ORIENTATION TO

SURVEILLANCE

Dominga C Gomez, R.N.

Healthcare Associated

Infection (Nosocomial)

CDC/NATIONAL HEALTHCARE

SAFETY NETWORK DEFINITION

– Localized or systemic condition resulting

from an adverse reaction to the presence

of an infectious agent or its toxins. There

must be no evidence that the infection was

present or incubating at the time of

admission to the acute care setting.

Endogenous- body sites such as skin.

Nose, mouth ,git, vagina that are

normally inhabited by microorganisms

Exogenous-external to the patients such

as other patients, hcws, visitors,

equipment, medical devices or

healthcare environment

Sources of infectious

agents

Sites of HCAIs

UTI- Urinary tract Infections

Surgical Site Infection

Bloodstream infection

Pneumonia

Bone and joint infection

Central Nervous System

Cardiovascular

Systemic Infection

SURVEILLANCE

“The ongoing systematic collection, analysis and interpretation of healthcare data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those contributing data or to other interested groups who need to know.”

Lennox K. Archibald and Walter J. Hierholzer, Jr.

C. Gen Mayhall’s Hospital Epidemiology and Infection Control.

3rd Edition. 2004. Page 5

SURVEILLANCE

“…is used to identify nosocomial

infections and other adverse events that

may be prevented…”

Goals of Surveillance

to define endemic rates

to identify increases in infection rates

to identify specific risks

to inform hospital personnel of the risks

of the cares or procedures they provide

SURVEILLANCE

“…is used to establish endemic rates

of health-related events or

diseases…”

COMPONENTS

OF

SURVEILLANCE

“The building blocks of

surveillance comprise

collecting relevant data

systemically for a

specified purpose and

during a defined period

of time, managing and

organizing the data,

analyzing and

interpreting the data and

communicating the

results to those

empowered to make

beneficial changes…”

Jean M Pottinger, Loreen A. Herwaldt and Trish

M. Perl.

Infection Control and Hospital Epidemiology.

July 1997. Vol. 18 No. 7 page 513

Components of

Surveillance

DEFINITIONS

– develop

standardized

definitions

– gain widespread

acceptance of

the criteria for the

definition

Components of

Surveillance

DEFINITIONS

Definition of Nosocomial Infection

Clinical

– direct observation (surgery, procedure)

Laboratory

– microscopic, culture, antigen-antibody

Other diagnostic test

– radiograph, wbc count

Physicians’ Diagnosis -ACCEPTED

Example

SUTI

Fever, urgency, dysuria or suprapubic

tenderness and a positive and a positive

culture that is greater or equal to 10 to

the fifth per cc of urine with no more

than 2 species of microorganisms

Not HCAI

Infections associated with complications

or extensions of infections already

present on admission unless a change

in pathogen or symptoms strongly

suggest the acquisition of new infection

Reactivation of a latent infection e.g.

herpes, tb, syphilis

Not infection

Colonization- the presence of

microorganisms on skin. Mucous

membranes, open wound, or in

excretions or secretions but are not

causing adverse clinical symptoms

Inflammation-result from tissue

response to injury or stimulation by non

infectious agents , i.e. chemicals

Components of

Surveillance

DEFINITIONS

COLLECTING

DATA

– Concurrent

– Retrospective

Components of

Surveillance

COLLECTING DATA

Concurrent

– epidemiology staff collect

data at the time the event

occurs and shortly

thereafter

– this allows infection control

staff to review the medical

record, assess the patient,

and discuss the event with

care givers

– additional information may

be available, such as ward

log books and nursing

reports

Components of

Surveillance

COLLECTING DATA

Retrospective

– the epidemiology team collects data after the patient is discharged

– dependent on the completeness, accuracy and quality of the medical records

– does not identify problems as promptly as concurrent surveillance

Components of

Surveillance

DEFINITIONS

COLLECTING

DATA

MANAGING

DATA

Components of

Surveillance

MANAGING DATA

Objective: to identify patterns or trends

Data should be organized in a meaningful fashion

record surveillance data systematically on a flow sheet or line-listing ( e.g. columnar accounting paper or use of database of computer)

Components of

Surveillance

DEFINITIONS

COLLECTING

DATA

MANAGING

DATA

ANALYZING

DATA

Components of

Surveillance

ANALYZING DATA

should be done promptly and be able to identify problems quickly and make changes that reduce the risk of infection

analysis of data should be done regularlydepending on the purpose of surveillance and nature of nosocomial event

