by Ms. Dominga C. Gomez

1. ORIENTATION TO
SURVEILLANCE
Dominga C Gomez, R.N.

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.  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. Sites of HCAIs
 UTI- Urinary tract Infections
 Surgical Site Infection
 Bloodstream infection
 Pneumonia
 Bone and joint infection
 Central Nervous System
 Cardiovascular
 Systemic Infection

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. SURVEILLANCE
 “…is used to identify nosocomial
infections and other adverse events that
may be prevented…”

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. SURVEILLANCE
 “…is used to establish endemic rates
of health-related events or
diseases…”

9. COMPONENTS
OF
SURVEILLANCE

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. Components of
Surveillance
 DEFINITIONS
– develop
standardized
definitions
– gain widespread
acceptance of
the criteria for the
definition

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. 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. 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. 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. Components of
Surveillance
 DEFINITIONS
 COLLECTING
DATA
– Concurrent
– Retrospective

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. 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. Components of
Surveillance
 DEFINITIONS
 COLLECTING
DATA
 MANAGING
DATA

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. Components of
Surveillance
 DEFINITIONS
 COLLECTING
DATA
 MANAGING
DATA
 ANALYZING
DATA

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. 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. Components of
Surveillance
 DEFINITIONS
 COLLECTING DATA
 MANAGING DATA
 ANALYZING DATA
 COMMUNICATING
RESULTS

25. SURVEILLANCE FOR
NOSOCOMIAL
INFECTIONS

26. SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Validation

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. 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. Sources of Data for
Surveillance
 Laboratory-based
Information
 Patient-based
Information
 Other departments ,
services or agencies

30. Sources of Data for
Surveillance
 Patient-based
Information
 Patient examination
 Clinical ward rounds

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. 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. 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. 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. SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates

36. SURVEY
 Incidence Rate (I)
No. of infections acquired in a month
No. of patients discharged in a month
=

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. SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation

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. SURVEILLANCE FOR
NOSOCOMIAL INFECTIONS
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Validation

41. VALIDATION
 Key aspect of surveillance to assure
accuracy of data collection while being
efficient and cost-effective

42. VALIDATION
 Concurrent surveillance
 MD / Nurse Epidemiologist (Gold
Standard)
 Prospective / Retrospective Review of
Charts
 Examine the chart, microbiologic data
 Various unit / staggered interval

43. OTHER FORMS OF
SUVEILLANCE
 HAND HYGIENE
 VAP BUNDLE
 5S