SURVEILLANCE FOR NOSOCOMIAL INFECTION IN LTCFs

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SURVEILLANCE FOR NOSOCOMIAL INFECTION IN
LTCFs

• WHY
• WHO
• WHERE
• WHEN
• 
  HOW

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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.

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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

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WHO Should Conduct Surveillance

• It is YOUR ultimate responsibility
• Shoe leather epidemiology
• Allows for visual/verbal communication with the
  staff

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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

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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)

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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

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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.

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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

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Definitions for Infection in LTCFs by
Specific Anatomic Site

• McGeer definitions
• American Journal of Infection Control,
  
  
  
  
  199119 1-7

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EVIDENCE OF NOSOCOMIAL INFECTION WHERE TO LOOK

• Physicians orders
• Microbiology reports
• Nursing notes
• 24 hour report
• Antibiotic monitoring
• Communication forms
• Verbal reports

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CHART REVIEW

• 1. MDs orders for
• antibiotics hospital admission
• C S/CXR invasive devices
• 2. MDs progress notes
• 3. Microbiology reports
• 4. Nursing notes

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DATA COLLECTION

• Patient name and location
• Symptoms and date of onset
• Admission date
• Gender
• Risk factors
• Anatomic site involved
• Pathogen and date of culture

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DATA TABULATION

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

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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

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DATA INTERPRETATION

• Clusters of infection
• Outbreaks
• Sentinel events (a single occurrence which
  requires attention)
• Trends (an increase in specific infections
• over time)

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DATA DISSEMINATION

• Director of Nursing
• Medical Director
• Administration
• Nursing personnel
• Employee Health Coordinator

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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

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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

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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

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Thats All Folks