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AN OVERVIEW ON INFECTION
CONTROL DATA COLLECTION,
ANALYSIS

12/31/2013

١
DATA COLLECTION
 Healthcare

Associated
Infections (HAIs)
VAP, CLABSI, CAUTI & SSI.
 Hand Hygiene
 Alert Organisms
 Sharp Injuries
12/31/2013

٢
DATA PROCESSING

Data are collected ,
analyzed, and
transformed into
useful information
12/31/2013

٣
Presentation Outline
 CDC

Criteria of HAIs
 Type & Methodology of Surveillance
work
 Design an interpretive surveillance
report
 Data display
 Benchmarking
 Benchmarking requirements and
problems
12/31/2013

٤
What is Surveillance?
The ongoing, system collection,
analysis, and interpretation of
health data essential to the
planning, implementation, and
evaluation of public health
practice, closely integrated with
timely dissemination of these
data to those who need to know.
12/31/2013

٥
SURVEILLANCE, Why?

12/31/2013

٦
Purposes of Surveillance-1
1. Reducing the infection rate
within a hospital.
2. Establishing endemic (baseline)
rates.
3. Identifying outbreaks.

12/31/2013

٧
Purposes of Surveillance-2
4. Convincing medical staff.
5. Defending malpractice claims.
6. Comparing infection rates
among hospitals.

12/31/2013

٨
Steps in Surveillance
Definition of the event(s).
Systematic collection of data.
Preparation of Surveillance Report
Analysis & interpretation.
Benchmarking.
Consuming the results for
improvement.
12/31/2013

٩
Making Surveillance Work
Measurement

Knowledge

Action

12/31/2013

Case definitions
Accurate data
Systematic collection
Planning
Active feedback
Engage leaders &clinicians
Training
Audit and evaluate practice
Stimulate change
What can be improved & how?

١٠
SURVEILLANCE FOR
WHAT?

12/31/2013

١١
Device-Associated Infection


There is no minimum period of time that the device
must be in place for the infection to be considered
device-associated.



The date of the device-associated HAI event is
either the date on which the first clinical evidence
appeared or the date on which the specimen used
to meet the HAI criteria was collected, whichever
came first.



If the device-associated HAI develops within 48
hours of discharge from a location, then the HAI is
associated with the discharging location.

12/31/2013

١٢
Central Line-Associated Bloodstream Infection
(CLABSI) Event



A CLABSI is a primary bloodstream infection
(BSI) in a patient who had a central line or
umbilical catheter in place at the time of or
within 48 hours before onset of the BSI.

 Use
12/31/2013

CDC Criteria for Identification
١٣
Ventilator-Associated Pneumonia (VAP)
Event:


A VAP is pneumonia (PNEU) that is
identified using a combination of
radiologic, clinical and laboratory criteria
and occurs in a patient who was intubated
and ventilated at the time of or within 48
hours before the onset of pneumonia.

 Use
12/31/2013

CDC Criteria for Identification
١٤
Catheter-Associated Urinary Tract Infection
(CAUTI) Event:


CAUTI is defined as a symptomatic urinary
tract infection (SUTI) or asymptomatic
bacteremic UTI (ABUTI) in a patient who
had an indwelling urinary catheter at the
time of or within 48 hours before onset of
the event.

 Use
12/31/2013

CDC Criteria for Identification
١٥
Dialysis Event (DE)
Hospitalization

In-unit IV
antimicrobial starts

Positive blood
culture

12/31/2013

All hospitalizations that involved an
overnight stay in a hospital and is
not limited to infections or
situations
All IV antimicrobial starts and is not
limited to those with vancomycin or
for a vascular access problem
All patients with a positive blood
culture even if they did not have an
associated hospitalization or in-unit
IV antimicrobial start

١٦
PROCEDURE-ASSOCIATED
MODULE
Surgical Site Infection (SSI) Event:
The SSI is an infection that occurs within 30 days
(or within one year for an implant in the case of
organ/space SSI) after an operative procedure that
involves the skin or subcutaneous tissue
(superficial incisional SSI), deep soft tissue (deep
incisional SSI), or any other part of the body that is
opened or manipulated during the operative
procedure (organ/space SSI).

Use CDC Criteria for Identification
12/31/2013

١٧
Post-Procedure Pneumonia (PPP)
Event:


PPE is a pneumonia that is identified
using a combination of radiological,
clinical and laboratory criteria (such
as VAP) and occurs after an inpatient
operation but prior to discharge.

12/31/2013

١٨
Location/Period of
Surveillance Events











CLABSI: Surveillance for CLABSI in at least one location
(ICU, NICU, SCA, others) in the healthcare institution for at
least one calendar month.
VAP: Surveillance for VAP in at least one location (ICU,
NICU, SCA, others) in the healthcare institution for at least
one calendar month
CAUTI: Surveillance for CAUTI performed in at least one
location (ICU, SCA, others) in the healthcare institution for at
least one calendar month
DE: Surveillance for DE for at least 6 months among chronic
hemodialysis patients at an outpatient hemodialysis facility
SSI: Surveillance for at least one NHSN operative procedure
performed in surgical patients in any inpatient/outpatient
setting for at least one month
PPP: Surveillance for at least one NHSN operative
procedure performed only in a surgical inpatient setting for
at least one month

12/31/2013

١٩
SURVEILLANCE METHODOLOGY
The Patient Safety surveillance modules
 Active
 Patient-based
 Prospective,
 Priority-directed surveillance
 Of device/medication/procedure-associated
infection events
 Their corresponding denominator data by a
trained infection control professional (ICP).
12/31/2013

٢٠
SURVEILLANCE METHODOLOGY
Active surveillance
a) Trained personnel, mainly ICPs, are vigorously
look for HAIs
b) Information is accumulated using a variety of data
sources within and beyond the nursing ward
 Passive surveillance
a) Persons who do not have a primary surveillance
role, such as ward nurses or respiratory therapists,
identify and report HAIs


12/31/2013

٢١
Patient-based and laboratory-based
surveillance
1. Patient-based surveillance
a) Count HAIs, assess risk factors, and monitor patient
care procedures and practices for adherence to
infection control principles
b) Requires ward rounds and discussion with
caregivers
2. Laboratory-based surveillance
a) Detection is based solely on the findings of
laboratory studies of clinical Specimens.

