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1
SURVEILLANCE
OF HAIs
Name of Speaker
Date and venue
@gonnabedess @gonnabedess
Philippine Hospital Infection Control Soci...
2
Case
Philippine Hospital Infection Control Society, Inc.
OUTLINE
 Definition of Surveillance
 Goals of Surveillance
 ...
3
Disclaimer
 This lecture is intended to overwhelm
provide you with an overview about
surveillance NOT to teach you the
...
4
SURVEILLANCE
 “…is used to identify nosocomial
infections and other adverse events that
may be prevented…”
Philippine H...
5
Goals of Surveillance
 to define endemic rates
 to identify increases in infection rates
 to identify specific risks
...
6
COMPONENTS
OF
SURVEILLANCE
Kenrad E. Nelson and Carolyn Masters Williams.
Infectious Disease Epidemiology: Theory and Pr...
7
The The building blocks of surveillance comprise collecting relevant data systemically for a specified purpose and durin...
8
Collection
 Know your population to determine which
subset requires targeting
 Assess your capability to identify your...
9
Data Management
 Note that rates can be accurate and
consistent but still not useful or
interpretable if the numerator ...
10
OUTLINE
 Definition of Surveillance
 Goals of Surveillance
 Components of Surveillance
 Steps in Surveillance of
No...
11
STEPS IN SURVEILLANCE
FOR HAIs
1. Identify Surveillance Strategy
2. Data collection
3. Case-Finding Method
4. Consolida...
12
Surveillance Strategies for
Case Findings
 Scope of
infection control
program
 Patient or
Laboratory -
based
 Active...
13
1. Hospital-Wide Surveillance
(TRADITIONAL)
Advantage
 MOST comprehensive
method
 collects data on all
infection, sit...
14
3. PREVALENCE
SURVEILLANCE
ADVANTAGE
 documents nosocomial
infection trends identifies
risk factors
 relatively quick...
15
4. Targeted Surveillance
Advantage
 requires less personnel and
liberates ICP to perform other
activities
 increases ...
16
4. Targeted Surveillance :
ROTATING
Advantage
 less expensive
 less time-consuming
 less personnel
 all areas of ho...
17
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Philippine Hospital Infection Control Soc...
18
Sources of Data for
Surveillance
 Patient-based Information
 Patient examination
 Clinical ward rounds
Sources of Da...
19
Sources of Data for
Surveillance
 Patient-based
Information
 Patient examination
 Clinical ward rounds
 Communicati...
20
Sources of Data for
Surveillance
 Laboratory-based
Information
 Patient-based
Information
 Bacteriology, Mycology,
P...
21
Sources of Data for
Surveillance
 Laboratory-based
Information
 Patient-based
Information
 Other departments , servi...
22
CASE-FINDING
METHODS
 TOTAL CHART REVIEW
 SELECTIVE MEDICAL RECORD
REVIEW BASED ON :
– Laboratory Reports, Kardex scr...
23
CASE FINDING
METHODS
METHOD DEFINITION Sensitivity Estimated
Time(Hrs)
/500 beds
Selective Medical Record
Review based ...
24
CASE FINDING
METHODS
METHOD DEFINITION Sensitivity Estimated
Time(Hrs)
/500 beds
Selective Medical Record
Review based ...
25
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tab...
26
SURVEY
 Prevalence Rate (P)
No of infections (ACTIVE) in
hospitalized patients at the time of the
survey
No. of patien...
27
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tab...
28
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tab...
29
VALIDATION
 Concurrent surveillance
 MD / Nurse Epidemiologist (Gold
Standard)
 Prospective / Retrospective Review o...
30
Thank you!
ANTIBIOTIC
POLICIES
31
OUTLINE
Goals of antibiotic policy
Difficulties in formulating
antibiotic policies
Selected policies on
antibiotic usag...
32
Difficulties in Formulating
Antibiotic Policies...
 bacterial population differ
 antibiotic resistance pattern differ...
33
1. Restriction of
antibiotic use
ANTIBIOTIC POLICIES
Classification of Antibiotics
Non-Restricted
 issuance of these a...
34
Classification of Antibiotics
Restricted
 issuance of these antibiotics require
approval of an Infectious Disease
Cons...
