???.?.?????????????????????

1
??????????????????????
2
??????????????????????

• ???????????
• ???????????????????????????????????????????????
  ??????????????
• ???/?????????????????????????????
• ???????????????????????????????????????????????
  ?
• ???????????????????????????????????????????????
  ??????
• ?????????????????????

3
????????????????????????????????

• ???.?. ?????????????? ???????
• 2531 23 11.7
• 2535 33 7.3
• 2541 44 7.6
• 2543 44 7.8
• 2544 42 6.4

4
????????????????????????????????

• ???????????????????
• ????????
• ????????????????????
• ??????????????
• ??????????????????
• ???????????????????????????????????

5
????????????????????????????????
???????????????????????????????
?????????????????? (???) UTI 10.05 (1-31) S
kin 10.98 (1-33) Prim.Bact. 11.61 (1-31)
LRI 12.46 (1-55) SSI 12.47 (1-40)
6
????????????????????? N.I. (???)
???????????????????? 1 ??????? 5,919.47 LRI
9,891.64 Prim. Bact. 6,249.12 SSI 4,543.
82 UTI 4,713.69 Skin 4,613.69 Other
2,799.35 ???????????????????? 2 ???????
14,599.14 3 ???????
16,246.20 4 ???????
26,558.50
7
?????????????????????????????????

• ??????????????
• ???????????????
• ?????????????????
• ????????????????

8
???????????????????????????????????????

• ??????????????????
• ????????????
• ????????????????
• ????????????????
• ?????????????????

9
???????????????????????????????

• ?????????????
• ?????????
• ????????????
• ?????????????????????????
• ????????
• ???????? ???????????? ???

10
??????????????????????????????????? 1.
???????????????????????? 2. ?????????????????????
??????????????????? 3. ??????????????????????????
?? 4. ??????????? 5. ???????????????????????????
?????? 6. ?????????????????????????????? 7.
???????????????
11
?????????????????????? (Nosocomial
Infection) ?????????????????????
(Endemic) ???????????????????????? (Epidemic)
12
(No Transcript)
13
?????????????????????????????????? ??????????????
???????????? ??????????????????????????????? ?????
???????????????
14
??????????????? ???????????? (1) 1.
?????????????????????????????????? 2.
?????????????????????????????????????
???????????????????????? (endemic) 3.
???????????????????????? 4. ?????
????????????????????????????????????? 5.
??????????????????????????????????????????
???????????
15
??????????????? ???????????? (2) 6.
??????????????????????????????????????
??????????????????? 7. ?????????????????????? 8.
????????????????????????????????? 9.
???????????? ?????????????????????
???????????????? ???????????? ?
16

• ??????????????????????????????????
• ?????????????????????????????
• (??????????????)
• ?????????????????????????
• (????????????)

17
????????????????????????????? ???????????????????
????????????? ??????????? - ???????????????
18
?????????????????????????????
????? ????????????????????????????????
?????????????????????? ???????
???????????????????
19
?????????????????????????
????????????????????????????????????????
(active infection) 1. ???????????????????????????
???????? (Period prevalence) 2.
?????????????????????????????? (Point
prevalence)
20
?????????????????????????
????? ?????????
???????????? ??????? ??????????????????????
??????????????
21

• ??????????????????????????????????
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22
????????????? ?????????????????????????????
??????????? ???????????????????????
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23
???????????? ?????? - ?????????????????????????
?????? - ?????????????????????????????
?????????????????????????? ??????????????????
????????????????????? ????????????????????
?? ??????????
24
??????????????? ?????????????????????????????????
? ?????? ???? - ???? ??????? ???, ????,
HN ????, ?????????????????
????????????-????????. ??????????????????
?????????????????? ????????????
???????????????? ?
25
???????????????
???????? ?????????????????????????????? ????????
??????????????
26
??????????????????????????????
??????????????????????????????????
?????????????????????????????????
????? ????????????????????????????????
???
27

• ??????????????????????????????
• ?????
• ????????????????????????????????
• ????????????????????????????????????
• ???????????
• ???????
• ???????????????????? ???????
• - ???????????????????
• - ???????????????????????
• - ??????????????????????????????
• ?????????????????????????????????????????????

28
?????????????????????? ????????????????????????
??????????
????? ?????????????????????????????????
??????
29
?????????????????????? ????? -
??????????????????????????.?????????? -
???????????????????????????? -
??????????????????????????? ??????? -
???????? - ??????????????????????????????? -
???????????????????????
30
?????????????????????

• 1. ??????????????????????
• (hospital, house wide or comprehensive
  surveillance)
• 2. ?????????????????????????????
• (focused or targeted surveillance)

31
?????????????????????

