overall, 82% of the homes in the province responded. MRSA was the most frequent ARO identified at 3 cases per 100 residents, followed by ESBL at 0.83 per 100 residents, and VRE at 0.56 per 100 residents. The microbiological findings and their distribution were consistent with available provincial laboratory data reporting test results for AROs in hospitals.

Conclusions: We describe an ARO point prevalence study which demonstrated the feasibility of collecting data from long term care homes securely across the province and providing strong privacy and confidentiality assurances, while obtaining high response rates.

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Conflict of interest statement

Competing Interests: Privacy Analytics Inc. is a spin-off company from the University of Ottawa and the Children's Hospital of Eastern Ontario Research Institute. It is a software company commercializing the results of the research on data anonymization conducted by our laboratory. The lead author, Khaled El Emam, has a financial interest in the company, as does the University of Ottawa and the Children's Hospital of Eastern Ontario, who hold equity in the company. The two co-authors who have affiliations with the company, Ben Eze and Grant Middleton, worked on a consulting basis with the research team to develop the software used to implement the secure surveillance protocol described in the paper. The software developed for the purpose of the study reported here is not currently part of the Privacy Analytics product portfolio. The authors' affiliation with Privacy Analytics Inc. does not influence our objective presentation of the research conducted in this submission, nor does it alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. The flow of information in the secure surveillance system.
See this image and copyright information in PMC

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