Surveillance Flashcards
1
Q
when would you use syndromic surveillance?
A
to help quickly identify potential cases, allowing for a faster response
2
Q
define syndromic surveillance
A
the collection and analysis of pre-diagnostic and non clincal disease indicators using pre-existing electronic data, usually collected on a daily basis
3
Q
what are some benefits of histograms?
A
-idenfity diferent data, the frequency of occurence, and categories.
-shows largest and smallest categories and immediately gives the distribution of the data
4
Q
describe the null hypothesis
A
states there is no difference
5
Q
what is a type 1 error?
A
the null hypothesis is rejected despite being true
6
Q
what are the 4 types of data?
A
- nominal
- ordinal
- interval
- raito
7
Q
define event data
A
a mixture of qualitative and quantiative data; includes HAIs and BBP exposures
8
Q
define the wheel of causation
A
a hub (host or human) with an inner core of genetic information.
the environment surrounding the host is divided into physical, biological, and social. the size of each component is related to disease process under consideration. (i.e., genetic core is large for heritary disease and small for childhood viral diseases)
9
Q
epidemiology provides information in what areas?
A
-community and preventative medicine
-analysis of health assessments
-safety programs
-utilization review and management of resources
-health planning and resources
10
Q
the 3 levels of prevention are sometimes referred to as what
A
Leavell’s levels
11
Q
define secondary prevention
A
early diagnosis of disease so treatment can begin and prevent further consequences of disease.
-TB skin tests, mammograms to detect breast cancer early, stopping people smoking who have chronic bronchitis
12
Q
define tertiary prevention
A
improve quality of life by reducing disability and restoring function to the greatest extent possible.
-rehab
-organ transplant
13
Q
define outbreak
A
a sudden increase in cases above the expected norm or the presence of unusual microbes
14
Q
define risk
A
the probbaility or likelihood of an event occuring
15
Q
define community acquired infection
A
present within 48 hours of admission with no recent hospital stays
16
Q
define contamination
A
the presence of infectious agents on a body surface or inanimate object
17
Q
define infection-unapparent, asymptomatic or subclinical
A
the presence of microorganisms in or on a host with multiplication but without interaction between the host and organism (no tissue damage). Host appears well but they may serve as disseminators of the infectious agent.
18
Q
what does the wheel model of causation focus on
A
interactions between the host and environment and agent and environment
19
Q
describe the web model of disease causation
A
capture interactions between host, environmental, and social factors and how these contribute to disease.
20
Q
what is the difference between external and internal vector born transmission?
A
external: mechanism transfer of microorgansims by a vector (a fly on food)
internal: transfer of infectious material from the vector dirctly into the host (mosquito with malaria)
21
Q
what is the first step of an effective surveillance program
A
the interdisciplinary team
22
Q
what are the 4 categories that define the purpose of surveillance?
A
- infection-related
- facility-related
- regulatory/guidance
- Public Health
23
Q
define infection related surveillance cateogry
A
-determine baseline rates
-detect outbreaks
-detect and report notifiable diseases to the health department
-detect bioterrorist and emerging diseaes
-assess effectiveness of IPAC measures
-monitor potential risk factors based on occurence
24
Q
define public health related surveillance cateogry
A
-guide policy and programs
-contact tracing
-enable IPAC of infections
25
define facility ralted surviellance category
-provide and gather info for HCP educatin
-monitor personnel injuries and risk factors
-collection and share info on QAPI activites
-provide and gather info on the risk assessment
-observe compliance
26
define regulatory/compliance surveillance category
-ensure compliance with recommendations and reporting requirements
27
how are the goals and objectives of a surveillance program identified?
risk assessment
28
what are risk assessment types
-community wide
-facility all hazards approach
-IPC specific
29
what is the purpose of a risk assessmnet
identify trends and interventions that will help prevent and control infections
30
what is the goal of sruveillance?
prevent HAIs and improve patient outcome
31
define surveillance plan
set of protocols and guidelines that will direct surveillance activities
32
what are some components of a surveillance plan?
-facility information
-purpose, goals, and objectives
-risk assessment results
-events monitored and criteria used
-reason behind event selection
-methodology
-strategies
-reporting requirements
-reports and recipients
33
what are some things to consider when deciding whether to sruveil process or outcome measures?
