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Basic HAI Surveillance
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
Case
Philippine Hospital Infection Control Society, Inc.
OUTLINE
īŽ Definition of Surveillance
īŽ Goals of Surveillance
īŽ Components of Surveillance
īŽ Steps in Surveillance of Nosocomial
Infection
Philippine Hospital Infection Control Society, Inc.
3. 3
Disclaimer
īŽ 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
īŽ âThe 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.â
Lennox K. Archibald and Walter J. Hierholzer, Jr.
C. Gen Mayhallâs Hospital Epidemiology and Infection Control.
4th Edition. 2011
Philippine Hospital Infection Control Society, Inc.
4. 4
SURVEILLANCE
īŽ ââĻis used to identify nosocomial
infections and other adverse events that
may be preventedâĻâ
Philippine Hospital Infection Control Society, Inc.
SURVEILLANCE
īŽ ââĻis used to establish endemic rates
of health-related events or
diseasesâĻâ
Philippine Hospital Infection Control Society, Inc.
5. 5
Goals of Surveillance
īŽ to define endemic rates
īŽ to identify increases in infection rates
īŽ to identify specific risks
īŽ to inform hospital personnel of the risks
of the cares or procedures they provide
â 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
īŽ Definition of Surveillance
īŽ Goals of Surveillance
īŽ Components of Surveillance
īŽ Steps in Surveillance of Nosocomial
Infection
Philippine Hospital Infection Control Society, Inc.
6. 6
COMPONENTS
OF
SURVEILLANCE
Kenrad E. Nelson and Carolyn Masters Williams.
Infectious Disease Epidemiology: Theory and Practice, 3rd
edition. 2013.
âThe 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 changesâĻâ
Philippine Hospital Infection Control Society, Inc.
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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
changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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
changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ
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 changesâĻ
Xy = a+b+c ; y= mc â rtaâ 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
īŽ Use standardized written case definitions to
ensure precise surveillance. Where available
and applicable, use previously published,
validated definitions.
īŽ For accurate and valid comparisons of data,
use the same definitions over time.
Philippine Hospital Infection Control Society, Inc.
8. 8
Collection
īŽ Know your population to determine which
subset requires targeting
īŽ Assess your capability to identify your method
of data collection
Data Management
īŽ Combine only homogenous data
â Always qualify and describe your data source
â May apply risk stratification to ensure homogeneity
īŽ Comparisons are valid only if all contributors
to the data have:
â used the same surveillance intensity
â used similar data collection methods
â applied the same surveillance definitions
â addressed differences in populations/case mix
â stratified data as appropriate
9. 9
Data Management
īŽ 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
īŽ Timely
īŽ Simple and understandable
īŽ Relayed to the relevant persons
10. 10
OUTLINE
īŽ Definition of Surveillance
īŽ Goals of Surveillance
īŽ Components of Surveillance
īŽ Steps in Surveillance of
Nosocomial Infection
STEPS IN SURVEILLANCE
FOR NOSOCOMIAL
INFECTIONS
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
Surveillance Strategies for
Case Findings
īŽ Scope of
infection control
program
īŽ Patient or
Laboratory -
based
īŽ Active
vs
Passive
īŽ Retrospective
vs
Prospective
or concurrent
īŽ 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
1. Hospital-Wide Surveillance
(TRADITIONAL)
Advantage
īŽ MOST comprehensive
method
īŽ collects data on all
infection, sites, units
īŽ establishes baseline
infection rates
īŽ recognizes outbreaks
early
īŽ identifies clusters
īŽ increase visibility of
infection control
professional (ICP)
Disadvantage
īŽ expensive, labor intensive
labor , time-consuming,
yields excessive data
īŽ leaves little time to
analyze data and initiate
changes (no definite
management objective)
īŽ detects infections that can
not be prevented
īŽ Overall infection rate not
valid for interhospital
comparison
2. Limited Periodic Surveillance
Advantage
īŽ increases efficiency of
surveillance
īŽ liberates ICP to perform
other activities
īŽ utilized resources more
effectively
īŽ reduces time spent
doing surveillance by
45%
Disadvantage
īŽ provides data only
during periods in which
surveillance is
conducted
īŽ may miss cluster or
outbreaks during
nonsurveyed periods
14. 14
3. PREVALENCE
SURVEILLANCE
ADVANTAGE
īŽ documents nosocomial
infection trends identifies
risk factors
īŽ relatively quick and
inexpensive
īŽ identifies areas that need
additional surveillance
DISADVANTAGE
īŽ data collection may be
tedious
īŽ must collect data in short
time period
īŽ data are restricted to a
specified time period
īŽ cannot compare
prevalence rate with
incidence rates
īŽ few studies on prevalence
rates published
īŽ may miss clusters or
outbreaks
4. Targeted Surveillance
Advantage
īŽ focus on patient at risks; on infections
with known control measures to reduce
infection risk
īŽ concentrates limited resources on high-
risk areas
īŽ can determine valid denominator
Philippine Hospital Infection Control Society, Inc.