12/31/2013

٢٢
Prospective and Retrospective
Surveillance
1. Prospective surveillance
a) Monitor patients during their
hospitalization
b) For SSIs, also monitor during the
post-discharge period
2. Retrospective surveillance
a) Identify infections via chart reviews
after patient discharge
12/31/2013

٢٣
Priority-directed and
comprehensive surveillance
1. Priority-directed surveillance
(Targeted or focused surveillance)
a) Objectives for surveillance are defined
b) The focus is on specific events, processes,
organisms, and/or patient populations
2. Comprehensive surveillance
Universal Surveillance
a) Continuous monitoring of all patients for all events
and/or processes
12/31/2013

٢٤
Risk-based
Unit-based
Pathogen-based
Procedure-based
12/31/2013

25
Surveillance Collection Forms
MC 2 7 0 5 (R e v . 0 6 /0 4 )

V a n d e r b i l t U n i v e rs ity M e d ic a l C en te r
M o n ro e C a re ll J r.

OR

at V an d e r b il t

N u r s i n g C h e c k l i s t:
C e n tr a l V e n o u s C a t h e te r I n s e r ti o n
N O T E : P le a s e u s e e i th e r b l a c k o r b l u e i n k to c o m p l e te th i s f o rm .
CCU
B I CU
M R #:

T im e s t ar t
( 1 s t n e e d le s ti c k ) :
In s e r t io n S it e :
In t e r n a l J u g u l a r
S ub c lav ia n
F em or a l
O th e r ( s p e c i fy ) :

S id e :
Rig ht
L e ft

L is t a ll s it e s w h e r e in s e r t io n w a s a t te m p t e d .
R IJ
L IJ
RS C
L SC

M IC U
PCCU

/
:

D a te :

T y p e o f c a th e t e r :
D ou ble lum e n
Tr i p le lu m e n
In t ro d u c e r
S w a n- G a n z
V a s c a th

TI C U
NI C U

RF

N SI C U
O th e r

S I CU

P le a s e u s e m il i ta ry ti m e
(i .e . 1 :0 0 p m i s 1 3 :0 0 )

/
T im e en d
( c a th e te r s e c u r e d ) :

In d ic a t io n s fo r u s e :
P r es s or s
H e m o d y n a m i c m o n i t.
F l u i d s /b l o o d p r o d u c ts
F r e q u e n t la b d r a w s
LF

:

C h e c k if :
C o n s e n t o b ta i n e d
P t /F a m i l y t e a c h i n g d o n e
G uid ew ir e e x c h an ge

O th e r ( s p e c i fy ) :

T h e p r o v id e r in s e r t in g t h is lin e :
a . H a n d e d - o f f h is /h e r pa g e r b e fo r e th e p r o c e d u r e ?
Yes
No
D id n’t as k
b . W a s h e d h a n d s im m e d ia te ly p r io r to p r o c e d u r e ?
Yes
No
D id n’t as k
c . H a s p r e v io u s ly p la c e d a t le a s t f iv e ( 5 ) c e n t r a l lin e s ?
Yes
No *
D id n’t as k
* If “ N o ” , w a s th is p r o c e d u r e s u p e rv is e d b y s om e on e w ith le a s t f iv e ( 5 ) c e n t r a l lin e s e x p e r ie n c e ?
Ye s
No
Did n’t a s k
B a r r ie r p r e c a u t io n s ( c h e c k a n y u s e d ) :
S t er ile glov es

S te r il e g o w n

Ma sk

S te r i le to w e l s

F ull bo dy dr a pe

D e s c r ib e th e le v e l o f t r a in in g o f t he p e r s o n w h o a c t u a ll y in s e r t e d t h e lin e ?
M e d i c a l S tu d e n t
In te r n ( P G Y -1 )
R e s i d e n t (P G Y - 2 + )
F ellow

A tte n d i n g
N u r s e P ra c ti ti o n e r

H o w m a n y d if f e r e n t ne e d le s t ic k s d id t h e p a tie n t r e c e iv e ( n u m b e r o f s k in b r e a k s ) ?
1
2
3
4
5
6+
U n k no w n
W a s t h e s t e r ile f ie ld m a in t a in e d t h r o u g h ou t th e e n t ir e p r o c e d u r e ?

Yes

P r e - in s e r tio n s k in p r e p (c h e c k a n y u s e d ) :
A lc o ho l
B e ta d i n e (p o v i d o n e -i o d i n e )

O th e r ( s p e c i fy ) :

C h lo r h e x i d i n e

D e s c r ib e th e c ir c u m s t a n c e s u n de r w h ic h t h is lin e w a s p la c e d :
No n- e m e r ge nt
E m e r g e n t ( l i fe - th r e a te n i n g o r c o d e s i t u a ti o n )
F o llo w - u p C X R :

O r d e re d

C X R f in d in g s (c h e c k a ll t h a t a p p ly ) :
N o p n e u m o th o r a x
C a t h e te r i n g o o d p o s i t io n

P n e u m o t h o r a x (d e s c r i b e a c ti o n t a k e n ):
C a th e te r p o s i ti o n a d ju s te d ( d e s c r i b e ) :

T y p e o f d re s s in g :

B io - oc c lus iv e

D r e s s in g a p p lie d b y :

Nu r s e

G a uz e

O th e r ( s p e c i fy ) :

P r o c e d u r a li s t

P a t ie n t to le r a t e d t he p r oc e d u r e w e ll?
C o m p lic a tio n s ?