-frequency of the event
-cost or impact of the negative outcome
-community served
-customer needs
-microbio data
-regulatory requirements
34
true or false. The surveillance plan should be updated whenever the IPC risk assessment is updated
true
35
what does an action plan do>
details the steps necessary for reaching the goals and addressing the issues identified during surveillance
36
when is syndromic data collected?
-rapid occuriing cluster
-trends of public health importance
37
what are some examples of syndromic surveillance?
uses leading indcitaors
-# of patients in ER
-# admitted patients
-# purchases over the counter diarrhea meds
-frequency of symptoms entered into online symptom trackers
-# patients presenting to ER with flu like symptoms
38
what is an example of a subtype syndromic surveillance
animal syndromic surveillance
39
what are some examples of process measures?
-injection safety
-abx use
-SSI
-blood glucose equipment
-respiratory equipment
-laundry
-cleaning
-food prep
40
how can you measures process surveillance?
a checklist
41
what are some potential process measures interventions?
-supply management
-medication manaement
-food storage and prep
-urinary catheter care
42
what are the two primary data collection methodologies?
1. concurrent
2. retrospective
*both can be adopted into targeted, comprehensive, or combination surveillance
43
define concurrent data
data in real time while the patient is still under care at the facility.
problems: large amount of data which could take time to find the problem, reliable & continuous resource access
44
define retrospective data
collating data that has alrady been collected
-access to more complete info
-follow up can be a problem, might miss info about an emerging trend
45
what are some advantages and disadvatnages of concurrent data
advantage: montior all HAIs, real time data, extrapolate future trends, quick interventions
disadvantage: disruptions to info flow can cause problems, medical records aren't complete, miss historical factors
46
what are some advanages and disadvantages of retrospective data
advantage: completed medical records, collection & analysis begin right away
disadvantage: dependent upon completness of records, no opportunity to intervene, slow to incorperate newer data
47
another name for case defintions is
surveillance criteria
48
define demographic data and give examples
socio-econmic data
-age, sex, ethnicity, location, patient or HCP
49
define event data
high volume and high risk events in the facility
-HAIs, colonization, sharps injruy, CUATIs, SSIs, TB conversions, immunization rates
50
how is time data reported?
months, quarters, or years
51
define validity
the degree to which a measurement, test, or study actually measures or detects what it is intnded to
52
validation may be ___ or ____
internal or external
53
define internal validation
active efforts by a reporting facility to assure completeness and accuracy of data
54
define external validation
survey and audit process by an external agency to assure quality of NHSN surveillane and reporting
55
For internal validation, electronic denominators should be comapred to manual counts for 3 months, and counts should match within ___
5%
56
what are some patient and facility focused surveillance data sourves
patient: admisisons, records, lab repotrs, device days, test results, assessments, incients
facility: finance deparmtnet records, sick leave logs, observations of care process reports
57
true or false. An outbreak describes an epidemic limited to a geographical area
true
58
What are the steps to outbreak investigation?
1. confirm and verify the outbreak
2. notify and involve key steakholders
3. identify and investigate team and available resources
4. perform lit review
5. define the outbreak
6. prepare an initial line list and epidemic curve
7. observe and review implicated patient care practices
8. consider if environmental or HCP sampling should be done
9. implement control measures
10. communicate with steakholders and prepare outbreak report
11. declare an end to the outbreak
59
what are some indications of a potential outbreak?
-a single hospital acquired case of a highly infectious agent
-a single case of an emerging or novel pathogen
-an increase in infection trends at least 10% higher than historical trends
-3 or more cases of a specific infection, over a length of time in a particular location
60
which type of studies are often used when the hypothesis is in development?
case-control
61
what does the lit review help inform?
they determine info on potential sources and control measures and generate hypothesis. They can help identify errors commonly associated with outbreaks.
62
true or false. The case definition should be narrow enough to focus investigate efforts but broad enough to capture the majroity of cases
true
63
true or false. The pathogen in question will inform how broad the initial case defintion is
true (case defintion may change as you gather more information)
64
do all case defintions have a microbio component?
No
65
what are some methodologoies for case findings?
