Nosocomial infection
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NOSOCOMIAL INFECTION. Masud Yunesian, M.D., Epidemiologist. SURVEILLANCE METHODS. Definition. A dynamic process of gathering, managing, analyzing and reporting data on events that occur in a specific population. Importance : SENIC study:.

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NOSOCOMIAL INFECTION

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Nosocomial infection

NOSOCOMIAL INFECTION

Masud Yunesian,

M.D., Epidemiologist

SURVEILLANCE METHODS


Definition

Definition

  • A dynamic process of gathering, managing, analyzing and reporting data on events that occur in a specific population


Importance senic study

Importance : SENIC study:

  • Surveillance was the only component essential for reducing SSI, Pneumonia, UTI, & bacteremia.

  • Other essential components:

    • Sufficient no. of trained infection control staff and A system for reporting infection rates of SSI to surgeons.


Steps in surveillance

Steps in surveillance:

  • Definition of the event(s).

  • Systematic collection of data.

  • Summarization of data.

  • Analysis & interpretation.

  • Consuming the results for improvement.


Purposes of the surveillance 1

Purposes of the surveillance-1

  • Reducing the infection rate within a hospital.

  • Establishing endemic (baseline) rates.

  • Identifying outbreaks.


Purposes of the surveillance 2

Purposes of the surveillance-2

4. Convincing medical staff.

5. Satisfying regulators.

6. Defending malpractice claims.

7. Comparing infection rates among hospitals.


Surveillance methods 1

Surveillance methods-1

  • Concurrent

  • Retrospective


Concurrent

Concurrent

  • Flexible,

  • Informative

  • Timely

  • Capable of cluster detection

  • Capable of changing behavior

  • But expensive


Retrospective

Retrospective

  • Depends on completeness, validity & accuracy of existing data.

  • Does not identify problems as promptly as concurrent does.

  • But isn’texpensive.


Surveillance methods 2

Active :

accurate

complete

expensive

Passive :

misclassification

underreporting

lack of timeliness

less expensive

Surveillance methods-2


Surveillance methods 3

Surveillance methods-3

  • Hospital wide.

  • Periodic.

  • Targeted.

  • Defining the threshold limit.

  • Post discharge.


Hospital wide surveillance sources of data

Hospital wide surveillanceSources of data:

  • Daily reports of microbiology labs.

  • Medical records of febrile patients.

  • Medical records of patients taking antibiotics.

  • Medical records of isolated patients

  • Daily interview with nurses & patients

  • Periodic review of autopsy reports

  • Periodic review of medical records of staff.


Periodic surveillance s

Periodic surveillance(S.):

Hospital wide (H.W.S) during specified periods,

And ,

  • Targeted S. during alternate periods

    Or ,

  • Rotating H.W.S. from one unit to another


Targeted surveillance

Targeted surveillance

  • Focuses its effort on :

    • Selected geographic area (e.g. ICU)

    • Selected service (e.g. cardio thoracic surgery)

    • Specific populations of patients or infections:

      • At high risk of acquiring infection ( e.g. transplantation)

      • Undergoing specific interventions( e.g. dialysis)

      • At specific site (e.g. blood stream)


Characteristics of targeted s

Characteristics of targeted S.

  • High accuracy & efficiency .

  • Incapable of detecting other infections .

  • Criteria for selection of target :

    • Frequency.

    • mortality & morbidity .

    • Cost.

    • preventability.


Defining the threshold limits

Defining the threshold limits


Case finding issues

Case finding issues

  • Total chart review (standard method).

  • Laboratory reports.

  • Clinical ward rounds (twice a week).

  • Kardex screening (once or twice a week).

  • Fever chart.

  • High risk patients (transplant, diabetic, leukemia, invasive methods, .. )


Analysis 1

Analysis-1

  • The data should be analyzed.

  • The analysis should be done by staff engaged in surveillance.

  • Staff should decide how frequently to analyze the data:

    • Frequently enough to detect clusters promptly.

    • Collecting the data for a long enough period of time for changes to be meaningful.


Analysis 2

Analysis-2

Numerator & Denominator


Overall rate n o of ni

Overall rate = No. of NI

Total no. of admitted or discharged patients


Adjusted rates

Adjusted rates

  • For severity of illness.

  • For length of stay.

  • For exposure to device (e.g. ventilator)


Essential numerator data

Essential numerator data:

  • Demographic :

    • name, age, sex , service, ward,admission date, hospital identification number .

  • Infection :

    • onset date , site of infection.

  • Laboratory :

    • pathogen antibiogram


Numerator data risk factors only when these data used for analysis

Numerator data : Risk factors“only when these data used for analysis”

  • An example for SSI:

  • Kind of surgery.

  • Date of surgery.

  • Duration of surgery.

  • Type of wound (clean ,dirty, …).

  • Date of discharge.


Denominator data

Denominator data:

Total no. of admitted or discharged pts.

OR

No. of days of exposure :

  • Total no. of pts. & pt-days in the unit,

  • Total no. of ventilator days,

  • Total no. of central line days,

  • Total no. of urinary catheter days.


Comparing rates necessary assumptions

Comparing rates necessary assumptions:

  • Same definitions.

  • Same methods of S. & case finding.

  • Same accuracy of methods & personnel.

  • Same characteristics of hospitals/wards:

    • Length of stay,

    • Risk indices,

    • exposure to devices,

    • ...


Nosocomial infection

“Dissemination” “Surveillance is not complete until the results are disseminated to those who use it to prevent and control”


Dissemination continued

dissemination - continued

  • Confidentiality must be regarded

  • Regular time intervals for reporting .

  • Format of reports :

    • Summary , table , graph


Evaluation

Evaluation

  • At least annually ask yourself :

    • Did the system detect clusters ?

    • Which practices were changed based on S. ?

    • Were the data used to decrease the endemic rate ?

    • Were the data used to assess the efficacy of interventions ?

    • Are administrative & clinical staff aware of Surveillance Findings ?


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