35
Classification of Antibiotics
Very Restricted
 indicated for treatment of life-
threatening infections documented by
c...
36
OSPITAL NG STA. CRUZ
Name: Juan de la Cruz Age: 35 yrs old Sex: Male Room Number: Room 322 Bed A
Hospital Number: 2004-...
37
1. Restriction of
antibiotic use
2. Limited
susceptibility
reporting
3. Concurrent
monitoring of
antibiotic usage
ANTIB...
38
Methods to Evaluate
Antimicrobial Use in Hospital
A. PATTERN OF USE OF ANTIBIOTICS
BY MEDICAL STAFF
 Survey of usage o...
39
Methods to Evaluate
Antimicrobial Use in Hospital
C. DATA
 number of units (grams), cost for each agent
 number of pa...
40
ANTIBIOTIC AUDIT
Some Practices that warrant auditing…
 orders for antibiotics in the absence
of minimal diagnostic pr...
41
ANTIBIOTIC AUDIT
Some Practices that warrant auditing…
 use of aminoglycosides without
obtaining a measure of renal fu...
42
EMPIRIC THERAPY
 treatment of suspected serious or
life-threatening infection pending
results of culture and sensitivi...
43
DEFINITIVE THERAPY
 Treatment of serious or life-threatening
infection documented by culture and
sensitivity tests
 a...
44
1. Restriction of
antibiotic use
2. Limited
susceptibility
reporting
3. Concurrent
monitoring of
antibiotic usage
4. “A...
45
HOSPITAL FORMULARY
 Draft an antibiotic policy
 Discuss the draft policy
with the clinicians
 When policy has been
a...
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Basic HAI Surveillance

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Basic HAI Surveillance

  1. 1. 1 SURVEILLANCE OF HAIs Name of Speaker Date and venue @gonnabedess @gonnabedess Philippine Hospital Infection Control Society, Inc. Case From 29 December 1988 to 21 January 21 1989, B. cepacia was isolated from 1. PF of 4 patients on PD (peritonitis) 2. Blood of two patients at another children's hospital March 03, 1989 / 38(8);133-134 Philippine Hospital Infection Control Society, Inc.
  2. 2. 2 Case Philippine Hospital Infection Control Society, Inc. OUTLINE  Definition of Surveillance  Goals of Surveillance  Components of Surveillance  Steps in Surveillance of Nosocomial Infection Philippine Hospital Infection Control Society, Inc.
  3. 3. 3 Disclaimer  This lecture is intended to overwhelm provide you with an overview about surveillance NOT to teach you the specific steps to conduct it Philippine Hospital Infection Control Society, Inc. 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. 4th Edition. 2011 Philippine Hospital Infection Control Society, Inc.
  4. 4. 4 SURVEILLANCE  “…is used to identify nosocomial infections and other adverse events that may be prevented…” Philippine Hospital Infection Control Society, Inc. SURVEILLANCE  “…is used to establish endemic rates of health-related events or diseases…” Philippine Hospital Infection Control Society, Inc.
  5. 5. 5 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 ■ to apply targeted interventions and to evaluate their effect in an ongoing system (Mintjes-de Groot AJ 2000) Philippine Hospital Infection Control Society, Inc. OUTLINE  Definition of Surveillance  Goals of Surveillance  Components of Surveillance  Steps in Surveillance of Nosocomial Infection Philippine Hospital Infection Control Society, Inc.
  6. 6. 6 COMPONENTS OF SURVEILLANCE Kenrad E. Nelson and Carolyn Masters Williams. Infectious Disease Epidemiology: Theory and Practice, 3rd edition. 2013. “The building blocks of surveillance comprise: 1. collecting relevant data systemically for a specified purpose and during a defined period of time, 2. managing and organizing the data, 3. analyzing and interpreting the data and 4. communicating the results to those empowered to make beneficial changes…” Philippine Hospital Infection Control Society, Inc.
  7. 7. 7 The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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 The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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 The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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 5 The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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 The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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 The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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… Xy = a+b+c ; y= mc – rta’ The 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 5 Definition  Use standardized written case definitions to ensure precise surveillance. Where available and applicable, use previously published, validated definitions.  For accurate and valid comparisons of data, use the same definitions over time. Philippine Hospital Infection Control Society, Inc.