No ne

No

P r e -e x i s ti n g i n fe c ti o n

N o t o r d e r e d ( s p e c i fy r e a s o n ):

O th e r ( s p e c i fy ) :

Ye s

No

C o m m e n ts :

P l a c e m e n t u n s u c c e s s fu l

O th e r ( d e s c ri b e ) :

P l e a s e f ile p a g e 2 in p a t ie n t s c h a r t a n d r e t u r n t o p f o r m t o t h e de s ig n a te d lo c a t io n i n th e IC U .
S ig n a t u r e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

D a t e : _ _ __ __ _ __ __ _ __ __ _

MC 2 7 0 5 (R e v . 0 6 /0 4 )

Va n d e r b i l t U n i v e rs ity M e d ic a l C en te r
M o n ro e C a rell J r.

OR

at V an d e r b il t

N u r s i n g C h e c k l i s t:
C e n tr a l V e n o u s C a t he te r I n s e r ti o n
NO T E : P le a s e u s e eith er blac k o r blue in k to c om ple te th is f o rm .
CCU
B I CU
M R #:

T im e s t ar t
( 1 s t ne ed le s tic k ) :
In se rt io n S it e :
S id e :
Int er na l J ugu lar
Rig ht
S ub c lav ia n
Le ft
F em or a l
O th er ( s pe c ify ) :

L ist all sit e s w h e re in s e rt io n w a s a t te m p t e d .
R IJ
L IJ
RS C
L SC

M IC U
PCCU

/
:

D a te :

T yp e o f c a th e t er :
D ou ble lum e n
Tr ip le lu m e n
Int ro d uc e r
S w a n- G a n z
V as c a th

TI C U
NI C U

N SI C U
O the r

S I CU

P le a s e u s e m il i ta ry ti m e
(i .e . 1 :0 0 p m i s 1 3 :0 0 )

/

T im e en d
( c a th ete r s ec ur e d) :
In d ic at io n s fo r u se :
C h e ck if :
P r es s or s
C on s e nt o bta ine d
H e m o dy na m ic m o nit.
P t /F a m ily t e ac h ing do ne
F luid s /b lo od pr o du c ts
G uid ew ir e e x c h an ge
F r e qu en t la b dr aw s

RF

:

LF

O th er ( s pe c ify ) :

T h e p ro v id e r in s e rt in g t h is lin e :
a. H a n d ed - o f f h is /h e r pa g e r b e fo r e th e p ro c e d u re ?
Yes
No
D id n’t as k
b . W a s h ed h an d s im m e d ia te ly p rio r to p ro c ed u re ?
Yes
No
D id n’t as k
c. H a s p rev io u s ly p la c ed a t le a st f iv e ( 5) c en t ra l lin e s ?
Yes
No *
D id n’t as k
* If “ No ” , w as th is p ro c ed u re s u p e rv is e d b y s om e on e w ith le as t f iv e ( 5) c en t ra l lin e s e x p erie n c e?
Ye s
No
Did n’t a s k
Ba rr ier p re c au t io n s ( ch e c k a n y u se d ) :
S t er ile glov es
S te r ile g ow n

Ma sk

S te r ile tow e ls

F ull bo dy dr a pe

De s c rib e th e lev e l o f t ra in in g o f t he p ers o n w h o a ct u a ll y in se rt e d t h e lin e ?
M e dic al S tu de nt
In te r n ( P G Y -1 )
Re s ide nt (P G Y - 2+ )
F ellow

A tte nd in g
N u r s e P ra c titio ne r

Ho w m a n y d if f er en t ne e d le st ic k s d id t h e p a tie n t r ec eiv e ( n u m b e r o f s kin b re ak s ) ?
1
2
3
4
5
6+
U n k no w n
W a s t h e st e rile f ie ld m ain t a in e d t h ro u g h ou t th e e n t ire p ro c ed u re?

Yes

P re - in s er tio n s kin p re p (c h e ck a n y u se d ) :
A lc o ho l
B e ta dine (p ov id on e -io din e)

O th er ( s pe c ify ) :

Ch lo r he x id ine

De s c rib e th e c irc u m st an ce s u n de r w h ic h t h is lin e w as p lac e d :
No n- e m e r ge nt
E m e r ge n t ( life - thr e a te ning o r c o de s it ua tion )
F o llo w - u p C X R :

O r de re d

CX R f in d in g s (c h e ck a ll t h a t a p p ly) :
No p ne u m o th or a x
C at he te r in g oo d po s it io n
T yp e o f d re s sin g :

P n eu m ot ho r ax (d es c r ibe a c tio n t a k en ):
C a the te r p os itio n ad ju s te d ( de s c r ibe ) :

B io - oc c lus iv e

G a uz e

O th er ( s pe c ify ) :

Nu r s e
P r o c e dur a lis t
Dr es s in g a p p lie d b y :
P a t ien t to le ra t ed t he p roc e d u re w e ll?
Ye s
Co m p lic a tio n s?

No ne

No

P r e -e x is tin g in fe c tio n

No t or de r e d ( s pe c ify r e as o n ):

O th er ( s pe c ify ) :
No

C o m m e n ts :

P la c e m e nt un s uc c e s s ful

O th er ( d es c rib e) :

P l e as e f ile p ag e 2 in p at ie n t s ch a rt a n d re t u rn t o p f o rm t o t h e de s ig n a te d lo ca t io n i n th e IC U .
S ig n at u re : _ __ __ _ __ __ __ _ __ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ __ _

D a t e : _ _ __ __ _ __ __ _ __ __ _

MC 2 7 0 5 (R e v . 0 6 /0 4 )

V a n d e r b i l t U n i v e rs ity M e d ic a l C en te r
M o n ro e C a re ll J r.

