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Orientation to Surveillance

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by Ms. Dominga C. Gomez

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Orientation to Surveillance

  1. 1. ORIENTATION TO SURVEILLANCE Dominga C Gomez, R.N.
  2. 2. Healthcare Associated Infection (Nosocomial)  CDC/NATIONAL HEALTHCARE SAFETY NETWORK DEFINITION – Localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent or its toxins. There must be no evidence that the infection was present or incubating at the time of admission to the acute care setting.
  3. 3.  Endogenous- body sites such as skin. Nose, mouth ,git, vagina that are normally inhabited by microorganisms  Exogenous-external to the patients such as other patients, hcws, visitors, equipment, medical devices or healthcare environment Sources of infectious agents
  4. 4. Sites of HCAIs  UTI- Urinary tract Infections  Surgical Site Infection  Bloodstream infection  Pneumonia  Bone and joint infection  Central Nervous System  Cardiovascular  Systemic Infection
  5. 5. SURVEILLANCE  “The ongoing systematic collection, analysis and interpretation of healthcare data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those contributing data or to other interested groups who need to know.” Lennox K. Archibald and Walter J. Hierholzer, Jr. C. Gen Mayhall’s Hospital Epidemiology and Infection Control. 3rd Edition. 2004. Page 5
  6. 6. SURVEILLANCE  “…is used to identify nosocomial infections and other adverse events that may be prevented…”
  7. 7. Goals of Surveillance  to define endemic rates  to identify increases in infection rates  to identify specific risks  to inform hospital personnel of the risks of the cares or procedures they provide
  8. 8. SURVEILLANCE  “…is used to establish endemic rates of health-related events or diseases…”
  9. 9. COMPONENTS OF SURVEILLANCE
  10. 10. “The building blocks of surveillance comprise collecting relevant data systemically for a specified purpose and during a defined period of time, managing and organizing the data, analyzing and interpreting the data and communicating the results to those empowered to make beneficial changes…” Jean M Pottinger, Loreen A. Herwaldt and Trish M. Perl. Infection Control and Hospital Epidemiology. July 1997. Vol. 18 No. 7 page 513
  11. 11. Components of Surveillance  DEFINITIONS – develop standardized definitions – gain widespread acceptance of the criteria for the definition
  12. 12. Components of Surveillance  DEFINITIONS Definition of Nosocomial Infection  Clinical – direct observation (surgery, procedure)  Laboratory – microscopic, culture, antigen-antibody  Other diagnostic test – radiograph, wbc count  Physicians’ Diagnosis - ACCEPTED
  13. 13. Example  SUTI  Fever, urgency, dysuria or suprapubic tenderness and a positive and a positive culture that is greater or equal to 10 to the fifth per cc of urine with no more than 2 species of microorganisms
  14. 14. Not HCAI  Infections associated with complications or extensions of infections already present on admission unless a change in pathogen or symptoms strongly suggest the acquisition of new infection  Reactivation of a latent infection e.g. herpes, tb, syphilis
  15. 15. Not infection  Colonization- the presence of microorganisms on skin. Mucous membranes, open wound, or in excretions or secretions but are not causing adverse clinical symptoms  Inflammation-result from tissue response to injury or stimulation by non infectious agents , i.e. chemicals
  16. 16. Components of Surveillance  DEFINITIONS  COLLECTING DATA – Concurrent – Retrospective
  17. 17. Components of Surveillance  COLLECTING DATA  Concurrent – epidemiology staff collect data at the time the event occurs and shortly thereafter – this allows infection control staff to review the medical record, assess the patient, and discuss the event with care givers – additional information may be available, such as ward log books and nursing reports
  18. 18. Components of Surveillance  COLLECTING DATA  Retrospective – the epidemiology team collects data after the patient is discharged – dependent on the completeness, accuracy and quality of the medical records – does not identify problems as promptly as concurrent surveillance
  19. 19. Components of Surveillance  DEFINITIONS  COLLECTING DATA  MANAGING DATA
  20. 20. Components of Surveillance MANAGING DATA  Objective: to identify patterns or trends  Data should be organized in a meaningful fashion  record surveillance data systematically on a flow sheet or line-listing ( e.g. columnar accounting paper or use of database of computer)
