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NOSOCOMIAL INFECTION SURVEILLANCE METHODS Masud Yunesian, M.D., Epidemiologist.

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Presentation on theme: "NOSOCOMIAL INFECTION SURVEILLANCE METHODS Masud Yunesian, M.D., Epidemiologist."— Presentation transcript:

1 NOSOCOMIAL INFECTION SURVEILLANCE METHODS Masud Yunesian, M.D., Epidemiologist

2 Definition A dynamic process of gathering, managing, analyzing and reporting data on events that occur in a specific population

3 Importance : SENIC study: Surveillance was the only component essential for reducing SSI, Pneumonia, UTI, & bacteremia. Other essential components: –Sufficient no. of trained infection control staff and A system for reporting infection rates of SSI to surgeons.

4 Steps in surveillance: Definition of the event(s). Systematic collection of data. Summarization of data. Analysis & interpretation. Consuming the results for improvement.

5 Purposes of the surveillance-1 1.Reducing the infection rate within a hospital. 2.Establishing endemic (baseline) rates. 3.Identifying outbreaks.

6 Purposes of the surveillance-2 4. Convincing medical staff. 5. Satisfying regulators. 6. Defending malpractice claims. 7. Comparing infection rates among hospitals.

7 Surveillance methods-1 1.Concurrent 2.Retrospective

8 Concurrent Flexible, Informative Timely Capable of cluster detection Capable of changing behavior But expensive

9 Depends on completeness, validity & accuracy of existing data. Does not identify problems as promptly as concurrent does. But isn’t expensive. Retrospective

10 Surveillance methods-2 Active : accurate complete expensive Passive : misclassification underreporting lack of timeliness less expensive

11 Surveillance methods-3 Hospital wide. Periodic. Targeted. Defining the threshold limit. Post discharge.

12 Hospital wide surveillance Sources of data: 1.Daily reports of microbiology labs. 2.Medical records of febrile patients. 3.Medical records of patients taking antibiotics. 4.Medical records of isolated patients 5.Daily interview with nurses & patients 6.Periodic review of autopsy reports 7.Periodic review of medical records of staff.

13 Periodic surveillance(S.): Hospital wide (H.W.S) during specified periods, And, –Targeted S. during alternate periods Or, –Rotating H.W.S. from one unit to another

14 Targeted surveillance Focuses its effort on : –Selected geographic area (e.g. ICU) –Selected service (e.g. cardio thoracic surgery) –Specific populations of patients or infections: At high risk of acquiring infection ( e.g. transplantation) Undergoing specific interventions( e.g. dialysis) At specific site (e.g. blood stream)

15 Characteristics of targeted S. High accuracy & efficiency. Incapable of detecting other infections. Criteria for selection of target : –Frequency. –mortality & morbidity. –Cost. –preventability.

16 Defining the threshold limits

17 Case finding issues Total chart review (standard method). Laboratory reports. Clinical ward rounds (twice a week). Kardex screening (once or twice a week). Fever chart. High risk patients (transplant, diabetic, leukemia, invasive methods,.. )

18 Analysis-1 The data should be analyzed. The analysis should be done by staff engaged in surveillance. Staff should decide how frequently to analyze the data: –Frequently enough to detect clusters promptly. –Collecting the data for a long enough period of time for changes to be meaningful.

19 Analysis-2 Numerator & Denominator

20 Overall rate = N o. of NI Total no. of admitted or discharged patients

21 Adjusted rates For severity of illness. For length of stay. For exposure to device (e.g. ventilator)

22 Essential numerator data: Demographic : –name, age, sex, service, ward,admission date, hospital identification number. Infection : –onset date, site of infection. Laboratory : –pathogen antibiogram

23 Numerator data : Risk factors “only when these data used for analysis” An example for SSI: Kind of surgery. Date of surgery. Duration of surgery. Type of wound (clean,dirty, …). Date of discharge.

24 Denominator data: Total no. of admitted or discharged pts. OR No. of days of exposure : –Total no. of pts. & pt-days in the unit, –Total no. of ventilator days, –Total no. of central line days, –Total no. of urinary catheter days.

25 Comparing rates necessary assumptions: Same definitions. Same methods of S. & case finding. Same accuracy of methods & personnel. Same characteristics of hospitals/wards: –Length of stay, –Risk indices, –exposure to devices, –...

26 “Dissemination” “Surveillance is not complete until the results are disseminated to those who use it to prevent and control”

27 dissemination - continued Confidentiality must be regarded Regular time intervals for reporting. Format of reports : –Summary, table, graph

28 Evaluation At least annually ask yourself : –Did the system detect clusters ? –Which practices were changed based on S. ? –Were the data used to decrease the endemic rate ? –Were the data used to assess the efficacy of interventions ? –Are administrative & clinical staff aware of Surveillance Findings ?


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