1. EPIDEMIOLOGY KSU College of Applied Medical Sciences CHS 334 Epidemiology Mohammed S. Alnaif, PhD alnaif@ksu.edu.sa 28/12/1437Dr. Mohammed ALnaif 1

2. 2 Nosocomial infection Any infection that is not present or incubating at the time the patient is admitted to the hospital Hospital Epidemiology

3. 3 Why do we need hospital epidemiology?? Hospitals are complex institutions where patients go to have their health problem diagnosed and treated However, hospitals and medical/surgical interventions introduce risks that may harm a patient’s health Hospital Epidemiology

4. 4 Consequences of Nosocomial Infections Additional morbidity Prolonged hospitalization Long-term physical, developmental and neurological sequelae Increased cost of hospitalization Death Hospital Epidemiology

5. 5 Challenges to the hospital epidemiologist Make a hospital safe ◦ Prevent harm to the patient and employees  initial focus on infectious diseases  increasingly all adverse (harmful) events are targets Improve hospital efficiency ◦ Eliminate unnecessary costs ◦ Eliminate wasteful practices Hospital Epidemiology

6. 6 What is hospital epidemiology? The fundamental roles of hospital epidemiology are to: Identify risks Understand risks Eliminate or minimize risks Hospital Epidemiology

7. 7 What is the role of hospital epidemiology? Identify risks to patient’s health Find nosocomial infections surveillance Identify and study risk factors for nosocomial infection understand epidemiologic principles and methods case-control and cohort studies, bias, confounding understand nosocomial pathogens what is it about hospitalization that increases risk? Hospital Epidemiology

8. 8 What is the role of hospital epidemiology? Eliminate or minimize risks to a patient’s health O rganize care to minimize risk eliminate risk factors work around risk factors develop improved policies and procedures educate physicians and nurses regarding risks study risk factors to learn more about them and how to eliminate them Hospital Epidemiology

9. 9 Responsibilities of the Infection Control Program Surveillance of nosocomial infections Outbreak investigation Develop written policies for isolation of patients Development of written policies to reduce risk from patient care practices Cooperation with occupational health Cooperation with quality improvement program Hospital Epidemiology

10. 10 Responsibilities of the Infection Control Program Education of hospital staff on infection control Ongoing review of all aseptic, isolation and sanitation techniques Monitoring of antibiotic utilization Monitoring of antibiotic resistant organisms Eliminate wasteful or unnecessary practices Hospital Epidemiology

11. 11 Areas of interest to a hospital epidemiologist Surveillance for nosocomial infection bloodstream infections pneumonia urinary tract infections surgical wound infections Patterns of transmission of nosocomial infections Outbreak investigation Isolation precautions Evaluation of exposures Hospital Epidemiology

12. 12 Areas of interest to a hospital epidemiologist Employee health Disinfection and sterilization Hospital engineering and environment water supply air filtration Reviewing policies and procedures for patient care Hospital Epidemiology

13. 13 Areas of interest to a hospital epidemiologist Antibiotic use Antibiotic resistant pathogens Microbiology support National regulations on infection control Infection control committee Quantitative methods in epidemiology Hospital Epidemiology

14. 14 Organizing for Infection Control Requires cooperation, understanding and support of hospital administration and medical/surgical/nursing leadership There is no simple formula: Every hospital is different Every hospital’s problems are different Every hospital’s personnel are different The hospital must develop its own unique program Hospital Epidemiology

15. 15 Essential Components of an Effective Infection Control Program One full time infection control practitioner per 250 beds optimal ratio may be different A physician with training and expertise in infection control Surveillance and feedback of rates to clinicians Control activities (interventions, policies, training) Hospital Epidemiology

16. The quality of a hospital's or health center's infection control program is a reflection of the overall standard of care provided by that institution. Good infection control programs reduce nosocomial infections, length of stay in the hospital, and costs associated with hospitalization. 9/30/2016Dr. Mohammed ALnaif 16

17. Hospital Epidemiology Countries with developed health care systems have responded to the need to control hospital infections, by establishing infection control programs that span the spectrum of hospital practice and clinical activity and provide means of evaluating the outcome of infection by clinical audit. Good programs develop standards for quality care of patients that are integrated into clinical practice. 9/30/2016Dr. Mohammed ALnaif 17

18. Hospital Epidemiology In developing health care programs, however, the situation is different. Infection control programs are either in their infancy or nonexistent. Individual hospitals and physicians struggle to establish programs with little support from policy makers and government officials. Infection control is considered a low priority. 9/30/2016Dr. Mohammed ALnaif 18

19. Hospital Epidemiology Mission The mission of the Department of Hospital Epidemiology and Infection Control at the Johns Hopkins Hospital is to support the institution's tripartite mission of research, teaching, and patient care; to promote patient safety by reducing the risk of acquiring and transmitting infections; and to be a leader in healthcare epidemiology and infection control. 9/30/2016Dr. Mohammed ALnaif 19

20. Hospital Epidemiology The Department of Hospital Epidemiology Hospital Epidemiology Departmental Functions Perform comprehensive surveillance for healthcare-associated infections and epidemiologically significant organisms Identify and investigate clusters or outbreaks of infection Analyze procedure and device-associated infections Create evidence-based interventions to prevent healthcare-associated infections 9/30/2016Dr. Mohammed ALnaif 20

21. Hospital Epidemiology The Department of Hospital Epidemiology Hospital Epidemiology Departmental Functions Evaluate methods and technologies to reduce transmission of pathogens within the institution Create and maintain appropriate infection control policies Develop and maintain educational programs regarding infection control for all hospital employees, physicians, and trainees Provide consultation to health care providers in the assessment and management of patients and employees with communicable diseases 9/30/2016Dr. Mohammed ALnaif 21

