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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

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.
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,
    • ...
slide26
“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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