3 Surveillance Flashcards
Surveillance has been described as systematic collection, analysis, and interpretation
of data on specific events/infections and disease, followed by dissemination of that
information to those who can improve the outcomes.
What are the objectives of surveillance?
◆ Establish endemic/baseline rate of infections as part of benchmarking exercise .
◆ Compare HCAI rates within/between health care facilities .
◆ Convince the clinical team to adopt best practices .
◆ Reduce HCAIs rates within health care facilities by introducing evidence-based
and cost-effective interventions .
◆ Identify and control outbreaks
◆ Evaluate success of IPC interventions using both outcome and process monitoring
tools.
Objectives need to be tailored to local hospital, and prioritised based on resources available
What are the most common HCAI?
UTI - catheter related
LRTI - ventilated related usually
Surgical site infections
Bacteraemia associated with intravascular devices
How do we define HCAI?
An infection is classified as HCAI if it was not present or incubating at the time the patient was admitted to the health care facility.
Infections should be considered as HCAIs if they are related to procedures, treatments, or other events.
Most HCAIs appear before the patient is discharged, although some are incubating at discharge and do not become apparent until later. Thus, an infection is not considered a HCAI if it represents a complication or extension of an infectious process present on admission.
When trying to define HCAI, what timeframe do we use?
In general, infections that occur more than 48–72 hours after admission and within 10 days after discharge from the health care facility are defined as HCAIs.
The time frame is modified for infections that have incubation periods less than 48–72 hours (e.g. gastroenteritis caused by Norwalk virus) or longer (e.g. viral hepatitis B and C).
Surgical site infections are considered as HCAI if the infection occurs within 30 days after the operative procedure or within 1 year if a device or foreign material is implanted.
What are sources of surveillance data?
Electronic patient record
Laboratory date
Ward-liaison - attending ward to discuss all infected patients
What are different types of targeted surveillance?
Site specific
Unit specific - e.g ITU
Rotating - through all wards. May miss clusters, or over/underestimate
Outbreak - although does not provide baseline infection rate
Limited periodic - e.g respiratory infections during winter
Priority based - focussing on specific issue at institution
Syndromic - can help identify an early outbreak
What are the draw-backs of surveillance?
expensive
resource intensive
time-consuming
need specialist staff - IT, statisticians, microbiology
What are the draw-backs of surveillance?
expensive
resource intensive
time-consuming
need specialist staff - IT, statisticians, microbiology
What are examples of alert organisms - bacteria
◆ MRSA, other resistant Staph. aureus , and
Panton–Valentine leucocidin (PVL)
◆ Streptococcus pyogenes (Group A Streptococcus )
◆ Streptococcus agalactiae (Group B Streptococcus )
◆ Penicillin-resistant Streptococcus
pneumoniae (PRP)
◆ Influenza virus
◆ Legionella spp.
◆ Glycopeptide/vancomycin-resistant enterococci
(GRE/VRE)
◆ Pathogenic Neisseria spp.
◆ Clostridium spp., e.g. C. difficile
◆ Salmonella or Shigella spp.
◆ Escherichia coli 0157
◆ Multi-resistant Gram-negative bacilli,
e.g. ESBL, NDM beta-lactamase
◆ Any unusual bacteria e.g. Legionella
What are examples of alert organisms - viruses
◆ Rotavirus ◆ Norovirus and other small round structured virus ◆ Respiratory syncytial virus ◆ Chickenpox/varicella zoster ◆ Measles ◆ Mumps ◆ Rubella ◆ Parvovirus
What information does surveillance data tell you?
Tells you the magnitude of the problem at a specific time
Does not tell you the cause of the problem
What is process surveillance?
Monitoring of steps in the process of controlling an infection
For example, surveillance counts number of MRSA cases
Process surveillance would monitor number of staff washing hands, and number of staff using skin prep for cannulas. This way we can identify early failures in the process.
Monitoring care bundle compliance is an example of process surveillance