Components of

Surveillance

ANALYZING DATA

compute incidence of event and compare data over time

for microbiologic data, better do focused microbiologic surveillance on specific units

finally, data should be intrepreted

Components of

Surveillance

DEFINITIONS

COLLECTING DATA

MANAGING DATA

ANALYZING DATA

COMMUNICATING

RESULTS

SURVEILLANCE FOR

NOSOCOMIAL

INFECTIONS

SURVEILLANCE FOR

NOSOCOMIAL INFECTIONS

Identify Surveillance Strategy

Data collection

Case-Finding Method

Consolidation and Tabulation

Calculating Rates

Analysis and Interpretation

Validation

Surveillance Strategies for

Case Findings

Scope of infection control

program

Patient or

Laboratory -

based

Active

vs

Passive

Retrospective

vs

Prospective

Methods

of

Surveillance

Methods of Surveillance

1. Hospital-wide Surveillance

(Traditional)

2. Limited Periodic Surveillance

3. Prevalence Surveillance

4. Targeted Surveillance : unit /

site specific / rotational

5. Objective/Priority Based

Surveillance

Sources of Data for

Surveillance

Laboratory-based

Information

Patient-based

Information

Other departments ,

services or agencies

Sources of Data for

Surveillance

Patient-based

Information Patient examination

Clinical ward rounds

Sources of Data for

Surveillance

Patient-based

Information Patient examination

Clinical ward rounds

Culture

organism

antimicrobial

susceptibility

pattern

Clinical Data

fever

p.e. findings

x-ray results

Predisposing

factors

surgery

chemotherapy

antibiotics

steroids

underlying disease

Exposure factor

Patient’s name

Age

Sex

Hospital number

Ward service

Admission data

Infection onset

data

Sources of Data for

Surveillance

Laboratory-based

Information

Patient-based

Information

Other departments , services or agencies

Admission department

Operating suite

Emergency Department

Outpatient clinics

Risk Control (for

incident reports and

other data)

Employee health

Sources of Data for

Surveillance

Laboratory-based

Information

Patient-based

Information

Other departments , services or agencies Home-care agencies

Multicenter surveillance systems (e.g. NNIS)

Local and state health departments (e.g. MMWR)

CASE-FINDING

METHODS

TOTAL CHART REVIEW

SELECTIVE MEDICAL RECORD

REVIEW BASED ON :

– Laboratory Reports, Kardex screening,

Fever, Antibiotic use, Fever and

Antibiotic use, Readmission, Autopsy

reports, Ward Liason surveillance,

Laboratory-based and ward-liason

surveillance, risk-factor-based

surveillance

SURVEILLANCE FOR

NOSOCOMIAL INFECTIONS

Identify Surveillance Strategy

Data collection

Case-Finding Method

Consolidation and Tabulation

Calculating Rates

SURVEY

Incidence Rate (I)

No. of infections acquired in a month

No. of patients discharged in a month=

SURVEY

Prevalence Rate (P)

No of infections (ACTIVE) in

hospitalized patients at the time of the

survey

No. of patients present at the time of the

survey

=

SURVEILLANCE FOR

NOSOCOMIAL INFECTIONS

Identify Surveillance Strategy

Data collection

Case-Finding Method

Consolidation and Tabulation

Calculating Rates

Analysis and Interpretation

Data Analysis and

Interpretation

significant change in current rates

monitor both rate and pattern of

endemic disease (significant fluctuation)

tabulated data and analysis should be

distributed

examine how component parts relates

Chi-square, Fisher’s test, Student T-test

SURVEILLANCE FOR

NOSOCOMIAL INFECTIONS

Identify Surveillance Strategy

Data collection

Case-Finding Method

Consolidation and Tabulation

Calculating Rates

Analysis and Interpretation

Validation

VALIDATION

Key aspect of surveillance to assure

accuracy of data collection while being

efficient and cost-effective

VALIDATION

Concurrent surveillance

MD / Nurse Epidemiologist (Gold

Standard)

Prospective / Retrospective Review of

Charts

Examine the chart, microbiologic data

Various unit / staggered interval

OTHER FORMS OF

SUVEILLANCE

HAND HYGIENE

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