22. Hospital Epidemiology The Department of Hospital Epidemiology Hospital Epidemiology Departmental Functions Provide input for the content and scope of occupational health and safety programs related to infection control and prevention Advise senior leadership on issues related to reduction of infection risks and regulatory requirements Administer ongoing programs and initiatives for continuous quality assessment, quality improvement, and infection risk reduction (e.g. hand hygiene promotion and monitoring). 9/30/2016Dr. Mohammed ALnaif 22

23. The modern hospital epidemiologist has broad perspectives and influence across clinical departmental lines. The opportunities to improve patient care by expanding traditional areas of focus beyond infection control are great. Useful skills include epidemiology, communication, and respect for colleagues. 9/30/2016Dr. Mohammed ALnaif 23

24. The hospital epidemiologist needs training in methods for surveillance, prevention, and control of nosocomial infections. The hospital epidemiologist also must know how to apply these methods to other areas, including the epidemiology of noninfectious adverse outcomes of medical care. 9/30/2016Dr. Mohammed ALnaif 24

25. Hospital epidemiologists are professionals who use their knowledge and skills to determine the potential causes of disease and find out how diseases spread. Hospital epidemiologists translate their expertise into institutional policy and gain the support of administrators through the infection control committee. 9/30/2016Dr. Mohammed ALnaif 25

26. The infection control committee is the arm of hospital administration that regulates most infection control activities throughout the organization. Committee members have the important task of helping disseminate information to all important hospital constituencies. 9/30/2016Dr. Mohammed ALnaif 26

27. Purpose of the Infection Control Committee The infection control committee is responsible for assuring that the internal hospital environment minimizes the exposure of both patients and hospital personnel to infectious complications. It therefore develops policies and procedures relative to infection control and assures accurate reporting of infections occurring in the hospital. 9/30/2016Dr. Mohammed ALnaif 27

28. Purpose of the Infection Control Committee The committee's purpose is to ratify the ideas of the infection control team and to disseminate infection control information. The committee provides the political support that empowers the infection control team to implement infection control policies. 9/30/2016Dr. Mohammed ALnaif 28

29. Purpose of the Infection Control Committee Committee members who understand the policies will take critical information to their work areas where they can relay it to peers. The committee itself does not do the actual work of infection control and rarely generates independent ideas. 9/30/2016Dr. Mohammed ALnaif 29

30. Committee Membership The hospital epidemiologist should recruit people who can help the committee meet its goals. The committee should include a core group that does the real day-to-day work of infection control. 9/30/2016Dr. Mohammed ALnaif 30

31. Committee Membership The infection control "team" should includes the hospital epidemiologist, the infection control professionals, the clinical microbiologist, and the employee health director, the people who perform surveillance, analyze trends, and develop policies. 9/30/2016Dr. Mohammed ALnaif 31

32. Committee Membership Other members should represent important department, depending on the structure of the health care organization; administration, nursing, family practice, internal medicine, surgery, pediatrics, pharmacy, and central services. 9/30/2016Dr. Mohammed ALnaif 32

33. Committee Chair The chair of the infection control committee is usually the hospital epidemiologist. He or she is often an infectious disease specialist or medical microbiologist with training in infection control. 9/30/2016Dr. Mohammed ALnaif 33

34. Logistics The committee should meet at a set time and place monthly or quarterly, on the same week of the same month and day of the week. The committee members should receive the agenda several days in advance to remind them of the meeting and to allow them to prepare for it. 9/30/2016Dr. Mohammed ALnaif 34

35. Getting Things Done To keep things running smoothly in today's bureaucratic environment, the hospital epidemiologists must prepare extensively before each meeting. He or she must know who is in the power structure and gain their support ahead of time. Once he or she has gained the administrator's approval, you should have the authority to implement the policy as needed. 9/30/2016Dr. Mohammed ALnaif 35

36. Getting Things Done The hospital epidemiologist should consult with persons who have expertise in the area addressed by the proposed policy. It would be wise to have the expert present relevant background data at the infection control meeting. 9/30/2016Dr. Mohammed ALnaif 36

37. Getting Things Done Finally, you should identify people who are likely to oppose your goal. If you talk with opponents individually in a non-confrontational manner before the meeting, you may disarm them and win their support. 9/30/2016Dr. Mohammed ALnaif 37

38. Minutes The minutes of the infection control committee are a legal document. They record the topics that the committee discussed and the policies or procedures that the committee approved. 9/30/2016Dr. Mohammed ALnaif 38

39. Minutes An appointed secretary should compose them with care. Copies should be sent to committee members for review. The committee should approve the minutes at the next scheduled meeting. 9/30/2016Dr. Mohammed ALnaif 39

40. Meeting Agenda The agenda should be structured so that the meeting will finish within its allotted time. "Old business" should be limited to updates on items of ongoing interest, for example outbreaks, TB, or antibiotic-resistant organisms. "New business" at each meeting should include a brief summary of surveillance data. 9/30/2016Dr. Mohammed ALnaif 40

41. Meeting Agenda Overly detailed reports of infection rates usually do not interest the full committee. You should discuss new policies or procedures and substantial revisions to current protocols. 9/30/2016Dr. Mohammed ALnaif 41

42. Meeting Agenda You should try approving one new policy or procedure per meeting and do not schedule a policy for discussion until your team has thoroughly reviewed the literature and sought the advice of clinical experts. 9/30/2016Dr. Mohammed ALnaif 42

43. Reassessment The infection control committee should periodically reassess its performance. Infection control team members should list and evaluate their accomplishments and state their priorities. This way the infection control committee can adapt to changes in the health care environment. 9/30/2016Dr. Mohammed ALnaif 43

44. THANK YOU 9/30/2016Dr. Mohammed ALnaif 44