  8. 8. 8 Collection  Know your population to determine which subset requires targeting  Assess your capability to identify your method of data collection Data Management  Combine only homogenous data – Always qualify and describe your data source – May apply risk stratification to ensure homogeneity  Comparisons are valid only if all contributors to the data have: – used the same surveillance intensity – used similar data collection methods – applied the same surveillance definitions – addressed differences in populations/case mix – stratified data as appropriate
  9. 9. 9 Data Management  Note that rates can be accurate and consistent but still not useful or interpretable if the numerator is too small (infrequent event) or the denominator is of inappropriate size (usually too small). Communication  Timely  Simple and understandable  Relayed to the relevant persons
  10. 10. 10 OUTLINE  Definition of Surveillance  Goals of Surveillance  Components of Surveillance  Steps in Surveillance of Nosocomial Infection STEPS IN SURVEILLANCE FOR NOSOCOMIAL INFECTIONS
  11. 11. 11 STEPS IN SURVEILLANCE FOR HAIs 1. Identify Surveillance Strategy 2. Data collection 3. Case-Finding Method 4. Consolidation and Tabulation 5. Calculating Rates 6. Analysis and Interpretation 7. Validation STEPS IN SURVEILLANCE FOR HAIs Identify Surveillance Strategy Philippine Hospital Infection Control Society, Inc.
  12. 12. 12 Surveillance Strategies for Case Findings  Scope of infection control program  Patient or Laboratory - based  Active vs Passive  Retrospective vs Prospective or concurrent  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 Philippine Hospital Infection Control Society, Inc.
  13. 13. 13 1. Hospital-Wide Surveillance (TRADITIONAL) Advantage  MOST comprehensive method  collects data on all infection, sites, units  establishes baseline infection rates  recognizes outbreaks early  identifies clusters  increase visibility of infection control professional (ICP) Disadvantage  expensive, labor intensive labor , time-consuming, yields excessive data  leaves little time to analyze data and initiate changes (no definite management objective)  detects infections that can not be prevented  Overall infection rate not valid for interhospital comparison 2. Limited Periodic Surveillance Advantage  increases efficiency of surveillance  liberates ICP to perform other activities  utilized resources more effectively  reduces time spent doing surveillance by 45% Disadvantage  provides data only during periods in which surveillance is conducted  may miss cluster or outbreaks during nonsurveyed periods
  14. 14. 14 3. PREVALENCE SURVEILLANCE ADVANTAGE  documents nosocomial infection trends identifies risk factors  relatively quick and inexpensive  identifies areas that need additional surveillance DISADVANTAGE  data collection may be tedious  must collect data in short time period  data are restricted to a specified time period  cannot compare prevalence rate with incidence rates  few studies on prevalence rates published  may miss clusters or outbreaks 4. Targeted Surveillance Advantage  focus on patient at risks; on infections with known control measures to reduce infection risk  concentrates limited resources on high- risk areas  can determine valid denominator Philippine Hospital Infection Control Society, Inc.
  15. 15. 15 4. Targeted Surveillance Advantage  requires less personnel and liberates ICP to perform other activities  increases efficiency of surveillance  flexible - can be mixed with other methods Philippine Hospital Infection Control Society, Inc. 4. Targeted Surveillance Disadvantage  no baseline rates in other units  collects data only for targeted patients at risk  can miss clusters or outbreaks in nonsurveyed areas or populations Philippine Hospital Infection Control Society, Inc.
