Epi, Surveillance, and Outbreaks Flashcards by Ash Schafer

study of the frequency, distribution, cause, and control of disease in populations- forms the basis of all health-related studies. Provides the background for interventions to reduce transmission of infecting organisms, reduce the number of healthcare ass infections, and protect hc providers from infection

epidemiology

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Main components of epi definition

frequency
distribution
cause
control

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Ds of epi

Distribution
Determinants
Deterrents

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How we describe determinants

Person
Place
Time

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epi triangle

Host
Agent
Env

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As one variable changes, there is a concomitant or resultant change in the quantity or quality of another variable

Association

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3 types of associations

artifactual (spurious)
Indirect or noncausal
causal

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This type of association may be caused by errors in study design or analysis, bias, errors in analysis, or failure to control for confounding variables

Artificial or spurious association

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this type of association may be caused by mixing of effects between the exposure, disease, and confounding variable that may be associated with the exposure and independently affect the outcome of interest

Indirect or noncausal

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This type of association occurs when evidence indicates that one factor is clearly shown to increase the probability of the occurrence of a disease

Causal

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The stronger the relation between a risk factor and the effect, the less likely it is that the relation is due to a third or extraneous factor

Strength of assocition

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Multiple studies in a range of settings report similar results

Consistency

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Ideally, the effect has only one cause

Specificity

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the purported cause should be present before the effect occurs

temporality

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A dose-response relation between the risk factor and the effect

Biological gradient

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there should be a rational the theoretical basis explaining how or why the risk factor led to the effect

Biological plausabiity

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The association should not conflict with known facts

Coherence

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Is there any supportive research based on experiment; if preventative action is taken, does the effect dissipate?

Experimental evidence

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A previously accepted phenomenon in one area can be applied to another

Analogy

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strength of association
consistency
specificity
temporality
biological gradient
biological plausibility
coherence
experimental evidence
analogy

Bradford Hill’s Criteria for Causation

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Level of prevention with the goal to complete prevention of diseases before any manifestation of that disease occurs

Primary

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Early dx and treatment and preventing further deterioration by intervention as early in the disease course as possible

secondary

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Reducing complications

Tertiary

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Examples secondary prevention

Screening
skin testing for TB
Mammograms

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Examples Primary prevention

Wellness programs Immunizations Folic Acid Exercise Seat Belts

Examples of tertiary prevention

Rehab Organ transplantation

the number of existent cases of a given disease at a given time

prevalence

An excess over the expected incidence of disease within a given geographical area during a specified time period

Epidemic

An epidemic spread over a wide geographical area, across countries or continents

Pandemic

The usual incidence of a given disease within a geographical area during a specified time period

Endemic

Is a sudden increase in occurrences of a disease in a particular time and place

Outbreak

The number of new cases of a given disease in a given time periods

incidence

The probability or likelihood of an event occurring

RIsk

A place in which an infectious agent can survive but may or may not multiple

Reservoir

A characteristic, behavior, or experience that increases the probability of developing a negative health status

Risk factor

An inanimate object on which organisms may exist for some period of time

Fomite

The resistance of a group to invasion and to spread of an infectious gent, based on the immunity of a high proportion of individual members of the group

herd immunity

Infection that is not present at the time of admission to the hospital, but are temporally associated with the admission to or a procedure performed in a healthcare faciity

Healthcare associated infection

Infection present on admission with no association to a recent hospitalization

Community acquired infection

Reasons for OBs (often multifactorial)

- lapses in IP - Colonization or infection for HCP - Defects or contamination of product or device

When should outbreaks in healthcare be suspected?

HAIs or adverse events occur above the baseline rate or when an unusual microbe or adverse event is recognized

Can 1 case of an unusual disease be an outbreak?

Yes

Outbreak investigation: confirm

confirm presence of an outbreak

Outbreak investigation: alert

alert key partners about the investigation

Outbreak investigation: research

Perform a literature review

Outbreak investigation: define

Establish a preliminary case definition

Outbreak investigation: finding cases

Develop methodology for finding cases

Outbreak investigation: line list

Prep line list and epi curve

Outbreak investigation: observation

observe and review potentially implicated patient care activities

Outbreak investigation: sampling

consider whether env sampling should be performed

Outbreak investigation: control

implement control measures

Follow up investigation components

- refine the case def - continue case finding and surveillance - review regulatory control measures - consider whether an analytic study should be performed

Organism response tier: - contains resistance mechanisms novel to the U.S. - Pan-resistant - needs more extensive evaluation to better define risk for transmission

Tier 1

Example of Tier 1

Pan-R OXA-23 Acinetobacter baumanni

Organism response tier: - primarily found if hc settings but not believe to be found regularly in the region - information is available about how transmission occurs and groups primarily at risk

Tier 2

Examples of Tier 2

-Cabapenem resistant enterobacteriaceae with novel mechanisms - VIM producing Pseudomonas aeruginosa - NDM-producing CRE - OXA-48 type producing CRE

Organism response tier: - already established in U.S. and have been identified in the region before - not endemic - info is available about transmission

Tier 3

Example of tier 3

-carbapenem-resistant Enterobacteriaceae producing Klebsiella pneumoniae carbapenemase in regions where organism more commonly identified

What shows facilities with need for improvement?

TAP- targeted assessment prevention

What is CAD?

Cumulative attributable dif (# of infections to prevent to meet goals)

Elements of a successful surveillance program : methods

Select methodology