  21. 21. Components of Surveillance  DEFINITIONS  COLLECTING DATA  MANAGING DATA  ANALYZING DATA
  22. 22. Components of Surveillance ANALYZING DATA  should be done promptly and be able to identify problems quickly and make changes that reduce the risk of infection  analysis of data should be done regularly depending on the purpose of surveillance and nature of nosocomial event
  23. 23. Components of Surveillance ANALYZING DATA  compute incidence of event and compare data over time  for microbiologic data, better do focused microbiologic surveillance on specific units  finally, data should be intrepreted
  24. 24. Components of Surveillance  DEFINITIONS  COLLECTING DATA  MANAGING DATA  ANALYZING DATA  COMMUNICATING RESULTS
  25. 25. SURVEILLANCE FOR NOSOCOMIAL INFECTIONS
  26. 26. SURVEILLANCE FOR NOSOCOMIAL INFECTIONS Identify Surveillance Strategy Data collection Case-Finding Method Consolidation and Tabulation Calculating Rates Analysis and Interpretation Validation
  27. 27. Surveillance Strategies for Case Findings  Scope of infection control program  Patient or Laboratory - based  Active vs Passive  Retrospective vs Prospective  Methods of Surveillance
  28. 28. Methods of Surveillance 1. Hospital-wide Surveillance (Traditional) 2. Limited Periodic Surveillance 3. Prevalence Surveillance 4. Targeted Surveillance : unit / site specific / rotational 5. Objective/Priority Based Surveillance
  29. 29. Sources of Data for Surveillance  Laboratory-based Information  Patient-based Information  Other departments , services or agencies
  30. 30. Sources of Data for Surveillance  Patient-based Information  Patient examination  Clinical ward rounds
  31. 31. Sources of Data for Surveillance  Patient-based Information  Patient examination  Clinical ward rounds Culture organism antimicrobial susceptibility pattern Clinical Data fever p.e. findings x-ray results Predisposing factors surgery chemotherapy antibiotics steroids underlying disease Exposure factor Patient’s name Age Sex Hospital number Ward service Admission data Infection onset data
  32. 32. Sources of Data for Surveillance  Laboratory-based Information  Patient-based Information  Other departments , services or agencies  Admission department  Operating suite  Emergency Department  Outpatient clinics  Risk Control (for incident reports and other data)  Employee health
  33. 33. Sources of Data for Surveillance  Laboratory-based Information  Patient-based Information  Other departments , services or agencies  Home-care agencies  Multicenter surveillance systems (e.g. NNIS)  Local and state health departments (e.g. MMWR)
  34. 34. CASE-FINDING METHODS  TOTAL CHART REVIEW  SELECTIVE MEDICAL RECORD REVIEW BASED ON : – Laboratory Reports, Kardex screening, Fever, Antibiotic use, Fever and Antibiotic use, Readmission, Autopsy reports, Ward Liason surveillance, Laboratory-based and ward-liason surveillance, risk-factor-based surveillance
  35. 35. SURVEILLANCE FOR NOSOCOMIAL INFECTIONS Identify Surveillance Strategy Data collection Case-Finding Method Consolidation and Tabulation Calculating Rates
  36. 36. SURVEY  Incidence Rate (I) No. of infections acquired in a month No. of patients discharged in a month =
  37. 37. SURVEY  Prevalence Rate (P) No of infections (ACTIVE) in hospitalized patients at the time of the survey No. of patients present at the time of the survey =
  38. 38. SURVEILLANCE FOR NOSOCOMIAL INFECTIONS Identify Surveillance Strategy Data collection Case-Finding Method Consolidation and Tabulation Calculating Rates Analysis and Interpretation
  39. 39. Data Analysis and Interpretation  significant change in current rates  monitor both rate and pattern of endemic disease (significant fluctuation)  tabulated data and analysis should be distributed  examine how component parts relates  Chi-square, Fisher’s test, Student T-test
  40. 40. SURVEILLANCE FOR NOSOCOMIAL INFECTIONS Identify Surveillance Strategy Data collection Case-Finding Method Consolidation and Tabulation Calculating Rates Analysis and Interpretation Validation
  41. 41. VALIDATION  Key aspect of surveillance to assure accuracy of data collection while being efficient and cost-effective
  42. 42. VALIDATION  Concurrent surveillance  MD / Nurse Epidemiologist (Gold Standard)  Prospective / Retrospective Review of Charts  Examine the chart, microbiologic data  Various unit / staggered interval
  43. 43. OTHER FORMS OF SUVEILLANCE  HAND HYGIENE  VAP BUNDLE  5S
  • MichaelPrades

    Nov. 28, 2018
  • meeyahcabrera

    Jul. 22, 2018

by Ms. Dominga C. Gomez

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