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LTC-CIP > Surveillance, Epi, and Reporting > Flashcards

Surveillance, Epi, and Reporting Flashcards

1
Q

describe an effective surveillance program

A

it begins with a facility risk assessment, and setting goals to ensure that the data collected are consistent, useful, actionable, and timely

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2
Q

define surveillance

A

collects useful, relevant, and timely information to identify trends and develop interventions that can help you prevent and control infections

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3
Q

define facility risk assessment

A

a risk assessment needed to determine the resources necessary to run and establish an effective IPAC program

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4
Q

what is baseline (benchmark) data

A

what is “typically” seen. Historical data is used

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5
Q

what are some different types of surveillance?

A

-electronic
-house wide/comprehensive
-outbreak
-outcome
-process
-prospective
retrospective
-targeted/priority directed surveillance

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6
Q

what are some advantages and disadvantages of eletronic surveillance?

A

advantages: many companies make software, reduces burden of paper records storage.

disadvantages: dependent upon minimum data set and requires pharmacy, lab, and facility to communicate

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7
Q

what is house wide/comprehensive surveillance?

A

looks at all infections, antibiotic usage, and lab reports. Data is included in the facility risk assessment.

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8
Q

what are some advantages and disadvantages of house wide surveillance?

A

advantages: provide a big picture, benchmarks, more like to detect infectious disease events

disadvantages: challenging in LTC facilities, large amount of data, overhwleming, significant resources required, often used in faciltiies with stable populations and sufficient staffing to collect data.

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9
Q

define outbreak surveillance

A

-one case of a highly communicable infection
-infection trends 10% higher than the historical rate
-two or three more cases of the same infection over a specific length of time on the same unit or defined area

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10
Q

what are some advantages and disadvantages of outbreak surveillance?

A

advantages: rapid detection of an outbreak can prevent widespread illness, requires immediate action and well planned interventions that can be implemented quickly, well presented outbreak summaries can provide public health with a clear picture of interventions.

disadvantages: requires consistent effort and accurate use of case definitions, need ability to implement oubreak plans (prophylaxis, suspend activities)

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11
Q

what is outcome surveillance?

A

provides rates associated with the incidence or prevalence of infections; or SIRs

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12
Q

what are some advantages and disadvantages of outcome surveillance?

A

advantages: looks at infections that can be considered a result of practices.

disadvantages: more complex and difficult than process surveillance, longitudinal analysis is often necessary

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13
Q

what is process surveillance?

A

looks for adherence to steps or techniques based on bst practices, regulations, policies, and procedures

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14
Q

what are some advantages and disadvantages of process surveillance?

A

advantage: looks at LTC facility-specific practices related to resident care, when combined with outcome surveillance it can be useful in cause/effect analysis

disadvantage: oversimplifies cause/effect relationship, benchmarking data may not be there to support conclusions

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15
Q

what are advantages and disadvantages of prospective surveillance?

A

advantage: access to real time information

disadvantage: requires consistent resources for data collection

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16
Q

what are advantages and disadvantages of retrospective surveillance?

A

advantage: analysis can be done right after collection, ready access to medical information

disadvantage: can miss important info; lack of real time information.

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17
Q

what is targeted/priority directed surveillance?

A

specific infections, procedures, or processes are selected for surveillance based on risk assessment, quality assurance, or process improvement goals.

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18
Q

what are advantages and disadvantages of targeted surveillance?

A

advantage: target highest risk areas, can have impact on infection rates, easier and more practical to implement than house-wide

disadvantage: requires careful development and understanding of risk assessment, does not present a comprehensive view of LTC facilitys infections

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19
Q

what is considered a suspect respiratory infection outbreak?

A

-two cases of ARI within 48 hours with any common epi link

OR

-one lab confirmed case of Influenza

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20
Q

what is the definition of a confirmed respiratory infection outbreak?

A

-two cases of ARI within 48 hours with any common epi link; at least one of which being lab confirmed

OR

-three cases of ARI (lab confirmation not necessary) occuring within 48 hours with any common epi link

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21
Q

what is the surveillance case definition for CDI?

A

both criteria 1 and 2 must be present

  1. One of the following GI criteria:
    Diarrhea: 3 or more liquid or watery stools above what is normal for the resident within 24 huors OR presence of toxic megacolon (abnormal dilation of large bowel documented radiologicallu)
  2. One of the following diagnostic critiera:

A stool specimen for which CDI is PCR detected or toxin test detected

pseudomembranous colitis is identified during endoscopic exam or surgery or in exam of biopsy specimen

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22
Q

the rate must always be for the _____ to allow comparison between different time periods. i.e., cant compare CAUTIs on one ward to CAUTIs in resident on the ward with with indwelling catheter

A

same number of units

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23
Q

rates are usually expressed per ____. The unit used for the dominator can be____

A

1000; number of days residents were in the LTC facility

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24
Q

what is the formula for SIR?

A

number of observed infections/number of predicted infections (based on a benchmark)

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25
Q

For a SIR<1, how would the percent reduction be calculated?

A

1 minus the SIR (Sir of 0.80 means that there was a 29% reduction from the baseline period)

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26
Q

For SIR >1, how would the percent increative be calculated?