OR

at V an d e r b il t

N u r s i n g C h e c k l i s t:
C e n tr a l V e n o u s C a t h e te r I n s e r ti o n
N O T E : P le a s e u s e e i th e r b l a c k o r b l u e i n k to c o m p l e te th i s f o rm .
CCU
B I CU
M R #:

D a te :

T y p e o f c a th e t e r :
D ou ble lum e n
Tr i p le lu m e n
In t ro d u c e r
S w a n- G a n z
V a s c a th

T im e s t ar t
( 1 s t n e e d le s ti c k ) :
In s e r t io n S it e :
In t e r n a l J u g u l a r
S ub c lav ia n
F em or a l
O th e r ( s p e c i fy ) :

L is t a ll s it e s w h e r e in s e r t io n w a s a t te m p t e d .
R IJ
L IJ
RS C
L SC

S id e :
Rig ht
L e ft

M IC U
PCCU

/
:

TI C U
NI C U

RF

N SI C U
O th e r

S I CU

P le a s e u s e m il i ta ry ti m e
(i .e . 1 :0 0 p m i s 1 3 :0 0 )

/
T im e en d
( c a th e te r s e c u r e d ) :

In d ic a t io n s fo r u s e :
P r es s or s
H e m o d y n a m i c m o n i t.
F l u i d s /b l o o d p r o d u c ts
F r e q u e n t la b d r a w s
LF

:

C h e c k if :
C o n s e n t o b ta i n e d
P t /F a m i l y t e a c h i n g d o n e
G uid ew ir e e x c h an ge

O th e r ( s p e c i fy ) :

T h e p r o v id e r in s e r t in g t h is lin e :
a . H a n d e d - o f f h is /h e r pa g e r b e fo r e th e p r o c e d u r e ?
Yes
No
D id n’t as k
b . W a s h e d h a n d s im m e d ia te ly p r io r to p r o c e d u r e ?
Yes
No
D id n’t as k
c . H a s p r e v io u s ly p la c e d a t le a s t f iv e ( 5 ) c e n t r a l lin e s ?
Yes
No *
D id n’t as k
* If “ N o ” , w a s th is p r o c e d u r e s u p e rv is e d b y s om e on e w ith le a s t f iv e ( 5 ) c e n t r a l lin e s e x p e r ie n c e ?
Ye s
No
Did n’t a s k
B a r r ie r p r e c a u t io n s ( c h e c k a n y u s e d ) :
S t er ile glov es

S te r il e g o w n

Ma sk

S te r i le to w e l s

D e s c r ib e th e le v e l o f t r a in in g o f t he p e r s o n w h o a c t u a ll y in s e r t e d t h e lin e ?
M e d i c a l S tu d e n t
In te r n ( P G Y -1 )
R e s i d e n t (P G Y - 2 + )
F ellow
H o w m a n y d if f e r e n t ne e d le s t ic k s d id t h e p a tie n t r e c e iv e ( n u m b e r o f s k in b r e a k s ) ?
1
2
3
4
5
6+
U n k no w n
W a s t h e s t e r ile f ie ld m a in t a in e d t h r o u g h ou t th e e n t ir e p r o c e d u r e ?

Yes

P r e - in s e r tio n s k in p r e p (c h e c k a n y u s e d ) :
A lc o ho l
B e ta d i n e (p o v i d o n e -i o d i n e )

F ull bo dy dr a pe
A tte n d i n g
N u r s e P ra c ti ti o n e r

O th e r ( s p e c i fy ) :

C h lo r h e x i d i n e

D e s c r ib e th e c ir c u m s t a n c e s u n de r w h ic h t h is lin e w a s p la c e d :
No n- e m e r ge nt
E m e r g e n t ( l i fe - th r e a te n i n g o r c o d e s i t u a ti o n )
F o llo w - u p C X R :

O r d e re d

C X R f in d in g s (c h e c k a ll t h a t a p p ly ) :
N o p n e u m o th o r a x
C a t h e te r i n g o o d p o s i t io n
T y p e o f d re s s in g :

B io - oc c lus iv e

D r e s s in g a p p lie d b y :

Nu r s e

P a t ie n t to le r a t e d t he p r oc e d u r e w e ll?
C o m p lic a tio n s ?

No ne

No

P r e -e x i s ti n g i n fe c ti o n

N o t o r d e r e d ( s p e c i fy r e a s o n ):
P n e u m o t h o r a x (d e s c r i b e a c ti o n t a k e n ):
C a th e te r p o s i ti o n a d ju s te d ( d e s c r i b e ) :
G a uz e

O th e r ( s p e c i fy ) :

P r o c e d u r a li s t
Ye s
P l a c e m e n t u n s u c c e s s fu l

O th e r ( s p e c i fy ) :
No

C o m m e n ts :
O th e r ( d e s c ri b e ) :

P l e a s e f ile p a g e 2 in p a t ie n t s c h a r t a n d r e t u r n t o p f o r m t o t h e de s ig n a te d lo c a t io n i n th e IC U .
S ig n a t u r e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

12/31/2013

D a t e : _ _ __ __ _ __ __ _ __ __ _

٢٦
SURVEILLANCE DATA ANALYSIS
1. Incidence rate:

This rate is a measure of the frequency with which an event
occurs in a population over a defined time period. The numerator
is the number of new cases that occur during the defned time
period, and the denominator is the population at risk.
2.

Prevalence rate:

This rate is the proportion of persons in a population who have a
particular disease or condition (new and previously existing) at a
specified point in time or over a specified period of time.
Note: Attack rate is a type of incidence rate used to measure the frequency
of new cases of a disease or condition in a specifc population during a
given (short) period of time and is expressed as a percentage.