15. 15
4. Targeted Surveillance
Advantage
īŽ requires less personnel and
liberates ICP to perform other
activities
īŽ increases efficiency of surveillance
īŽ flexible - can be mixed with other
methods
Philippine Hospital Infection Control Society, Inc.
4. Targeted Surveillance
Disadvantage
īŽ no baseline rates in other units
īŽ collects data only for targeted
patients at risk
īŽ can miss clusters or outbreaks in
nonsurveyed areas or populations
Philippine Hospital Infection Control Society, Inc.
16. 16
4. Targeted Surveillance :
ROTATING
Advantage
īŽ less expensive
īŽ less time-consuming
īŽ less personnel
īŽ all areas of hospital
surveyed
Disadvantage
īŽ can miss clusters of
infection
Philippine Hospital Infection Control Society, Inc.
Objective / Priority Based
Surveillance
Advantage
īŽ adaptable to
hospital with special
interest and
resources
īŽ focuses on specific
problems of the
individual institution
Disadvantage
īŽ no baseline rates of
infection
īŽ may miss clusters /
outbreaks
17. 17
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Philippine Hospital Infection Control Society, Inc.
Sources of Data for
Surveillance
īŽ Laboratory-based
Information
īŽ Patient-based
Information
īŽ Other departments ,
services or agencies
18. 18
Sources of Data for
Surveillance
īŽ Patient-based Information
īŽ Patient examination
īŽ Clinical ward rounds
Sources of Data for
Surveillance
īŽ Patient-based
Information
īŽ Patient examination
īŽ 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
Patientâs name
Age
Sex
Hospital number
Ward service
Admission data
Infection onset
data
19. 19
Sources of Data for
Surveillance
īŽ Patient-based
Information
īŽ Patient examination
īŽ Clinical ward rounds
īŽ Communication with staff
īŽ Patient medical record
â Medication records
â Temperature records
â Radiology reports
â Laboratory reports
īŽ Kardex review
Sources of Data for
Surveillance
īŽ Patient-based
Information
īŽ Patient examination
īŽ Clinical ward rounds
īŽ Communication with staff
īŽ Patient medical record
īŽ Kardex review
īŽ Treatments, Wound dressing
changes
īŽ Intravenous fluids, Antibiotics
īŽ Urinary catheter, Surgery
īŽ Isolation precautions
20. 20
Sources of Data for
Surveillance
īŽ Laboratory-based
Information
īŽ Patient-based
Information
īŽ Bacteriology, Mycology,
Parasitology, Serology , Virology
and Pathology reports
īŽ Antimicrobial susceptibility
patterns
Sources of Data for
Surveillance
īŽ Laboratory-based
Information
īŽ Patient-based
Information
īŽ Other departments , services or agencies
īŽ Admission department
īŽ Operating suite
īŽ Emergency Department
īŽ Outpatient clinics
īŽ Risk Control (for
incident reports and
other data)
īŽ Employee health
21. 21
Sources of Data for
Surveillance
īŽ Laboratory-based
Information
īŽ Patient-based
Information
īŽ Other departments , services or agencies
īŽ Home-care agencies
īŽ Multicenter surveillance systems (e.g. NNIS)
īŽ 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
CASE-FINDING
METHODS
īŽ TOTAL CHART REVIEW
īŽ SELECTIVE MEDICAL RECORD
REVIEW BASED ON :
â 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
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
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
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
SURVEY
īŽ Incidence Rate (I)
No. of infections acquired in a month
No. of patients discharged in a month
=
26. 26
SURVEY
īŽ 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
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
īŽ Significant change in current rates
īŽ Monitor both rate and pattern of
endemic disease (significant fluctuation)
īŽ Tabulated data and analysis should be
distributed
īŽ Examine how component parts relates
īŽ Chi-square, Fisherâs test, Student T-test
Philippine Hospital Infection Control Society, Inc.