• 1. ??????????????????????
• ( hospital wide or comprehensive surveillance)
• ????? ????????????????????????????????
• ?????????????????????
• ??????? ????????????????????
• ???????????????????

32
?????????????????????

• 2. ?????????????????????????????
• ( focused or targeted surveillance )
• ????? ??????????????????????????????????
• ????????????????????????????????
• ???????????
• ??????? ??????????????????????????????????
• ????????????????????????????????????

33
?????????????????????

• 2. ?????????????????????????????
• ( focused or targeted surveillance )
• ???????????
• 1. Unit directed surveillance
• 2. Rotating surveillance
• 3. Priority directed surveillance

34

• Unit directed surveillance
• ?????????????????????????????????????? ????
  ????????
• Rotating surveillance
• ?????????????????????? ?????????????
• Priority directed surveillance
• ????????????????????????????????
• ???? ???????????????????????????????????? ????
  UTI ???? LRI

35
?????????????????? - ??? - ??????? - ????? -
??
36
??????????????? 1.1 ????????????????????
(Infection ratio) ??? ?????
????????????????????????????????????
????????????? ???????????????????? Infectio
n ratio No of infections
No. patients at risk
37
??????????????? 1.2 ????????????????????
(Infection proportion) ???
??????????????????????????????????????????????????
???? ??????????????????????????????????????
Infection proportion No. patients with
N.I. No. patients at risk
38
??????????????? 1.3 ?????????????????????????????
?????????? ???????????????????????
(Incidence density) Incidence Density
No. N.I. Sum(patient x admission
day) No. N.I. Sum
(patient x device - days)
39
????????????????????????????????? 1.4
?????????????????????????????????? () ????????
??????????????????????????????????? (????????)
x 100
???????????????????????????
40
?????????????????????? ????????? 1.
???????????????????????????????? 2.
??????????????????????????? 3.
?????????????????????????????? 4.
??????????????????????? 5. ?????????????????????
6. ???????????????????????????
41
??????????????????????????????????????????????? ??
???????????????????????
??????? ?????? 1 ............
..................................................
.................. 2 ...........................
.... ...........................
........................ 3
..................................................
................................. 4
..................................................
..................................................
....... 5 ................
..................................................
.............. 6 ..............................
.............................
................... 7 .........................
..................................................
................................ 8
..................................................
...... ......................
9 ..............................................
..................................................
........... 10 ....
..................................................
.....................................
A
B
C
42
??????????????????????????????? Prevalence survey
??? Surveillance

• Prevalence survey Surveillance
• 1. ???????????
• Standard definition ????????????
  ????????????
• 2. ?????????????
• Standard data ????????????????
  ???????????????
• collection form
• ????????? Medicial ????????????
  ????????????
• laboratory record
• 3. ???????? ??????????????????
  ??????????? ????????
• 4. ????????????? ????????????
  ????????????????
• (Prevalence rate) (Infection
  rate)

43
???????????????????????????????????????
- Clinical based sings Symptoms - Laboratory
based
????????
??????????? -
inflammation ????????????????
???????????????????? - colonization
(C.I.)
(N.I.) - contamination
??????????????????????
?
44
???????????????????? ???????????????????????
??????????????????? - ?????????, ????
?????????????????? ?????????????????????????
????? - ???????????????????????????
45
??????????? ????? ??????????????????????
???????????????????????????????????????????
????????????????????????????????????
??????????????????????
46
??????????? ???????? ?????
????????????????????????????????????
47
??????????? ?????? - ??????????
??????????????????????????????? - ?????????
???????? ? ???????? - ??????? ???????????????????
- ????????????????????????? - ????????????????
????????????????? ?????????????
48

• ???????????????????????????????????
• ?????????????????????????
• ????
• - ??????? ?????????, ??????
• ???????????
• - ????????? ??????????, ??????????
• ????????????????????

