Surveillance of

Nosocomial Diseases
RMS Haripurnomo Kushadiwijaya
Wahyudi istiono
What you know on surveillance:

A continually, dynamic process of

gathering, managing, analyzing,
and reporting data on events
that occur in a specific population

You may observe only the problem itself or with its risk factors
 Surveillance
Hospital Preventing hospital
Surveillance
And other Surgical Site Infections,
methods
Medical services Pneumonia, Urinary
Tract infections, and
Bacteremia.
Steps: Purposes:
-Definition of events -Reducing the infection rate
-Systematic collection of data -Establishing base line rate
-Summarization of data -Identifying outbreak
-Analysis and interpretation -Convincing medical staff
-Consuming the results for -Defending malpractice claims
improvement
-Comparing infection rates
among hospitals
 Methods of nosocomial infection
surveillance
Concurrent:
flexible, informative, timely, capable of cluster
detection, capable of changing behavior, expensive

Retrospective:
- depends on completeness, validity and accuracy
of existing data
- does not identify problems as promptly as
concurrent does
- is not expensive
 Methods of nosocomial infection
surveillance
Active:
accurate, complete, expensive

Passive:
misclassification, underreporting, lack of timeliness,
less expensive
 Methods of nosocomial infection
surveillance
Hospital wide
Periodic
Targeted
Defining the threshold limits
Post discharge
 Hospital Wide Surveillance
(CDC, 1972)
(concurrent and prospective):
Sources of data:
-Daily reports of microbiology laboratories
-Medical records of febrile patients
-Medical records of patients taking antibiotics
-Medical records of isolated patients
-Daily interview with nurses and patients
-Periodic review of autopsy reports
-Periodic review of medical records of staff
 Types of HWS

Targeted surveillance:
Periodic surveillance:
Targeted surveillance during
HWS during specified periods
Alternate periods

Rotating HWS:
Rotating HWS from
One unit to another
 Targeted surveillance:
Focus of efforts:
-Selected geographic area (eg ICU)
-Selected service (eg cardiothoracic surgery)
-Specific population of patients or infections (high risk of acquiring
infection eg transplantation, undergoing specific intervention eg
dialysis, at specific site eg blood stream)
 Targeted surveillance:
Characteristics:
-High accuracy and efficiency
-Incapable of detecting other infections
-Criteria of selection target:
-Frequency
-Mortality and morbidity
-Cost
-Preventability
 Defining threshold limits:
Assess base line infection rate
Develop outbreak threshold on the basis
of the data (eg 80th centile)
Evaluate number of isolates or number of
positive cultures that exceed the threshold
 Case finding issues:
Total chart review (standard method)
Laboratory reports
Clinical ward rounds
Screening
Fever chart
High risk patients (transplant, diabetic,
leukemia, invasive methods)
 Analysis
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)
 Analysis
Numerator and denominator: events and
size of population of event source
Overall rate:
No. of NI
no. admitted or discharged patients

Note: drawbacks of use of this rate!

 Drawbacks
Treats all infections as though they are of equal
importance
Obscuring changes in uncommon important by
common unimportant diseases
Does not distinguish between one infection or
multiple infections in one patient
May underestimate
Does not account high risk patients
Does not account length of stay
Unadjusted rates cant be compared with rate of
other hospitals
 Adjusted rates:
For severity of illness
For length of stay
For exposure to device (eg ventilator)
 Essential numerator data:
Demographic (name, age, sex, service,
ward administrative data, hospital
identification number)
Infection (onset date, site of infection)
Laboratory (pathogen antibiogram)
 Numerator data:
Risk factors (only when these data used
for analysis)
An example of SSI (Surgical site infection)
Kind of surgery
Date of surgery
Duration of surgery
Type of wound (clean, dirty, ..)
Date of discharge
 Denominator data:
Total no. of admitted or discharged patients

Or
No. of days of exposure:
- no. of patients & patient-days in the unit
- no. of ventilator days
- no. of central line days
- no. of urinary catheter days
 Comparing rates:
Same definition
Same methods of surveillance & case
finding
Same accuracy of methods & personnel
Same characteristics of hospital wards
(length, risk, exposure to devices)
 Dissemination:
Results to be disseminated to those who
use it to prevent and control
Confidentiality kept
Regular time intervals or reporting
Format of report (summary, table, graph)
List of targets: infection control committee
staff, key prsons in individual nursing
units, nursing administration, hospital
administration, and education service
 Evaluation:
At least annually
Detect clusters?
Any practices changes based on surveillance?
Data used to decrease the endemic rate?
Data used to assess the efficacy of intervention?
Administrative & clinical staff aware of
surveillance findings?