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
īŽ Key aspect of surveillance to assure
accuracy of data collection while being
efficient and cost-effective
Philippine Hospital Infection Control Society, Inc.
29. 29
VALIDATION
īŽ Concurrent surveillance
īŽ MD / Nurse Epidemiologist (Gold
Standard)
īŽ Prospective / Retrospective Review of
Charts
īŽ Examine the chart, microbiologic data
īŽ Various unit / staggered interval
Philippine Hospital Infection Control Society, Inc.
OUTLINE
īŽ Definition of Surveillance
īŽ Goals of Surveillance
īŽ Components of Surveillance
īŽ Steps in Surveillance of HAIs
31. 31
OUTLINE
Goals of antibiotic policy
Difficulties in formulating
antibiotic policies
Selected policies on
antibiotic usage
GOALS
īŽ To promote rational antibiotic use
īŽ To prevent or delay emergence of
resistant bacterial strains
32. 32
Difficulties in Formulating
Antibiotic Policies...
īŽ bacterial population differ
īŽ antibiotic resistance pattern differ
īŽ clinical choice varies
īŽ availability of antibiotics
īŽ cost of antibiotic varies
īŽ route of antibiotic varies
Antimicrobial Agent Team
Functions :
īŽSelection of Antimicrobial
agent -> Formulary
īŽEducational Programs
33. 33
1. Restriction of
antibiotic use
ANTIBIOTIC POLICIES
Classification of Antibiotics
Non-Restricted
īŽ 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
īŽ Examples: erythromycin, penicillin V,
co-trimoxazole, amoxicillin, tetracycline,
chloramphenicol
Adapted from:
UP-PGH HICCU Antibiotic Policy
34. 34
Classification of Antibiotics
Restricted
īŽ issuance of these antibiotics require
approval of an Infectious Disease
Consultants or ID Fellows
īŽ Examples: amoxicillin-clavulanic acid,
gentamicin, clindamycin , cefoxitin etc.
Adapted from:
UP-PGH HICCU Antibiotic Policy
Classification of Antibiotics
Very Restricted
īŽ issuance of these antibiotics require
approval of Infectious Disease
Consultants .
īŽ Only very limited stocks should be
made available in the pharmacy
Adapted from:
UP-PGH HICCU Antibiotic Policy
35. 35
Classification of Antibiotics
Very Restricted
īŽ indicated for treatment of life-
threatening infections documented by
culture and sensitivity test, indicating
resistance to other effective and less
expensive antibiotics
īŽ 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
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
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
īŽ Review current practices for selected
indications
â prophylactic antibiotics in surgery
â antibiotics for specific infections
īŽ Gross utilization data based on pharmacy
record
38. 38
Methods to Evaluate
Antimicrobial Use in Hospital
A. PATTERN OF USE OF ANTIBIOTICS
BY MEDICAL STAFF
īŽ Survey of usage on individual services
īŽ Survey of routine orders for prophylaxis in
surgery
īŽ Survey of orders for specific infectious dse
īŽ Case review by independent cases
īŽ Guidelines for audit
Methods to Evaluate
Antimicrobial Use in Hospital
B. TRENDS
īŽ identify yearly purchase
īŽ identify consumption of
â each agent
â each group drugs (cephalosporins, etc.)
