1. Hospital Surveillance

2. Impact of infectious diseases  IDs are considered to be the leading cause of death  Mass population movement  Emerging and re-emerging microorganisms  Food poisoning  Antimicrobial drugs resistance  Media attention

3. Why do we need to study hospital infections? Not all hospital infections are preventable, but they are associated with Excess length of hospital stay Excess cost Excess mortality Law suits

4. What kinds of hospital infections exit? Device-related  Blood stream infections (BSI)  Urinary tract infections (UTI)  Ventilator-associated pneumonia (VAP) Procedure-related  Surgical site infections (SSI) Environmental contamination  Water, disinfectant, etc.

5. Surveillance  Definition  It is the continuous systematic collection, analysis, interpretation and dissemination of data.  That is essential to the planning, implementation and evaluation of PH practice.

6. What are hospital infections? Two types of infections you find in the hospital  Hospital-acquired infections  Community-acquired infections How can we distinguish them?  By latency period  CDC definition for NIs: development of infections after 48 hours of admission

7. Surveillance  Why to do it?  To know where you are  To see if you are heading in the right direction  Importance  Identification of cases  Determination of infection sites  Identification of factors contributing to infection

8. Purposes of surveillance  Reducing infection rates within the hospital  Establishing endemic baseline rate  Identifying outbreaks  Convincing medical personnel  Evaluating control measures  Satisfying regulators  Defending malpractice claims  Comparing infection rates between hospitals

9. Data collection  Confirm that the “caught case” is truly nosocomial.  Reviewing charts.  Talking to the staff (doctors and nurses).

10. Numerator  What data to collect? Demography Name AgeGender MRNService WardAdmission date Infection Onset date Site of infection Laboratory Pathogen(s) Antibiogram

11. Cont…numerator  Who should collect the data?  Infection control practitioner  Personnel who interact with patients or review charts

12. Cont…numerator  Data can be collected for all patients care area:  Hospital-wide surveillance  Data can be collected for certain groups in the hospital:  Targeted surveillance

13. Cont…numerator  Source of data  Admission dept., lab., wards, patients, charts.  How to collect data?  Review laboratory records & then patients’ charts (this is to achieve case finding)

14. Denominator  What data to collect  Patients-days, device-days (catheter, ventilator, drainage, etc…).  Data source and collection technique  mid-night census can be used  You may seek the help of others to collect denominators (admission office or computer dept.)

15. Data entry  Collect only necessary data  Record data in a systematic formatting  Organize data in a meaningful way:  Flow sheet or line-list.  Computer data-base (excel, Epi-info, SPSS or STATA).

16. Data analysis  Put the results of data collected into rates and ratios: A / B x 100 or 1000  For the numerator A use the number of nosocomial infection in particular group at risk.

17. Cont…  For the denominator B you may use one of the following:  Number of admission or discharge in an interval  Number of person undergoing a procedure  Patient-days in the hospital or on a particular unit  Number of device-days

18. Cont…  What are you approaching here is:  Defining and calculating rates  Prevalence which include point prevalence and period prevalence  Both types count active cases of a disease in a defined population  Incidence which is the total number of a new cases of disease that occurs among given population during a specified period of time

19. Cont…  Comparing rates among patient groups  The denominator must reflect the population at risk  Intrinsic risk factors  Extrinsic risk factors  Comparing rates overtime  The importance is risk related as major risks varies overtime  e.g. SSI are getting less than before as of hospital stay is getting less

20. Cont…  Identifying outbreaks  Looking at your trends  Assessing appropriateness of medical care  Comparing different devices

21. Dissemination of data  Data should not be used for punitive purposes but rather to augment quality improvement efforts.  Narrative summaries and tabular graphic reports of surveillance data will be provided to the hospital infection control committee, executive director, general manager and head of departments.

22. Methods for hospital surveillance SensitivityMethods 47%Fever curve 48%Antibiotic use 33 – 65%Microbiology reports 85%Review kardex 90%Total chart review Up to 100%Clinical wards rounds

23. Why?  10 ICU beds in January  10 ICU beds in February  100 admissions  Each patients stays for 1 day  10 NI  What is the rate of NI?  100 admissions  Each patient stays for 3 days  10 NI  What is the rate of NI?

24.  It is a 10%  But with a rate of 100/1000 days  But with a rate of 33.3/1000 days

25. Devices and procedures as major sources of hospital infections Surgeries Arterial/Venous Catheters Urinary Catheters Respirators Cross-infections: 20-40% Changes in flora due to antibiotic therapy :20-25% Others: 20% Patients’ own flora: 40-60%