orientation to surveillance
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ORIENTATION TO
SURVEILLANCE
Dominga C Gomez, R.N.
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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.
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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
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Sites of HCAIs
UTI- Urinary tract Infections
Surgical Site Infection
Bloodstream infection
Pneumonia
Bone and joint infection
Central Nervous System
Cardiovascular
Systemic Infection
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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
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SURVEILLANCE
“…is used to identify nosocomial
infections and other adverse events that
may be prevented…”
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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
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SURVEILLANCE
“…is used to establish endemic rates
of health-related events or
diseases…”
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COMPONENTS
OF
SURVEILLANCE
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“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
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Components of
Surveillance
DEFINITIONS
– develop
standardized
definitions
– gain widespread
acceptance of
the criteria for the
definition
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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
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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
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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
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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
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Components of
Surveillance
DEFINITIONS
COLLECTING
DATA
– Concurrent
– Retrospective
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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
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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
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Components of
Surveillance
DEFINITIONS
COLLECTING
DATA
MANAGING
DATA
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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)
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Components of
Surveillance
DEFINITIONS
COLLECTING
DATA
MANAGING
DATA
ANALYZING
DATA
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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
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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
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Components of
Surveillance
DEFINITIONS
COLLECTING DATA
MANAGING DATA
ANALYZING DATA
COMMUNICATING
RESULTS
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SURVEILLANCE FOR
NOSOCOMIAL
INFECTIONS
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SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Validation
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Surveillance Strategies for
Case Findings
Scope of infection control
program
Patient or
Laboratory -
based
Active
vs
Passive
Retrospective
vs
Prospective
Methods
of
Surveillance
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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
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Sources of Data for
Surveillance
Laboratory-based
Information
Patient-based
Information
Other departments ,
services or agencies
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Sources of Data for
Surveillance
Patient-based
Information Patient examination
Clinical ward rounds
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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
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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
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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)
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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
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SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
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SURVEY
Incidence Rate (I)
No. of infections acquired in a month
No. of patients discharged in a month=
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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
=
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SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
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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
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SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Validation
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VALIDATION
Key aspect of surveillance to assure
accuracy of data collection while being
efficient and cost-effective
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VALIDATION
Concurrent surveillance
MD / Nurse Epidemiologist (Gold
Standard)
Prospective / Retrospective Review of
Charts
Examine the chart, microbiologic data
Various unit / staggered interval
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OTHER FORMS OF
SUVEILLANCE
HAND HYGIENE
VAP BUNDLE
5S
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