-lab records
-surveillance findings
-disucssions with HCP
-public health press releases
66
what information must a line list include?
-demographics
-location
-signs and symptoms
-diagnostics
-outcomes
67
define epidemic curve
diseases that occur during an epidemic are plotted according to the time of illness onset.
68
Generally, if active surveilance has been in place for twice the incubation period
measures can be lifted
68
why is an epidemic curve used?
-determine whether source is common, propagated (continuing)
-establsih if short or long incubation period
-ascertain if outbreak is increasing or decreasing
69
define a table
data presented in rows and columns. Shows frequency which an event occurs. Data can be numbers or words but will most likely be numerical
70
true or false. Don't use acronyms when sharing information
true
71
describe charts
pie or bar
used when the magnitude of different events is important or when one wants to compare parts of the bigger picture
72
when do you use a pie chart?
to look at the proprotion that a group represents within the whole population
73
what is a bar graph and when are they used?
data as side by side bars for easy comparison of magnitudes, frequency distributoins, and time-series data
74
an example of a bar graph is
a pareto chart
75
what is a histogram
a graphic of frequency distribution that looks like a bar graph. difference is each bar represents a different time interval and there is no space between the intervals
shows infections over time
76
what is an example of a histogram
an epidemic curve
77
describe line charts
describe data over time (i.e., ICU CLABSIs over a year). each point between time periods is equidistant.
can illsutrate realtionship between process improvement interventions and outcomes. You can mark points where interventions were put in place
78
what are 2 types of maps used in epi?
spots maps and area maps
79
what are spot maps?
they use dots or other symbols to show where each case-patient lies or was exposed. Scale can be a countrry, state, or global.
may be used during an outbreak (i.e., building spot map)
80
what are some cons of spot maps?
they dont consdier the suze of thhe population at risk therefore they do not present info about disease risk (i.e, in densely populated area a lot of dots doesn;t mean high infections(
81
to shows rates of infection in different neighborhoods or areas, the IP may use
an area map (use different shades of color to illustrate infection rates)
82
define statistical process control
set of methods, i.e., control chart, that can be used for improving systems, processes and outcomes.
83
what is the goal of statistical process control
understand common and special cause variations that affect a process
84
what is the difference between common and special cause variations?
common: expected variability not due to exnteral factors
special cause: attributed to an external factor (out of statistical control-i.e., human error)
85
what are control charts?
track data points over a regular time-series to show observation trends. includes standard deviations.
86
Upper control limit is _____ SD from the mean above which any point is out of control. a Lower control limit is ____SD from the mean which is also out of control
+3; -3
87
how many data points are necessary for a proper control chart?
25 (otherwise special cause variation is hard to detect)
88
who are some stakeholders IPAC should report to?
-facility administration
-microbiology lab
-pharmacy
-clinicians/healthcare partners
-risk management
-public relations/press office
-food/dining services
-maintenance
89
true or false. Statistics cannot proven association or causality; it can only suggest assocation
true
90
true or false. for both OR and RR as the value increases from one, the likelihood a relationship exists increases.
true (i.e. OR 8.6 means higher likelihood than OR 2.0)
91
describe the nominal scale
crudest level of measurement
-categroical data in which no order is implied by the classifications. Values can't be measured mathematically but frequency or percentage can be applied.
I.e., proportion of patients with an infection at a specific site
92
describe ordinal scale data
a measurement in descriptive statistics that applies to ranking categorical data on a relative scale so that each category is distinct and stands in some definite relationship to other categories but does not indicate how much greater each level is than another.
examples are likert scales and disease severity scales
93
describe an interval scale
the exact distance between any two ordinal scale observations is known as assumed to be equal but attributes measured have no real rational zero point.
example: celcsius and farenheit
94
describe the ratio scale
the highest level of measurement in descriptive statistics. Creates interval scale observations that have an absolute, real zero point, which allows for higher levels of statistical analysis.
examples: patients with CLABSIs at a certain point in time
95
describe stratification
the population in a data set is separated into distinct data set
96
What is the purpose of stratification
1. meaningful and accurate comparisons can be made
2. understanding and acceptance of data by recipients
3. utility and validity of interventions
97
When is standardization used?
comparing the event rates of different groups (i.e., CAUTIs for 2 facilities)
Example: SIR
*account for issues that might confound comparison (i.e., risk adjust)
98
What are the 2 methods of risk adjusting for standardization?