12/31/2013

٢٧


Incidence = new cases x constant (1000)
population at risk



Prevalence = existing cases x constant(1000)
population at risk

12/31/2013

28
SURVEILLANCE DATA ANALYSIS
 Measures of Frequency:
1. Rate: an expression of the frequency with which an
event occurs in a defined population; for example, the
CLABSI incidence rate is 5.3 per 1,000 CL-days
2. Ratio: the value obtained by dividing one quantity by
another; for example, the ratio of females to males is 2:1
3. Proportion: a type of ratio in which the values in the
numerator are included in(i.e., are a subset of) the
denominator; for example, 33% of the population is in
risk category 1
12/31/2013

٢٩
½ X 1,000

12/31/2013

30
Population at risk
 Patient days / residents days
 Device days


 central

line days
 ventilator days
 Foley catheter days


Procedures performed

12/31/2013

31
 HAIs

cases-SSI, VAP, CLABSI,
CAUTI.
 Positive blood cultures
 Positive VRE
 Positive MRSA
 Patients on vancomycin

12/31/2013

32
Calculating Rates

CLABSI Infection Rate = No. of HAIs associated with Central Line x 1000
No. of Central Line days
Utilization Ratio of Central Line = No. of days of the Central Line used
Total no. of patient days

12/31/2013

٣٣
Calculating Rates

CAUTI Infection Rate = No. of HAIs associated with Urinary Catheter 1000
No. of urinary catheter days
Utilization Ratio of Urinary Catheter = No. of days of the Urinary Catheter
Total no. of patient days

12/31/2013

٣٤
Calculating Rates

VAP Infection Rate = No. of HAIs associated with ventilator x 1000
No. of ventilator days
Utilization Ratio of Ventilator = No. of days of the catheter used
Total no. of patient days

12/31/2013

٣٥
Calculating Rates

SSI Rate by Type of Operation = No. of SSI in a specific type of operation x 100
Total no. of that operation

12/31/2013

٣٦
Surveillance Report
1.Define the event, population, setting
and time period ( e.g. surgical site
infections in patients undergoing
coronary artery bypass graft in
hospital A from January through
December 2013

12/31/2013

٣٧
Surveillance Report
2. State the criteria used for defining a
case (CDC criteria)
3. Specify the number of cases or
events identified and the number in
population studied (e.g. 2 surgical site
infections in 179 total hip replacement
procedures performed)

12/31/2013

٣٨
Surveillance Report
4. Explain the methodology used to
identify cases (e.g., case reports from
personnel and review of medical
records and laboratory results.

12/31/2013

٣٩
Surveillance Report
5. Identify the statistical methods and
calculations used, when appropriate
(e.g., SSI Rate in April = # patients
with SSI after selected operations in
April/ Total # of selected operations
performed in April x 1000)

12/31/2013

٤٠
Surveillance Report
6. State the purpose for conducting
surveillance ( e.g., to reduce the rate
of occurrence of an event).
7. Interpret the findings in a manner
that is understandable to those who
read the report.

12/31/2013

٤١
Surveillance Report
8. Describe any actions taken and
recommendations made for
prevention and control measures.
9. Identify the author and date of the
report.
10. Identify the recipients of the report
12/31/2013

٤٢
Design an Interpretive
Surveillance Report
The report should be disseminated to
those managers and healthcare
providers in the organization who can
use the findings to influence
performance improvement activities.
Monthly Surveillance Report

12/31/2013

٤٣
Data Display Tools
Tables
Bar Charts
Histograms
Pie Charts
Run charts
Statistical Process Control Charts

12/31/2013

٤٤
Graphic Analytical Analysis


Bar graph



Line graph



Pie graph

12/31/2013

٤٥
12/31/2013

٤٦
12/31/2013

٤٧
Tables, Graphs, and Charts
 Complete

Title describing the contents
 Limited information
 Labels describe the content
Make it concise and easily readable
 If you use codes, abbreviations, or
symbols, use footnotes to explain
Monthly Surveillance Statistics
12/31/2013

٤٨
Why Analyze, Display and
Report Data?










Tracking and Trending
Trends/changes overtime
Seasonal occurrences
Outbreaks
Sentinel events
Benchmarking/ Comparison
Compare to others
Detects areas for improvement
Use to improve performance

12/31/2013

٤٩
BENCHMARKING
 Benchmarking

is the process of
comparing oneself to others who are
performing similar activities, so as to
continuously improve.
 The National Healthcare Safety
Network (NHSN)in the US is the oldest
and most widely used network for
benchmarking.
12/31/2013

٥٠
Requirement for Successful
Benchmarking
 Criteria for defining a case are standardized and up to date.
 The population and time period for the study are well defined.
 The surveillance methodology is standardized and consistently used
by all of the participants over time.
 Rates and ratios are calculated using the same numerators (number
of cases) and denominators (population at risk).
 All data collectors receive training on how to collect data and use a
standardized form.
 The facility and population that is compared is similar to the types of
facilities and populations in an aggregate database used for external
comparison

NHSN Report 2010
12/31/2013

٥١
12/31/2013

٥٢
Teamwork and Effective Communication For
Successive Surveillance Work

12/31/2013

٥٣

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OPIOID ANALGESICS AND THEIR IMPLICATIONS

Data collection and analysis [compatibility mode]