  16. 16. 16 4. Targeted Surveillance : ROTATING Advantage  less expensive  less time-consuming  less personnel  all areas of hospital surveyed Disadvantage  can miss clusters of infection Philippine Hospital Infection Control Society, Inc. Objective / Priority Based Surveillance Advantage  adaptable to hospital with special interest and resources  focuses on specific problems of the individual institution Disadvantage  no baseline rates of infection  may miss clusters / outbreaks
  17. 17. 17 STEPS IN SURVEILLANCE FOR HAIs Identify Surveillance Strategy Data collection Philippine Hospital Infection Control Society, Inc. Sources of Data for Surveillance  Laboratory-based Information  Patient-based Information  Other departments , services or agencies
  18. 18. 18 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
  19. 19. 19 Sources of Data for Surveillance  Patient-based Information  Patient examination  Clinical ward rounds  Communication with staff  Patient medical record – Medication records – Temperature records – Radiology reports – Laboratory reports  Kardex review Sources of Data for Surveillance  Patient-based Information  Patient examination  Clinical ward rounds  Communication with staff  Patient medical record  Kardex review  Treatments, Wound dressing changes  Intravenous fluids, Antibiotics  Urinary catheter, Surgery  Isolation precautions
  20. 20. 20 Sources of Data for Surveillance  Laboratory-based Information  Patient-based Information  Bacteriology, Mycology, Parasitology, Serology , Virology and Pathology reports  Antimicrobial susceptibility patterns 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
  21. 21. 21 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) STEPS IN SURVEILLANCE FOR HAIs Identify Surveillance Strategy Data collection Case-Finding Method Philippine Hospital Infection Control Society, Inc.
  22. 22. 22 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 METHOD DEFINITION Sensitivity Estimated Time(Hrs) /500 beds Total Chart Review Review all patient 0.74-0.94 35.7-53.6 medical records Selective Medical Record Review based on: Laboratory reports microbiology reports to 0.77-0.91 23.2 identify pts with (+) cultures CASE FINDING METHODS
  23. 23. 23 CASE FINDING METHODS METHOD DEFINITION Sensitivity Estimated Time(Hrs) /500 beds Selective Medical Record Review based on: Kardex screening Patient Kardex to det. 0.75-0.94 14.3-22.3 patients at risk for infxn Fever Temperature record to 0.09-0.56 8 ident. pts with T>37.8C Antibiotic use Medication record to 0.57 14.3 ident. pts receiving abs CASE FINDING METHODS METHOD DEFINITION Sensitivity Estimated Time(Hrs) /500 beds Selective Medical Record Review based on: Fever and Ab use Temp record to ident. 0.70 13.4 pts with T>37.8 and med rec. to ident. Pts on Abs Readmission admission record for pts 0.08 ------- readmitted with infection Autopsy report (AR) AR to ident. pts w/ infxn 0.08 0.53
  24. 24. 24 CASE FINDING METHODS METHOD DEFINITION Sensitivity Estimated Time(Hrs) /500 beds Selective Medical Record Review based on: Ward Liason Surv. Pts reported by nursing 0.62 17.6 (WLS) staff to have an infection Laboratory-based and Microbiology reports to 0.76-0.89 31.8 Ward Liason Surv. Ident. Pts with (+) culture and pts reported by nurses Risk-Factor-based S. Nursing rep and Med rec. 0.50-0.89 32.4 STEPS IN SURVEILLANCE FOR HAIs Identify Surveillance Strategy Data collection Case-Finding Method Consolidation and Tabulation
  25. 25. 25 STEPS IN SURVEILLANCE FOR HAIs 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 =
  26. 26. 26 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 = Device-related infections No. of infections (CAUTI, MV, CLABSI) No. of device days X 1000 Philippine Hospital Infection Control Society, Inc.
  27. 27. 27 STEPS IN SURVEILLANCE FOR HAIs Identify Surveillance Strategy Data collection Case-Finding Method Consolidation and Tabulation Calculating Rates Analysis and Interpretation Philippine Hospital Infection Control Society, Inc. 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 Philippine Hospital Infection Control Society, Inc.
  28. 28. 28 STEPS IN SURVEILLANCE FOR HAIs Identify Surveillance Strategy Data collection Case-Finding Method Consolidation and Tabulation Calculating Rates Analysis and Interpretation Validation Philippine Hospital Infection Control Society, Inc. VALIDATION  Key aspect of surveillance to assure accuracy of data collection while being efficient and cost-effective Philippine Hospital Infection Control Society, Inc.