1. direct: use a stnadard population to which the obsrved event rates of each group are applied
2. indirect: stadnadrd event rates applied to each groups population.
99
define rate, ratio, and proportion
rate: a ratio that includes a unit of time and provides information about how fast an event is occuring.
ratio: comparison of any two quantitative values.
Proportion: a specific type of ratio that compares part to the whole
100
Rates can be ___ and _____
crude and risk adjusted
101
describe crude rates
assumes that risk factors are distributed evenly for all events; cannot be used for comparisons
102
describe risk adjusted rates
assumes that risk factors are not evenly distributed for all events; controlled based on variations and can be used for comparisons
103
what is a bivariate relationship
the relationship between two variables
104
what are 2 examples of bivariate relationships
correlation and regression
105
describe regression
describes a relationship between a depenent variable (y-the outcome) and one or more explanatory (indepndent) variables
can be simple or multiple
106
what 2 factors affect data collection?
bias (results that are untrue) and confounders (potentially misleading but true results)
107
define bias
a systematic error in study design, data collection, analysis, etc that results in a mistaken estimate of the true population parameter.
108
wht are some examples of bias?
information, recall, observer, interviewer, publication, researcher, response, selection
109
how can incidence and duration of disease affect prevalence
-as incidence increases so does prevalence
-if incidence remains constant but rate of death decreases (cases cured), prevalence will decline
-if incidence is contant but lives are prolnged, prevalence will rise
110
What are the 2 types of incidence?
incidnce proportion (cumulative incidence)
incidence rate (incidence density)
111
mode determines what?
the height and shape of the curve
112
describe normal distribution
bell shaped curve where values on both side of the mean are equal
mean, median, and mode are all equal
as sample size increases in number, effects of confounders are diminished and normal dsitribution is reached
113
in general, flatter and wider curves show more...
variability in data than taller and narrow curves
114
how many forms of kurtosis are there?
3
115
if sample size is low, distribtion is ____ to be normal
unlikely
116
what does an elongated tail with skewness represent
where there are more data than would be expected in a normal distribution
117
describe parametric statistics
-assume a normal distribution of the sample population
-measurements on a continuous interval scale
-equal intervals between adjcent values
118
What are parametric examples used to analyse continous interval data?
z-test and t-test (help mesure whether there is a difference between two population means or proportions)
119
describe non parametric data
make no assumption about the distributon of population values and can be used with discrete data (infection, no infection), nominal or ordinla data, and interval data.
advatage: assumptions of normality are not requried.
examples: chi-square test and fisher's exact test
120
What does the chi sqaure test do?
determine if there is an association between categorical variables
121
What does fisher's exact test do?
researhers are testing assocation or relationship between two dichotmous categorical variables
-used with small samples and when researching rare outcomes
-used when one of the 4 cells on a 2 by 2 table has values less than 5
122
range is a measure of
central tendency and dispersion
123
define variance
deviation around the mean of a distribution
124
define standard deviation
distributon of values around the mean; average of all deviations in a data set
125
define deviation
the diffrence between an individual value in a data set and the mean value
126
describe positive deviation
give value is greater than the mean
127
to calcualte CI, the data must have a
normal distributoin
128
hypothesis can be ___ or __ tests
one tailed or two tailed tests
129
define rejection region
the cutoff point for accepting or rejecitng the null hypothesis
just one end on a one-tailed test but two ends on a two tailed
130
describe a one tailed test
preferredwhen the direction is predicted
131
describe a two tailed test
does not specify direction and a difference in either direction is important
132
describe level of significance (a)
the probability value arbitrarily chosen by the researcher as the desired level of probability at which one may feel secure rejecting the null hypothesis. typically set at .05 or .01
133
define P value
the probability of observing a sample in which the test statistic is greater than or equal to the test statistic for the sample that was actually observed
134
What are the 4 types of reliability?
1. test-retest: to what extent a test will give consistent results over time.
2. inter-rater: to what extent a test will achieve the same results if the individual running or conducting the test changes.
