SURVEILLANCE FOR NOSOCOMIAL INFECTION IN LTCFs

1. SURVEILLANCE FOR NOSOCOMIAL INFECTION IN LTCFs WHY WHO WHERE WHEN HOW

2. SURVEILLANCE DEFINED The collection, tabulation, interpretation and dissemination of data on the occurrence of nosocomial infections or other untoward events for the purpose of their prevention and control.

3. WHY Conduct Surveillance for Nosocomial Infection • Process Objectives • establish baseline rates • evaluate policies and procedures • evaluate control measures • outbreak control • licensing and compliance

4. WHY Conduct Surveillance for Nosocomial Infections • Outcome Objectives • identify risk factors • decrease the infection rate • decrease pain, suffering and death • decrease cost • medicolegal protection

5. WHO Should Conduct Surveillance • It is YOUR ultimate responsibility • Shoe leather epidemiology • Allows for visual/verbal communication with the staff

6. WHERE/WHEN TO CONDUCT SURVEILLANCE • Retrospective Good for calculating rates Bad for detecting ongoing problems • Prospective Good for calculating rates Good for detecting ongoing problem • Continuous vs. Periodic • Skilled vs. Intermediate

7. WHERE/WHEN TO CONDUCT SURVEILLANCE • Continuous All infections, All of the time Provides dependable endemic rates Potentially time consuming • Periodic Specific anatomic sites Specific time period (e.g. monthly)

8. WHERE/WHEN TO CONDUCT SURVEILLANCE • Skilled Care -- High risk (e.g. UTI, LRI, diabetics) -- Problem prone (e.g. non-ambulatory) -- Comparatively high infection rate • Intermediate Care -- Low risk -- Prone to infections of low severity

9. BASIC DEFINITIONS • Infection: The entry and subsequent multiplication of an infectious agent into the tissues of a host. • Disease: Untoward pathological change as a result of infection.

10. BASIC DEFINITIONS • Nosocomial infection: Infection which is manifested after admission and not incubating at the time of admission. • Culpability, preventability, etiology NOT part of this definition

11. Definitions for Infection in LTCFs by Specific Anatomic Site • McGeer definitions American Journal of Infection Control, 1991;19: 1-7

12. EVIDENCE OF NOSOCOMIAL INFECTION: WHERE TO LOOK • Physician’s orders • Microbiology reports • Nursing notes • 24 hour report • Antibiotic monitoring • Communication forms • Verbal reports

13. CHART REVIEW 1. MD’s orders for: antibiotics hospital admission C & S/CXR invasive devices 2. MD’s progress notes 3. Microbiology reports 4. Nursing notes

14. DATA [COLLECTION] • Patient name and location • Symptoms and date of onset • Admission date • Gender • Risk factors • Anatomic site involved • Pathogen and date of culture

15. DATA [TABULATION] • Visual Presentation tables, charts, graphs, etc. • House-wide and Unit specific data • Anatomic site and Nursing ward • Anatomic site and pathogen

16. DATA [INTERPRETATION] • Compare data with previous report periods • Consider involvement of specific risk factors • Watch for increases on any specific nursing unit or floor • Seasonal occurrences

17. DATA [INTERPRETATION] • Clusters of infection • Outbreaks • Sentinel events (a single occurrence which requires attention) • Trends (an increase in specific infections over time)

18. DATA [DISSEMINATION] • Director of Nursing • Medical Director • Administration • Nursing personnel • Employee Health Coordinator

19. Measures of Frequency Basic formula X/Y x k X (numerator) = number of events Y (denominator) = population at risk or some defined time interval k (constant): Usually some multiple of 10

20. MEASURES OF FREQUENCY • Numerators: No. of infected patients No. of infections, falls, medication errors, etc. • Denominators: Census, patient days, device days, etc. Note: N and D must agree with one another

21. MEASURES OF FREQUENCY • Attack Rate (usually expressed as a percent) X/Y x 100 = ____% • Incidence Rate (related to some unit of time) exps. X/Y x 1000 = NIs/1000 patient days X/Y x 1000 = BSIs/1000 line days X/Y x 1000 = UTIs/1000 catheter days

22. That’s All Folks