Hospital Surveillance

Impact of infectious diseases

IDs are considered to be the leading cause of death

Mass population movement Emerging and re-emerging microorganisms Food poisoning Antimicrobial drugs resistance Media attention

Why do we need to study hospital infections? Not all hospital infections are

preventable, but they are associated with Excess length of hospital stay Excess cost Excess mortality Law suits

What kinds of hospital infections exit?

Device-relatedBlood stream infections (BSI)Urinary tract infections (UTI)Ventilator-associated pneumonia (VAP)

Procedure-relatedSurgical site infections (SSI)

Environmental contaminationWater, disinfectant, etc.

Surveillance

Definition It is the continuous systematic collection, analysis,

interpretation and dissemination of data. That is essential to the planning, implementation and

evaluation of PH practice.

What are hospital infections? Two types of infections you find in

the hospitalHospital-acquired infectionsCommunity-acquired infections

How can we distinguish them?By latency periodCDC definition for NIs:

development of infections after 48 hours of admission

Surveillance

Why to do it? To know where you are To see if you are heading in the right direction

Importance Identification of cases Determination of infection sites Identification of factors contributing to infection

Purposes of surveillance

Reducing infection rates within the hospital Establishing endemic baseline rate Identifying outbreaks Convincing medical personnel Evaluating control measures Satisfying regulators Defending malpractice claims Comparing infection rates between hospitals

Data collection

Confirm that the “caught case” is truly nosocomial.Reviewing charts.Talking to the staff (doctors and nurses).

Numerator

What data to collect?

Demography

NameAgeGender

MRNService

WardAdmission date

Infection

Onset date

Site of infection

Laboratory

Pathogen(s)

Antibiogram

Cont…numerator

Who should collect the data? Infection control practitioner Personnel who interact with patients or review charts

Cont…numerator

Data can be collected for all patients care area: Hospital-wide surveillance

Data can be collected for certain groups in the hospital: Targeted surveillance

Cont…numerator

Source of dataAdmission dept., lab., wards, patients, charts.

How to collect data?Review laboratory records & then patients’

charts (this is to achieve case finding)

Denominator

What data to collect Patients-days, device-days (catheter, ventilator,

drainage, etc…). Data source and collection technique

mid-night census can be used You may seek the help of others to collect

denominators (admission office or computer dept.)

Data entry

Collect only necessary data Record data in a systematic formatting Organize data in a meaningful way:

Flow sheet or line-list. Computer data-base (excel, Epi-info, SPSS or

STATA).

Data analysis

Put the results of data collected into rates and ratios: A / B x 100 or 1000

For the numerator A use the number of nosocomial infection in particular group at risk.

Cont…

For the denominator B you may use one of the following: Number of admission or discharge in an interval Number of person undergoing a procedure Patient-days in the hospital or on a particular unit Number of device-days

Cont…

What are you approaching here is: Defining and calculating rates

Prevalence which include point prevalence and period prevalence

Both types count active cases of a disease in a defined population

Incidence which is the total number of a new cases of disease that occurs among given population during a specified period of time

Cont…

Comparing rates among patient groups The denominator must reflect the population at risk

Intrinsic risk factors Extrinsic risk factors

Comparing rates overtime The importance is risk related as major risks varies

overtime e.g. SSI are getting less than before as of hospital stay is getting

less

Cont…

Identifying outbreaks Looking at your trends

Assessing appropriateness of medical care Comparing different devices

Dissemination of data

Data should not be used for punitive purposes but rather to augment quality improvement efforts.

Narrative summaries and tabular graphic reports of surveillance data will be provided to the hospital infection control committee, executive director, general manager and head of departments.

Methods for hospital surveillance

Methods Sensitivity

Fever curve 47%

Antibiotic use 48%

Microbiology reports 33 – 65%

Review kardex 85%

Total chart review 90%

Clinical wards rounds Up to 100%

Why?

10 ICU beds in January 10 ICU beds in February 100 admissions Each patients stays for 1

day

10 NI

What is the rate of NI?

100 admissions

Each patient stays for 3 days

10 NI What is the rate of NI?

It is a 10% It is a 10%

But with a rate of 100/1000 days

But with a rate of 33.3/1000 days

Devices and procedures as major sources of hospital infections

Surgeries

Arterial/VenousCatheters

Urinary Catheters

Respirators

Cross-infections:

20-40%

Changes in flora due to antibiotic therapy :20-25% Others

: 20%

Patients’ own flora:

40-60%

BSI/1000 DDs

02468

1012141618

March April May June July

Months

IR /10

00 d

evic

e d

ays

UTI/1000 DDs

0

5

10

15

20

25

30

March April May June July

Months

IR /10

00 c

ath

eter

day

s

VAP/1000 VD

0

5

10

15

20

25

30

35

March April May June July

Months

IR /10

00 v

enti

lato

r d

ays

SSI/1000 Procedure

0

2

4

6

8

10

12

14

March April May June July

Months

SS

I

/

1000

Pro

ced

ure

0

1

2

3

4

5

6

7

BSI Pneumo SSI UTI Mixed Total

Aug

0

1

2

3

4

5

6

7

BSI Pneumo SSI UTI Mixed Total

Aug

Sept

0

1

2

3

4

5

6

7

8

BSI Pneumo SSI UTI Mixed Total

Aug

Sept

Oct

0

1

2

3

4

5

6

7

8

BSI Pneumo SSI UTI Mixed Total

Aug

Sept

Oct

Nov

0

1

2

3

4

5

6

7

8

BSI Pneumo SSI UTI Mixed Total

Aug

Sept

Oct

Nov

Dec

0

1

2

3

4

5

6

7

8

BSI Pneumo SSI UTI Mixed Total

Aug

Sept

Oct

Nov

Dec

Jan

0

1

2

3

4

5

6

7

8

BSI Pneumo SSI UTI Mixed Total

Aug

Sept

Oct

Nov

Dec

Jan

Feb