49
SURVEILLANCE METHODS
SourceInternational Infection Control
MN. US. June 12-16,2000
50
Seven Essential Components of a Surveillance
Program
Assess the population Select the outcome or
process for surveillance Use surveillance
definitions Collect surveillance data
Calculate and analyze surveillance rates Apply
risk stratification methodology Report and use
surveillance information
51
Assess the population
What type patients are served? What are
common diagnoses? What are most frequent
procedures? Costs/Resources utilized? High
risk, high volume, problem prone Community
health issues( TB,HIV,etc.) Consider employees
as a population
52
Select the outcome or process for surveillance
Consider both outcomes and processes Include
clinicians in selection What is cost or impact
of negative outcome? Potential to reduce
infection rates? What are priorities of
institution? What is frequency of event?
53
Outcome VS Process Indicators (cont)
Outcome is the result of care or performance.
(outcome may be negative - infection or injury,
SSI, VAP or positive such as short patient
stay) Process is the series of steps taken to
achieve an outcome.(timed antibiotic
prophylaxis to prevent surgical site
infections, flushing or urinary catheter care )
54
Characteristics of a Good Indicator (cont)
Clear, understandable and easily applied
definitions Clinically important Easy to
survey Amenable to risk stratification
Potential to improve outcomes
55
Use surveillance definitions
Use standardized written definitions NNIS
definitions from CDC Apply definitions
uniformly Valid definitions
56
Numerator Number of events being studied (cont)
Numerator is the number(or case) of
nosocomail infections identified in the study
period. .
57
Denominator Population at Risk (cont)
Choice is critical when calculating
infection rates Include everyone at risk To
describe risk and evaluate intervention
strategies, risk should be comparable in all
those included in the denominator
58
Denominators (cont)
Ex. Discharges Hospital days Pt. days by
unit Pt. exposed to specific devices Pt.
days exposed to specific devices Pt. days
exposed to specific devices in specific risk
group
59
Collect Surveillance Data
Systematic data collection Trained
surveillance staff Standardized data collection
forms Done with same intensity
60
Collect Surveillance Data (cont)
Risk factors-risk data must be recorded for
all of population Host-specific
age,diabetes,obesity, underlying disease
Device/ procedures surgery, indwelling
catheters, ventilator use.
61
Collect Surveillance Data (cont)
Interventions antibiotics, other treatments
started or devices removed Optional data
response to treatment, length of stay , and costs
of care.
62
Surveillance
Methods
Sensitivity
----14 to 34 ----73 to 80 ----33 to
71 ----48 to 81 ----85
Physician report Retrospective chart review
(SSI) Microbiology reports Antibiotic use
Selective chart review nurses care planes
63
Intrinsic and Extrinsic Factors
Extrinsic factors such as devices and
therapies Intrinsic factors such as severity of
illness, underlying diseases e.g. rates of
Methicillin-resistant Staphylococcus aureus
infections in burn patients
64
Risk Stratification for SSI
CLEAN CLEAN CONAMINATED CONTAMINATED DIRTY
65
SSI Risk Indices
NNIS Risk Index ASA score of 3,4 or
5 1 Procedure time gt T hours 1 Procedure
dirty or contaminated 1
66
Approaches to Surveillance
67
Approaches to Surveillance
Targeted /Focused/ Site Infections in
defined groups or types of patients (e.g.,
infections in surgical patients)
68
Targeted /Focused Surveillance
Consider procedures that Are associated with a
higher morbidity, mortality craniotomy, CABG
Vs hernia repair Have a history of high
infection rates High volume, or are very costly
69
Designing a Surveillance System
70
Denominator High risk unit,
Number of ICU admissions or discharges in
month/year Number of ICU patient days
71
Example of Selected Surveillance Activities for
12 months
Several focused surveillance projects
Ongoing ICU surveillance, including a project
related to reducing Ongoing site
surveillance-primary bacteremia Ongoing
laboratory surveillance for all multi-drug
resistant microorganisms Periodic
site surveillance - total hip replacements (3
month period 2) Periodic site
surveillance - open heart surgeries, (for 6
months) including 30 day post-discharge
surveillance Ongoing surveillance for
occupationally related infections in
hospital staff
72
Surgical Site Infection Surveillance as an
Example
73
Surveillance Objectives for SSI
Reduce SSI rates which will reduce mortality,
improve care
74
SSI
Definition
Purulent drainage Organisms from fluid or tissue
from incision Surgeon or attending physician
dx At least one of the following pain or
tenderness , localized swelling,redness
or heart surgeon opening incision
75
SSI Rates calculation
Service-specific
of SSIs in pt. on the neurosurgery service
x100
of neurosurgery pt.
76
SSI Rates calculation
Procedure-specific
of SSIs (specific procedure)
x100
of procedures.
77
SSI Rates calculation
Surgeon-specific
of SSIs in pt. of a particular surgeon
x100
of pt. Operated on by that surgeon
78
SSI Interventions
PRE OP INTRA OP POST
OP Skin prep Surgical
Dressing Technique
Technique Pre op stay Hand
scrub ATB ATB
79
Improvement of SSI Surveillance
Do surgeons agree with definitions? What type of
reports desired? Surgeon, OR nurse on IC
Committee Goals of SSI surveillance?
80
Interventions and Improvement Activities
Based on findings Improve pt. Care Consider
clinical outcomes resource consumption
81
(No Transcript)
82
CAUTI Rate ??? Device Utilization,
????????????????????? ??? ??????????? ?.?. 2545
83
CAUTI Rate ??? Device Utilization,
????????????????????? ??? ??????????? ?.?. 2545
84
CAUTI Rate ??? Device Utilization,
????????????????????? ??? ??????????? ?.?. 2545