  29. 29. 29 VALIDATION  Concurrent surveillance  MD / Nurse Epidemiologist (Gold Standard)  Prospective / Retrospective Review of Charts  Examine the chart, microbiologic data  Various unit / staggered interval Philippine Hospital Infection Control Society, Inc. OUTLINE  Definition of Surveillance  Goals of Surveillance  Components of Surveillance  Steps in Surveillance of HAIs
  30. 30. 30 Thank you! ANTIBIOTIC POLICIES
  31. 31. 31 OUTLINE Goals of antibiotic policy Difficulties in formulating antibiotic policies Selected policies on antibiotic usage GOALS  To promote rational antibiotic use  To prevent or delay emergence of resistant bacterial strains
  32. 32. 32 Difficulties in Formulating Antibiotic Policies...  bacterial population differ  antibiotic resistance pattern differ  clinical choice varies  availability of antibiotics  cost of antibiotic varies  route of antibiotic varies Antimicrobial Agent Team Functions : Selection of Antimicrobial agent -> Formulary Educational Programs
  33. 33. 33 1. Restriction of antibiotic use ANTIBIOTIC POLICIES Classification of Antibiotics Non-Restricted  issuance of these antibiotics does not require approval of Infectious Disease Consultants or ID Fellows, but their use should be based on sound clinical judgement  Examples: erythromycin, penicillin V, co-trimoxazole, amoxicillin, tetracycline, chloramphenicol Adapted from: UP-PGH HICCU Antibiotic Policy
  34. 34. 34 Classification of Antibiotics Restricted  issuance of these antibiotics require approval of an Infectious Disease Consultants or ID Fellows  Examples: amoxicillin-clavulanic acid, gentamicin, clindamycin , cefoxitin etc. Adapted from: UP-PGH HICCU Antibiotic Policy Classification of Antibiotics Very Restricted  issuance of these antibiotics require approval of Infectious Disease Consultants .  Only very limited stocks should be made available in the pharmacy Adapted from: UP-PGH HICCU Antibiotic Policy
  35. 35. 35 Classification of Antibiotics Very Restricted  indicated for treatment of life- threatening infections documented by culture and sensitivity test, indicating resistance to other effective and less expensive antibiotics  Example: vancomycin, imipenem- cilastatin, amphotericin B, amikacin etc. Adapted from: UP-PGH HICCU Antibiotic Policy 1. Restriction of antibiotic use 2. Limited susceptibility reporting ANTIBIOTIC POLICIES
  36. 36. 36 OSPITAL NG STA. CRUZ Name: Juan de la Cruz Age: 35 yrs old Sex: Male Room Number: Room 322 Bed A Hospital Number: 2004-000456 Attending Physician: Dr. Jose De La Rosa Specimen: Blood A and B Date Submitted: July 1, 2004 Date Reported: July 5, 2004 Organism: Positive growth of Salmonella typhi S I R S I R Amoxicillin Ertapenem Amoxicillin-Clavulanic acid Imipenem-Cilastatin Ampicillin X Meropenem Ampicillin-Sulbactam Aztreonam Cefoperazone-Sulbactam Ciprofloxacin X Ticarcillin-Clavulanid acid Gentamicin Piperacillin-Tazobactam Tobramycin Cephalothin Netilmycin Cefuroxime Amikacin Cefoxitin Erythromycin Ceftriaxone X Trimethoprim-Sulfamethoxazole X Ceftazidime Tetracycline Cefepime Clindamycin Cefpirome Chloramphenicol X Vancomycin Legend: S= sensitive, I= intermediate, R= resistant OSPITAL NG STA. CRUZ Name: Juan de la Cruz Age: 35 yrs old Sex: Male Room Number: Room 322 Bed A Hospital Number: 2004-000456 Attending Physician: Dr. Jose De La Rosa Specimen: Blood A and B Date Submitted: July 1, 2004 Date Reported: July 5, 2004 Organism: Positive growth of Salmonella typhi S I R S I R Amoxicillin Ertapenem Amoxicillin-Clavulanic acid Imipenem-Cilastatin Ampicillin X Meropenem Ampicillin-Sulbactam Aztreonam Cefoperazone-Sulbactam Ciprofloxacin Ticarcillin-Clavulanid acid Gentamicin Piperacillin-Tazobactam Tobramycin Cephalothin Netilmycin Cefuroxime Amikacin Cefoxitin Erythromycin Ceftriaxone Trimethoprim-Sulfamethoxazole X Ceftazidime Tetracycline Cefepime Clindamycin Cefpirome Chloramphenicol X Vancomycin Legend: S= sensitive, I= intermediate, R= resistant
  37. 37. 37 1. Restriction of antibiotic use 2. Limited susceptibility reporting 3. Concurrent monitoring of antibiotic usage ANTIBIOTIC POLICIES Methods to Evaluate Antimicrobial Use in Hospital A. PATTERN OF USE OF ANTIBIOTICS BY MEDICAL STAFF  Review current practices for selected indications – prophylactic antibiotics in surgery – antibiotics for specific infections  Gross utilization data based on pharmacy record
  38. 38. 38 Methods to Evaluate Antimicrobial Use in Hospital A. PATTERN OF USE OF ANTIBIOTICS BY MEDICAL STAFF  Survey of usage on individual services  Survey of routine orders for prophylaxis in surgery  Survey of orders for specific infectious dse  Case review by independent cases  Guidelines for audit Methods to Evaluate Antimicrobial Use in Hospital B. TRENDS  identify yearly purchase  identify consumption of – each agent – each group drugs (cephalosporins, etc.) – each class (antibacterial, etc.)
