2. 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.
3. 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
4. Sites of HCAIs
UTI- Urinary tract Infections
Surgical Site Infection
Bloodstream infection
Pneumonia
Bone and joint infection
Central Nervous System
Cardiovascular
Systemic Infection
5. 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
6. SURVEILLANCE
“…is used to identify nosocomial
infections and other adverse events that
may be prevented…”
7. 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
10. “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
12. 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
13. 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
14. 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
15. 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
17. 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
18. 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
20. 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)
22. 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 regularly
depending on the
purpose of surveillance
and nature of
nosocomial event
23. 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
26. SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Validation
27. Surveillance Strategies for
Case Findings
Scope of
infection control
program
Patient or
Laboratory -
based
Active
vs
Passive
Retrospective
vs
Prospective
Methods
of
Surveillance
28. 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
29. Sources of Data for
Surveillance
Laboratory-based
Information
Patient-based
Information
Other departments ,
services or agencies
30. Sources of Data for
Surveillance
Patient-based
Information
Patient examination
Clinical ward rounds
31. 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
32. 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
33. 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)
34. 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
36. SURVEY
Incidence Rate (I)
No. of infections acquired in a month
No. of patients discharged in a month
=
37. 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
=
39. 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
40. SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Validation
41. VALIDATION
Key aspect of surveillance to assure
accuracy of data collection while being
efficient and cost-effective
42. VALIDATION
Concurrent surveillance
MD / Nurse Epidemiologist (Gold
Standard)
Prospective / Retrospective Review of
Charts
Examine the chart, microbiologic data
Various unit / staggered interval