â each class (antibacterial, etc.)
39. 39
Methods to Evaluate
Antimicrobial Use in Hospital
C. DATA
īŽ number of units (grams), cost for each agent
īŽ number of patients treated with each drug
1. Restriction of
antibiotic use
2. Limited
susceptibility
reporting
3. Concurrent
monitoring of
antibiotic usage
4. âAudit of Useâ
ANTIBIOTIC POLICIES
40. 40
ANTIBIOTIC AUDIT
Some Practices that warrant auditingâĻ
īŽ orders for antibiotics in the absence
of minimal diagnostic procedures
īŽ concurrent use of more than 2
antibiotics
īŽ use of more than 5 antibiotics during
a single hospitalization
īŽ continuous treatment with
antimicrobial agents for more than 21
days
ANTIBIOTIC AUDIT
Some Practices that warrant auditingâĻ
īŽ use of parenteral drugs when
identical oral preparation can be
used
īŽ prophylactic use in surgery for >48
hours
īŽ procedure for which prophylaxis is
NOT an accepted practice
41. 41
ANTIBIOTIC AUDIT
Some Practices that warrant auditingâĻ
īŽ use of aminoglycosides without
obtaining a measure of renal function
īŽ 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. âAudit of Useâ
5. âAutomaticâ Stop
Order
ANTIBIOTIC POLICIES
42. 42
EMPIRIC THERAPY
īŽ treatment of suspected serious or
life-threatening infection pending
results of culture and sensitivity
tests
īŽ Initial dose may be issued for 24
hrs BUT subsequent doses will
need approval of the Antimicrobial
Agent Team
Antimicrobial Agent Team
Composition :
īŽ Infectious disease physician
īŽ Infection control practitioner
īŽ Clinical Microbiologist
īŽ Clinical Pharmacists
Example: Philippine General Hospital (PGH)
Antibiotic Surveillance and Control Team
(Infectious Disease Consultants and Fellows)
43. 43
DEFINITIVE THERAPY
īŽ Treatment of serious or life-threatening
infection documented by culture and
sensitivity tests
īŽ a 7-day automatic stop order shall be
implemented
PROPHYLAXIS USE
īŽ use to prevent infectious complications
in high risk setting
â Aminoglycosides : Netilmycin
â Cephalosporins : Cephalothin , Ceftriaxone
â Pen with BLI : Amoxiclav or Ampicillin-
sulbactam
â Quinolones : Ciprofloxacin
â Anaerobic Infection : Metronidazole,
Clindamycin
44. 44
1. Restriction of
antibiotic use
2. Limited
susceptibility
reporting
3. Concurrent
monitoring of
antibiotic usage
4. âAudit of Useâ
5. âAutomaticâ Stop
Order
6. Hospital Formulary
ANTIBIOTIC POLICIES
HOSPITAL FORMULARY
īŽ Lists the indication
for which the
antibiotics are
required
īŽ List the categories
of antibiotics
īŽ List the antibiotics
that are similar in
spectrum, safety,
kinetics
45. 45
HOSPITAL FORMULARY
īŽ Draft an antibiotic policy
īŽ Discuss the draft policy
with the clinicians
īŽ When policy has been
agreed, inform
Microbiology section
and Pharmacy
īŽ Enter the policy in the
hospital formulary
īŽ Review the policy
periodically
ãããã¨ã (JP) Thank you (En)
Arigatou