  39. 39. 39 Methods to Evaluate Antimicrobial Use in Hospital C. DATA  number of units (grams), cost for each agent  number of patients treated with each drug 1. Restriction of antibiotic use 2. Limited susceptibility reporting 3. Concurrent monitoring of antibiotic usage 4. “Audit of Use” ANTIBIOTIC POLICIES
  40. 40. 40 ANTIBIOTIC AUDIT Some Practices that warrant auditing…  orders for antibiotics in the absence of minimal diagnostic procedures  concurrent use of more than 2 antibiotics  use of more than 5 antibiotics during a single hospitalization  continuous treatment with antimicrobial agents for more than 21 days ANTIBIOTIC AUDIT Some Practices that warrant auditing…  use of parenteral drugs when identical oral preparation can be used  prophylactic use in surgery for >48 hours  procedure for which prophylaxis is NOT an accepted practice
  41. 41. 41 ANTIBIOTIC AUDIT Some Practices that warrant auditing…  use of aminoglycosides without obtaining a measure of renal function  use of antibiotics in afebrile patients with indwelling catheter 1. Restriction of antibiotic use 2. Limited susceptibility reporting 3. Concurrent monitoring of antibiotic usage 4. “Audit of Use” 5. “Automatic” Stop Order ANTIBIOTIC POLICIES
  42. 42. 42 EMPIRIC THERAPY  treatment of suspected serious or life-threatening infection pending results of culture and sensitivity tests  Initial dose may be issued for 24 hrs BUT subsequent doses will need approval of the Antimicrobial Agent Team Antimicrobial Agent Team Composition :  Infectious disease physician  Infection control practitioner  Clinical Microbiologist  Clinical Pharmacists Example: Philippine General Hospital (PGH) Antibiotic Surveillance and Control Team (Infectious Disease Consultants and Fellows)
  43. 43. 43 DEFINITIVE THERAPY  Treatment of serious or life-threatening infection documented by culture and sensitivity tests  a 7-day automatic stop order shall be implemented PROPHYLAXIS USE  use to prevent infectious complications in high risk setting – Aminoglycosides : Netilmycin – Cephalosporins : Cephalothin , Ceftriaxone – Pen with BLI : Amoxiclav or Ampicillin- sulbactam – Quinolones : Ciprofloxacin – Anaerobic Infection : Metronidazole, Clindamycin
  44. 44. 44 1. Restriction of antibiotic use 2. Limited susceptibility reporting 3. Concurrent monitoring of antibiotic usage 4. “Audit of Use” 5. “Automatic” Stop Order 6. Hospital Formulary ANTIBIOTIC POLICIES HOSPITAL FORMULARY  Lists the indication for which the antibiotics are required  List the categories of antibiotics  List the antibiotics that are similar in spectrum, safety, kinetics
  45. 45. 45 HOSPITAL FORMULARY  Draft an antibiotic policy  Discuss the draft policy with the clinicians  When policy has been agreed, inform Microbiology section and Pharmacy  Enter the policy in the hospital formulary  Review the policy periodically ありがとう (JP) Thank you (En) Arigatou
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by Dr. Arthur Dessie E. Roman

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