A

SIR minus 1 (Sir of 1.25 means there was a 25% increase from the baseline period)

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27
Q

define active and passive surveillance

A

actve: you actively look for cases (fever checks, swabbing admissions for MRSA)

passive: count it when you find it or it presents itself (i.e., a cough and fever is noticed during their morning bath. A sign that visitors with symptoms must report to a nurse before entering)

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28
Q

what are some elements of a surveillance program?

A

-select the surveillance type
-define the population
-choose the event to monitor
-determine the time period
-identify the case definition
-identify data elements to be collected
-determine methods for analysis
-determine methods for data collection and management
-make a surveillance report
-identify recipients of the report

29
Q

what are the steps in the outbreak investigation?

A

-establish the existence of an outbreak
-alert key partners (reporting)
-establish a case defintion
-record information and perform descriptive epidemiology
-prepare an initial line list
-schedule an OMT meeting
-implement control and prevention measures
-montior outbreak
-communicate findings and plan to stakeholders
-declare the outbreak over

30
Q

what is the most common surveillance reporting in LTC?

A

-UTI
-RTI
-skin and soft tissue/mucosal infections
-GI

31
Q

the USA uses NHSN for surveillance and tracking. What does this include?

A

-UTI, CDI, MRSA, HH, gown and glove use)

32
Q

define epidemiology

A

the study of what befalls a population.

the study of the distribution and determinants of health related states or events in specified population and the application of this study to control health problems

33
Q

what does epidemiology mean

A

epi: on or upon
demos: people
logos: study of

34
Q

how is surveillance part of epidemiology?

A

take the data from surveillance and look for associations between exposures and disease

35
Q

what are 3 concepts in epidemiology?

A

person: individual characteristics that lead to the illness (ate the ptoato salad)

place: where exposure occured (picnic)

time: when exposure occured (the day of the picnic)

36
Q

epi aids in understadning the ___ or disease by knowing its ____

A

cause; distribution and determinants in terms of persons, place, time, and natural history

37
Q

____ people 55+ will require a stay in LTC services

A

2/3 (40%)

38
Q

epi means
demos means
logos means

A

upon
people
the study of

39
Q

what is the APIC definition of epidemiology?

A

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

40
Q

what is the CDC definition of epidemiology?

A

the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems

41
Q

what are the 3 D’s of epidemiology?

A
  1. Distribution (how disease is distributed. Assumption it is not a random event and occurs at different rates in different populations)
  2. Determinants (factors that cause disease to increase or decrease. Risk regulators. Give clues as to cause)
  3. Deterrents (factors that prevent, reduce, or cure disease)
42
Q

define association

A

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

43
Q

When statistical association between a factor and disease has been demonstrated, it may be of three types

A

artifactual (or spurious)
indrect or noncausal
causal

44
Q

define artifactual

A

systematic erroror bias (can be spurious: not being what it purports to be; false or fake)

45
Q

define indirect or non-causal

A

may result from mixing of effects or a confounding variable. May independently affect the outcome of interest

46
Q

what can cause artificial association?

A

-errors in study design or analysis
-bias
-errors in analysis
-failure to control for confounding variables

47
Q

what acn cause indirect or noncausal association?

A

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

48
Q

dont confuse causal with

A

causality

49
Q

when does causal association occur?

A

when evidence indicates that one factor is clearly shown to increase the probability of the occurence of a disease

50
Q

what are Bradford Hill’s Criteria for Causation? (hint there are 9)

A
  1. strength of association
  2. consistency
  3. specificity
  4. temporality
  5. biological gradient
  6. biological plausability
  7. coherence
  8. experimental evidence
  9. analogy
51
Q

what are the levels of prevention?

A
  1. primary
  2. secondary
  3. tertiary
52
Q

define primary prevention

A

complete prevention of a disease before any manifestation of disease occurs (wellness programs, vaccines, exercise, seat belts)

53
Q

define secondary prevention

A

early diagnosis and treatment and preventing furhter deterioration by intervention as early in the disease course as possible (screening, mammograms, skin testing TB)

54
Q

define tertiary prevention

A

reducing complications (rehabilitation and organ transplants)

55
Q

define strength of association

A

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

56
Q

define consistency

A

multiple studies in a range of studies support similar results

57
Q

define specificity

A

ideally, the effect has only one cause

58
Q

define temporality

A

the purported cause should be present before the effect occurs

59
Q

define biological gradient

A

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

60
Q

define biological plausability

A

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

61
Q

define coherence

A

the association should not conflict with known facts

62
Q

define experimental evidence

A

is there any supportive research based on experiment; if preventive action is taken, does the effect disappate?

63
Q

define analogy

A

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

64
Q

define risk

A

the probability or likelihood of an event occurring

65
Q

define reservoir

A

a place an infectious organism can survive but may or may not multiply

66
Q

define community-acquired infection

A

infections present on admission with no association to a recent hospitalization

67
Q

what is a healthcare associated infection?

A

-not present at the time of admission to the hospital but are temporally associated with admission to or a procedure performed in a healthcare facility
-an infection POA may also be healthcare-associated if it is related to a recent hospitalization

68
Q

what are the 3 organism response tiers?

A
  1. resistance and pen-resistance
  2. found primarily in healthcare settings but not believed to be found regularly in the region. Information is available about how transmission occurs and at risk groups. I.e. CPE
  3. already established and identified in regions. not endemic. i.e., CPE producing klebseilla pneumoniae.

LTC-CIP (9 decks)

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