  • 1. AN OVERVIEW ON INFECTION CONTROL DATA COLLECTION, ANALYSIS 12/31/2013 ١
  • 2. DATA COLLECTION  Healthcare Associated Infections (HAIs) VAP, CLABSI, CAUTI & SSI.  Hand Hygiene  Alert Organisms  Sharp Injuries 12/31/2013 ٢
  • 3. DATA PROCESSING Data are collected , analyzed, and transformed into useful information 12/31/2013 ٣
  • 4. Presentation Outline  CDC Criteria of HAIs  Type & Methodology of Surveillance work  Design an interpretive surveillance report  Data display  Benchmarking  Benchmarking requirements and problems 12/31/2013 ٤
  • 5. What is Surveillance? The ongoing, system collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with timely dissemination of these data to those who need to know. 12/31/2013 ٥
  • 7. Purposes of Surveillance-1 1. Reducing the infection rate within a hospital. 2. Establishing endemic (baseline) rates. 3. Identifying outbreaks. 12/31/2013 ٧
  • 8. Purposes of Surveillance-2 4. Convincing medical staff. 5. Defending malpractice claims. 6. Comparing infection rates among hospitals. 12/31/2013 ٨
  • 9. Steps in Surveillance Definition of the event(s). Systematic collection of data. Preparation of Surveillance Report Analysis & interpretation. Benchmarking. Consuming the results for improvement. 12/31/2013 ٩
  • 10. Making Surveillance Work Measurement Knowledge Action 12/31/2013 Case definitions Accurate data Systematic collection Planning Active feedback Engage leaders &clinicians Training Audit and evaluate practice Stimulate change What can be improved & how? ١٠
  • 12. Device-Associated Infection  There is no minimum period of time that the device must be in place for the infection to be considered device-associated.  The date of the device-associated HAI event is either the date on which the first clinical evidence appeared or the date on which the specimen used to meet the HAI criteria was collected, whichever came first.  If the device-associated HAI develops within 48 hours of discharge from a location, then the HAI is associated with the discharging location. 12/31/2013 ١٢
  • 13. Central Line-Associated Bloodstream Infection (CLABSI) Event  A CLABSI is a primary bloodstream infection (BSI) in a patient who had a central line or umbilical catheter in place at the time of or within 48 hours before onset of the BSI.  Use 12/31/2013 CDC Criteria for Identification ١٣
  • 14. Ventilator-Associated Pneumonia (VAP) Event:  A VAP is pneumonia (PNEU) that is identified using a combination of radiologic, clinical and laboratory criteria and occurs in a patient who was intubated and ventilated at the time of or within 48 hours before the onset of pneumonia.  Use 12/31/2013 CDC Criteria for Identification ١٤
  • 15. Catheter-Associated Urinary Tract Infection (CAUTI) Event:  CAUTI is defined as a symptomatic urinary tract infection (SUTI) or asymptomatic bacteremic UTI (ABUTI) in a patient who had an indwelling urinary catheter at the time of or within 48 hours before onset of the event.  Use 12/31/2013 CDC Criteria for Identification ١٥
  • 16. Dialysis Event (DE) Hospitalization In-unit IV antimicrobial starts Positive blood culture 12/31/2013 All hospitalizations that involved an overnight stay in a hospital and is not limited to infections or situations All IV antimicrobial starts and is not limited to those with vancomycin or for a vascular access problem All patients with a positive blood culture even if they did not have an associated hospitalization or in-unit IV antimicrobial start ١٦
  • 17. PROCEDURE-ASSOCIATED MODULE Surgical Site Infection (SSI) Event: The SSI is an infection that occurs within 30 days (or within one year for an implant in the case of organ/space SSI) after an operative procedure that involves the skin or subcutaneous tissue (superficial incisional SSI), deep soft tissue (deep incisional SSI), or any other part of the body that is opened or manipulated during the operative procedure (organ/space SSI). Use CDC Criteria for Identification 12/31/2013 ١٧
  • 18. Post-Procedure Pneumonia (PPP) Event:  PPE is a pneumonia that is identified using a combination of radiological, clinical and laboratory criteria (such as VAP) and occurs after an inpatient operation but prior to discharge. 12/31/2013 ١٨
  • 19. Location/Period of Surveillance Events       CLABSI: Surveillance for CLABSI in at least one location (ICU, NICU, SCA, others) in the healthcare institution for at least one calendar month. VAP: Surveillance for VAP in at least one location (ICU, NICU, SCA, others) in the healthcare institution for at least one calendar month CAUTI: Surveillance for CAUTI performed in at least one location (ICU, SCA, others) in the healthcare institution for at least one calendar month DE: Surveillance for DE for at least 6 months among chronic hemodialysis patients at an outpatient hemodialysis facility SSI: Surveillance for at least one NHSN operative procedure performed in surgical patients in any inpatient/outpatient setting for at least one month PPP: Surveillance for at least one NHSN operative procedure performed only in a surgical inpatient setting for at least one month 12/31/2013 ١٩