3. parallel forms: measures how often distinct versions of a test, which are expected to be equivalent, return the same results.
4. internal consistency: describes to what extent individual components of a study or test are consistent
135
type 1 and 2 errors are ___ related
inversly
136
define positive predictive value
proportion of persons who test positive and have the disease
137
define negative predictive value
proportions of persons without a disease who test negative
138
define the power of a test
the ability to detect a specified difference (i.e., prob of rejecting the. null when it is false)
139
what are the 4 components of a case definition?
1. clinical information about the disease
2. characteristics about the people who are affected
3. information about the location or practice
4. a specification of time during which the outbreak occured
140
what is the case definition for infectious gastroenteritis?
must not be present or incubaitng on admission and at least one of the following:
-2 or more diarrhea within 24 hours
-two or more vomitting within 24 hours
-one or more diarhea and one or more vomitting with 24 hours
141
describe the hazard vulnerability assessment (facility wide all hazard risk assessment)
IPs role in hospital readiness for emergencies
identify faciltiies top 3-5 vulnerabilities
should be done annually
142
what are some factors taht affect the emergenous of infectious agents?
-social (war, urbanization)
-microbial (genetic mutation, antimicrboail use)
-environmental (earthquakes, floods)
143
what is the biggest factor that influences emergence of infectious agnets?
climate change
144
what patient history should be taken during a bioterrorist attack?
-past and current symptoms
-date of symptom onset
-seveity of illness
-possible source of exposure
-date and location of expsure
-route of exposure (body site affected)
145
true or false. indoor decontamination is needed only in areas exposed to anthrax due to the bioterrorism release; the hospital patient care environment is not a risk of secondary spread of anthrax because no form of anthrax is spread by the indirect contact route.
true
146
true or false. A chemical emergency can occur accidentally or as part of a bioterrorism event
true
147
what are some signs of a chemical emergency?
-large number of HCP or patients with watery eyes, twiching, choking, difficulty breahting or loss of coordination.
-dead birds or animals
148
what might a personal/family emergency plan include?
-communication
-evacuation plan
-disaster kit
-provisions for backup care of children and pets
-supply of food, water, medical supplies, PPE, and an out of region contact
149
a healthcare facility emergency management plan would be implemented when?
before, during, and after a mass casualty event
150
what is a community management plan?
a plan the community would implement to prevent or control a mass casulty incident
151
Who participates in community emergency management plans?
-first responders
-public health officials
-healthcare facilities
-other response agencies in the community
152
what are some components of the emergency management plan that should receive input from the IP?
-assessments
-biological agents disaster drills
-IPAC coverage
-OB investigation
-patient management
-negative pressure surge capacity
-resource management
-setting up and running alternative care sites
153
what are the 4 emergency management phases in order?
1. mitigation
2. preparedness
3. response
4. recovery
154
what are some components of the mitigation phase?
-HVA
-risk assessment
-capability self assessment (identify HVA gaps)
-altneartive power weather notification system
-HVAC systems that can switch airflow
-building maintenance that identifies probelms before they occur
-security system
-hazardous materials policy
-have memoranum of understanding (MOU) with other healthcare agencies
155
What is the ICS?
a tool for managing the demands of small or large emergency and nonemergency situations
156
post evacuation events can occur following what?
advance warning events: when damage to a building is greater than expected following shelter in place events, which necessitates the evacuation of personnel
no advance warning events: earthquakes, building fires, tornadoes, and terrorist attacks
157
true or false. Premature or unnecessary evacuation can pose additional risks to patients (especially the more vulnerable) as well as staff.
true
158
describe the preparedness phase
upon receiving warning of emergency:
-activate phone tree
-notify local communications
-confirm energency staff
-control facility access
-check food and water supplies
-prearrange emergency transport
-have a plan for bakcup pharmaceuticals
159
describe the response phase
-activate ermgency ops plan
-communicate with patients families and physicians
-prompt transfer of patient records
-coordiante assitance with emergency services
160
describe the recovery phase
immediately following the emergency situation:
-arrange altnerative housing
-surveillance is key
-provide authorities with a list of displaced or missing residents
-provide crisis counselling
