Presentation on theme: "Surveillance of nosocomial infections Johnny, Courtesy, Brocolli."— Presentation transcript:
Surveillance of nosocomial infections Johnny, Courtesy, Brocolli
Nosocomial infections (NCI) "nosus" = disease "komeion" = to take care of Infections that occur during hospitalization but are not present nor incubating upon hospital admission
Characteristics of hospitals Treatment is main focus Many stakeholders Shift work A lots of data, easily defined cohorts Different patient population Variation of length of stay Vulnerable patients Community vs. hospital
The problem of NCI USA –Urinary tract infections: 2.4 per 100 admissions –Pneumonia: 1 case per 100 admissions –Surgical site infections: 2.8 per 100 operations –NCI; one death every 6 th minutes Norway –One of 19 patients have a NCI
The problem of NCI Regional hospital, Zimbabwe: –1 of 6 developed SSI 2 referral hospitals, Ethiopia: –38.7% developed SSI –14 of 18 deaths attributed to SSI
Cost of NCI England Average cost per NCI: 3.000 pounds Extra days: Urinary tract infections: 6 Pneumonia:12 Surgical site infections: 7
Why surveillance? NCI cause of morbidity and mortality One third may be preventable Surveillance = key factor –an infection control measure –overview of the burden and distribution of NCI –allocate preventive resources Surveillance is cost-efficient!!
The surveillance loop Event Action Data Information Health care system Surveillance centre Reporting Feedback, recommendations Analysis, interpretation
Considerations when creating a surveillance system Goal of the surveillance system (why) Engage the stakeholders (who) Surveillance method (what, how, when) –definition –what to collect –how to collect (operation of system) Available resources
I may not have gone where I intended to go, but I think I have ended up where I needed to be Douglas Adams
Objectives Reducing infection rates Establishing endemic baseline rates Identifying outbreaks Identifying risk factors Persuading medical personnel Evaluate control measures Satisfying regulators Document quality of care Compare hospitals NCI rates
Who All hospitals? All departments? All specialties? Other health institutions?
Surveillance of surgical site infections Central adm. Local adm. ICP It- dep. Surgical wards Surgical ward. 2 PatientsLab Service dep. Ministry Of health Directorat Public Health instituteI ….. Stakeholders
Surveillance of one or more types of NCI Urinary tract infections Lower respiratory tract infections Surgical site infections Bloodstream infections Conjunctivitis Others…
Targeted surveillance Special patient population (surgical, medical, paediatric, intensive) Diagnostic and therapeutic procedures (endoscope, haemodialysis, catheterization, blood transfusion) Specific pathogens (staphylococcus aureus, MRSA, clostridium difficile, norovirus)
Variables Administrative data –Id, address, dates of admission, discharge.. Patient related factors: –Age, sex, severity of underlying disease Procedures –Surgery –Devices (e.g. catheters) Treatment, diagnosis –Use of antibiotics ……
Stratification points, surgical site infections
When? During hospital stay? –Frequency of data collection After discharge? –When and how?
How? Two main surveillance methods –incidence –prevalence Variations within these methods
Incidence (cohort) studies marching towards outcomes
Cohort design PAR = Population at Risk T = Time period PAR Study group Exposed Not exposed NCI Not NCI T NCI Not NCI T Retrospective Prospective
Measure Percentage –#NCI / # patients Incidence density –Patient-days as denominator Risk factors RR= risk in patients exposed risk in patients not exposed
Methodological issues Definitions NCI –Cut off 48 or 72 hours? –Criterias from Centers for Disease Control and Prevention (hospital) –McGeer (long-term care facilities) Risk variables Case finding –Active or passive –By whom? –After discharge? –Prospective or retrospective?
Case finding Active: by surveillance personnel Passive: by medical personnel Laboratory or clinical based Source of data –Clinical examinations –Medical records, reports from laboratories –Forms or interviews
Implementing surveillance system Administrators responsibility Involvement of stakeholders Identify available resources –Personnel –Money –Time –Equipment –It- solutions Realistic project plan –Organization map –Making forms and letters –It-solutions –Training –Use of data
Making surveillance work Support by the administrators Involve local experts Simple Minimize resources required by hospitals Training Feedback and use of data Flexibility
Training topics Why surveillance? How? –Definition –Case finding –Case studies –It-solution Use of data
Quality controls Define acceptable loss of follow-up Make sure all patients are included Identify infections –Use several sources –Compare data, conduct surveys –Training Clean data –Completeness –Logical values
Use of data Prevent NCI Ward audits Present data to hospitals, administrators, MoH, patients Argument for resource allocation Audits for medical personnel Raise awareness