  • 20. SURVEILLANCE METHODOLOGY The Patient Safety surveillance modules  Active  Patient-based  Prospective,  Priority-directed surveillance  Of device/medication/procedure-associated infection events  Their corresponding denominator data by a trained infection control professional (ICP). 12/31/2013 ٢٠
  • 21. SURVEILLANCE METHODOLOGY Active surveillance a) Trained personnel, mainly ICPs, are vigorously look for HAIs b) Information is accumulated using a variety of data sources within and beyond the nursing ward  Passive surveillance a) Persons who do not have a primary surveillance role, such as ward nurses or respiratory therapists, identify and report HAIs  12/31/2013 ٢١
  • 22. Patient-based and laboratory-based surveillance 1. Patient-based surveillance a) Count HAIs, assess risk factors, and monitor patient care procedures and practices for adherence to infection control principles b) Requires ward rounds and discussion with caregivers 2. Laboratory-based surveillance a) Detection is based solely on the findings of laboratory studies of clinical Specimens. 12/31/2013 ٢٢
  • 23. Prospective and Retrospective Surveillance 1. Prospective surveillance a) Monitor patients during their hospitalization b) For SSIs, also monitor during the post-discharge period 2. Retrospective surveillance a) Identify infections via chart reviews after patient discharge 12/31/2013 ٢٣
  • 24. Priority-directed and comprehensive surveillance 1. Priority-directed surveillance (Targeted or focused surveillance) a) Objectives for surveillance are defined b) The focus is on specific events, processes, organisms, and/or patient populations 2. Comprehensive surveillance Universal Surveillance a) Continuous monitoring of all patients for all events and/or processes 12/31/2013 ٢٤
  • 26. Surveillance Collection Forms MC 2 7 0 5 (R e v . 0 6 /0 4 ) V a n d e r b i l t U n i v e rs ity M e d ic a l C en te r M o n ro e C a re ll J r. OR at V an d e r b il t N u r s i n g C h e c k l i s t: C e n tr a l V e n o u s C a t h e te r I n s e r ti o n N O T E : P le a s e u s e e i th e r b l a c k o r b l u e i n k to c o m p l e te th i s f o rm . CCU B I CU M R #: T im e s t ar t ( 1 s t n e e d le s ti c k ) : In s e r t io n S it e : In t e r n a l J u g u l a r S ub c lav ia n F em or a l O th e r ( s p e c i fy ) : S id e : Rig ht L e ft L is t a ll s it e s w h e r e in s e r t io n w a s a t te m p t e d . R IJ L IJ RS C L SC M IC U PCCU / : D a te : T y p e o f c a th e t e r : D ou ble lum e n Tr i p le lu m e n In t ro d u c e r S w a n- G a n z V a s c a th TI C U NI C U RF N SI C U O th e r S I CU P le a s e u s e m il i ta ry ti m e (i .e . 1 :0 0 p m i s 1 3 :0 0 ) / T im e en d ( c a th e te r s e c u r e d ) : In d ic a t io n s fo r u s e : P r es s or s H e m o d y n a m i c m o n i t. F l u i d s /b l o o d p r o d u c ts F r e q u e n t la b d r a w s LF : C h e c k if : C o n s e n t o b ta i n e d P t /F a m i l y t e a c h i n g d o n e G uid ew ir e e x c h an ge O th e r ( s p e c i fy ) : T h e p r o v id e r in s e r t in g t h is lin e : a . H a n d e d - o f f h is /h e r pa g e r b e fo r e th e p r o c e d u r e ? Yes No D id n’t as k b . W a s h e d h a n d s im m e d ia te ly p r io r to p r o c e d u r e ? Yes No D id n’t as k c . H a s p r e v io u s ly p la c e d a t le a s t f iv e ( 5 ) c e n t r a l lin e s ? Yes No * D id n’t as k * If “ N o ” , w a s th is p r o c e d u r e s u p e rv is e d b y s om e on e w ith le a s t f iv e ( 5 ) c e n t r a l lin e s e x p e r ie n c e ? Ye s No Did n’t a s k B a r r ie r p r e c a u t io n s ( c h e c k a n y u s e d ) : S t er ile glov es S te r il e g o w n Ma sk S te r i le to w e l s F ull bo dy dr a pe D e s c r ib e th e le v e l o f t r a in in g o f t he p e r s o n w h o a c t u a ll y in s e r t e d t h e lin e ? M e d i c a l S tu d e n t In te r n ( P G Y -1 ) R e s i d e n t (P G Y - 2 + ) F ellow A tte n d i n g N u r s e P ra c ti ti o n e r H o w m a n y d if f e r e n t ne e d le s t ic k s d id t h e p a tie n t r e c e iv e ( n u m b e r o f s k in b r e a k s ) ? 1 2 3 4 5 6+ U n k no w n W a s t h e s t e r ile f ie ld m a in t a in e d t h r o u g h ou t th e e n t ir e p r o c e d u r e ? Yes P r e - in s e r tio n s k in p r e p (c h e c k a n y u s e d ) : A lc o ho l B e ta d i n e (p o v i d o n e -i o d i n e ) O th e r ( s p e c i fy ) : C h lo r h e x i d i n e D e s c r ib e th e c ir c u m s t a n c e s u n de r w h ic h t h is lin e w a s p la c e d : No n- e m e r ge nt E m e r g e n t ( l i fe - th r e a te n i n g o r c o d e s i t u a ti o n ) F o llo w - u p C X R : O r d e re d C X R f in d in g s (c h e c k a ll t h a t a p p ly ) : N o p n e u m o th o r a x C a t h e te r i n g o o d p o s i t io n P n e u m o t h o r a x (d e s c r i b e a c ti o n t a k e n ): C a th e te r p o s i ti o n a d ju s te d ( d e s c r i b e ) : T y p e o f d re s s in g : B io - oc c lus iv e D r e s s in g a p p lie d b y : Nu r s e G a uz e O th e r ( s p e c i fy ) : P r o c e d u r a li s t P a t ie n t to le r a t e d t he p r oc e d u r e w e ll? C o m p lic a tio n s ? No ne No P r e -e x i s ti n g i n fe c ti o n N o t o r d e r e d ( s p e c i fy r e a s o n ): O th e r ( s p e c i fy ) : Ye s No C o m m e n ts : P l a c e m e n t u n s u c c e s s fu l O th e r ( d e s c ri b e ) : P l e a s e f ile p a g e 2 in p a t ie n t s c h a r t a n d r e t u r n t o p f o r m t o t h e de s ig n a te d lo c a t io n i n th e IC U . S ig n a t u r e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D a t e : _ _ __ __ _ __ __ _ __ __ _ MC 2 7 0 5 (R e v . 