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NOSOCOMIAL INFECTION

NOSOCOMIAL INFECTION. Masud Yunesian, M.D., Epidemiologist. SURVEILLANCE METHODS. Definition. A dynamic process of gathering, managing, analyzing and reporting data on events that occur in a specific population. Importance : SENIC study:.

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NOSOCOMIAL INFECTION

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  1. NOSOCOMIAL INFECTION Masud Yunesian, M.D., Epidemiologist SURVEILLANCE METHODS

  2. Definition • A dynamic process of gathering, managing, analyzing and reporting data on events that occur in a specific population

  3. Importance : SENIC study: • Surveillance was the only component essential for reducing SSI, Pneumonia, UTI, & bacteremia. • Other essential components: • Sufficient no. of trained infection control staff and A system for reporting infection rates of SSI to surgeons.

  4. Steps in surveillance: • Definition of the event(s). • Systematic collection of data. • Summarization of data. • Analysis & interpretation. • Consuming the results for improvement.

  5. Purposes of the surveillance-1 • Reducing the infection rate within a hospital. • Establishing endemic (baseline) rates. • Identifying outbreaks.

  6. Purposes of the surveillance-2 4. Convincing medical staff. 5. Satisfying regulators. 6. Defending malpractice claims. 7. Comparing infection rates among hospitals.

  7. Surveillance methods-1 • Concurrent • Retrospective

  8. Concurrent • Flexible, • Informative • Timely • Capable of cluster detection • Capable of changing behavior • But expensive

  9. Retrospective • Depends on completeness, validity & accuracy of existing data. • Does not identify problems as promptly as concurrent does. • But isn’texpensive.

  10. Active : accurate complete expensive Passive : misclassification underreporting lack of timeliness less expensive Surveillance methods-2

  11. Surveillance methods-3 • Hospital wide. • Periodic. • Targeted. • Defining the threshold limit. • Post discharge.

  12. Hospital wide surveillanceSources of data: • Daily reports of microbiology labs. • Medical records of febrile patients. • Medical records of patients taking antibiotics. • Medical records of isolated patients • Daily interview with nurses & patients • Periodic review of autopsy reports • Periodic review of medical records of staff.

  13. Periodic surveillance(S.): Hospital wide (H.W.S) during specified periods, And , • Targeted S. during alternate periods Or , • Rotating H.W.S. from one unit to another

  14. Targeted surveillance • Focuses its effort on : • Selected geographic area (e.g. ICU) • Selected service (e.g. cardio thoracic surgery) • Specific populations of patients or infections: • At high risk of acquiring infection ( e.g. transplantation) • Undergoing specific interventions( e.g. dialysis) • At specific site (e.g. blood stream)

  15. Characteristics of targeted S. • High accuracy & efficiency . • Incapable of detecting other infections . • Criteria for selection of target : • Frequency. • mortality & morbidity . • Cost. • preventability.

  16. Defining the threshold limits

  17. Case finding issues • Total chart review (standard method). • Laboratory reports. • Clinical ward rounds (twice a week). • Kardex screening (once or twice a week). • Fever chart. • High risk patients (transplant, diabetic, leukemia, invasive methods, .. )

  18. Analysis-1 • The data should be analyzed. • The analysis should be done by staff engaged in surveillance. • Staff should decide how frequently to analyze the data: • Frequently enough to detect clusters promptly. • Collecting the data for a long enough period of time for changes to be meaningful.

  19. Analysis-2 Numerator & Denominator

  20. Overall rate = No. of NI Total no. of admitted or discharged patients

  21. Adjusted rates • For severity of illness. • For length of stay. • For exposure to device (e.g. ventilator)

  22. Essential numerator data: • Demographic : • name, age, sex , service, ward,admission date, hospital identification number . • Infection : • onset date , site of infection. • Laboratory : • pathogen antibiogram

  23. Numerator data : Risk factors“only when these data used for analysis” • An example for SSI: • Kind of surgery. • Date of surgery. • Duration of surgery. • Type of wound (clean ,dirty, …). • Date of discharge.

  24. Denominator data: Total no. of admitted or discharged pts. OR No. of days of exposure : • Total no. of pts. & pt-days in the unit, • Total no. of ventilator days, • Total no. of central line days, • Total no. of urinary catheter days.

  25. Comparing rates necessary assumptions: • Same definitions. • Same methods of S. & case finding. • Same accuracy of methods & personnel. • Same characteristics of hospitals/wards: • Length of stay, • Risk indices, • exposure to devices, • ...

  26. “Dissemination” “Surveillance is not complete until the results are disseminated to those who use it to prevent and control”

  27. dissemination - continued • Confidentiality must be regarded • Regular time intervals for reporting . • Format of reports : • Summary , table , graph

  28. Evaluation • At least annually ask yourself : • Did the system detect clusters ? • Which practices were changed based on S. ? • Were the data used to decrease the endemic rate ? • Were the data used to assess the efficacy of interventions ? • Are administrative & clinical staff aware of Surveillance Findings ?

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