0 6 /0 4 ) Va n d e r b i l t U n i v e rs ity M e d ic a l C en te r M o n ro e C a rell J r. OR at V an d e r b il t N u r s i n g C h e c k l i s t: C e n tr a l V e n o u s C a t he te r I n s e r ti o n NO T E : P le a s e u s e eith er blac k o r blue in k to c om ple te th is f o rm . CCU B I CU M R #: T im e s t ar t ( 1 s t ne ed le s tic k ) : In se rt io n S it e : S id e : Int er na l J ugu lar Rig ht S ub c lav ia n Le ft F em or a l O th er ( s pe c ify ) : L ist all sit e s w h e re in s e rt io n w a s a t te m p t e d . R IJ L IJ RS C L SC M IC U PCCU / : D a te : T yp e o f c a th e t er : D ou ble lum e n Tr ip le lu m e n Int ro d uc e r S w a n- G a n z V as c a th TI C U NI C U N SI C U O the r S I CU P le a s e u s e m il i ta ry ti m e (i .e . 1 :0 0 p m i s 1 3 :0 0 ) / T im e en d ( c a th ete r s ec ur e d) : In d ic at io n s fo r u se : C h e ck if : P r es s or s C on s e nt o bta ine d H e m o dy na m ic m o nit. P t /F a m ily t e ac h ing do ne F luid s /b lo od pr o du c ts G uid ew ir e e x c h an ge F r e qu en t la b dr aw s RF : LF O th er ( s pe c ify ) : T h e p ro v id e r in s e rt in g t h is lin e : a. H a n d ed - o f f h is /h e r pa g e r b e fo r e th e p ro c e d u re ? Yes No D id n’t as k b . W a s h ed h an d s im m e d ia te ly p rio r to p ro c ed u re ? Yes No D id n’t as k c. H a s p rev io u s ly p la c ed a t le a st f iv e ( 5) c en t ra l lin e s ? Yes No * D id n’t as k * If “ No ” , w as th is p ro c ed u re s u p e rv is e d b y s om e on e w ith le as t f iv e ( 5) c en t ra l lin e s e x p erie n c e? Ye s No Did n’t a s k Ba rr ier p re c au t io n s ( ch e c k a n y u se d ) : S t er ile glov es S te r ile g ow n Ma sk S te r ile tow e ls F ull bo dy dr a pe De s c rib e th e lev e l o f t ra in in g o f t he p ers o n w h o a ct u a ll y in se rt e d t h e lin e ? M e dic al S tu de nt In te r n ( P G Y -1 ) Re s ide nt (P G Y - 2+ ) F ellow A tte nd in g N u r s e P ra c titio ne r Ho w m a n y d if f er en t ne e d le st ic k s d id t h e p a tie n t r ec eiv e ( n u m b e r o f s kin b re ak s ) ? 1 2 3 4 5 6+ U n k no w n W a s t h e st e rile f ie ld m ain t a in e d t h ro u g h ou t th e e n t ire p ro c ed u re? Yes P re - in s er tio n s kin p re p (c h e ck a n y u se d ) : A lc o ho l B e ta dine (p ov id on e -io din e) O th er ( s pe c ify ) : Ch lo r he x id ine De s c rib e th e c irc u m st an ce s u n de r w h ic h t h is lin e w as p lac e d : No n- e m e r ge nt E m e r ge n t ( life - thr e a te ning o r c o de s it ua tion ) F o llo w - u p C X R : O r de re d CX R f in d in g s (c h e ck a ll t h a t a p p ly) : No p ne u m o th or a x C at he te r in g oo d po s it io n T yp e o f d re s sin g : P n eu m ot ho r ax (d es c r ibe a c tio n t a k en ): C a the te r p os itio n ad ju s te d ( de s c r ibe ) : B io - oc c lus iv e G a uz e O th er ( s pe c ify ) : Nu r s e P r o c e dur a lis t Dr es s in g a p p lie d b y : P a t ien t to le ra t ed t he p roc e d u re w e ll? Ye s Co m p lic a tio n s? No ne No P r e -e x is tin g in fe c tio n No t or de r e d ( s pe c ify r e as o n ): O th er ( s pe c ify ) : No C o m m e n ts : P la c e m e nt un s uc c e s s ful O th er ( d es c rib e) : P l e as e f ile p ag e 2 in p at ie n t s ch a rt a n d re t u rn t o p f o rm t o t h e de s ig n a te d lo ca t io n i n th e IC U . S ig n at u re : _ __ __ _ __ __ __ _ __ __ __ _ __ __ __ _ __ __ _ __ __ __ _ __ __ __ _ D a t e : _ _ __ __ _ __ __ _ __ __ _ MC 2 7 0 5 (R e v . 0 6 /0 4 ) V a n d e r b i l t U n i v e rs ity M e d ic a l C en te r M o n ro e C a re ll J r. OR at V an d e r b il t N u r s i n g C h e c k l i s t: C e n tr a l V e n o u s C a t h e te r I n s e r ti o n N O T E : P le a s e u s e e i th e r b l a c k o r b l u e i n k to c o m p l e te th i s f o rm . CCU B I CU M R #: D a te : T y p e o f c a th e t e r : D ou ble lum e n Tr i p le lu m e n In t ro d u c e r S w a n- G a n z V a s c a th T im e s t ar t ( 1 s t n e e d le s ti c k ) : In s e r t io n S it e : In t e r n a l J u g u l a r S ub c lav ia n F em or a l O th e r ( s p e c i fy ) : L is t a ll s it e s w h e r e in s e r t io n w a s a t te m p t e d . R IJ L IJ RS C L SC S id e : Rig ht L e ft M IC U PCCU / : TI C U NI C U RF N SI C U O th e r S I CU P le a s e u s e m il i ta ry ti m e (i .e . 1 :0 0 p m i s 1 3 :0 0 ) / T im e en d ( c a th e te r s e c u r e d ) : In d ic a t io n s fo r u s e : P r es s or s H e m o d y n a m i c m o n i t. F l u i d s /b l o o d p r o d u c ts F r e q u e n t la b d r a w s LF : C h e c k if : C o n s e n t o b ta i n e d P t /F a m i l y t e a c h i n g d o n e G uid ew ir e e x c h an ge O th e r ( s p e c i fy ) : T h e p r o v id e r in s e r t in g t h is lin e : a . H a n d e d - o f f h is /h e r pa g e r b e fo r e th e p r o c e d u r e ? Yes No D id n’t as k b . W a s h e d h a n d s im m e d ia te ly p r io r to p r o c e d u r e ? Yes No D id n’t as k c . H a s p r e v io u s ly p la c e d a t le a s t f iv e ( 5 ) c e n t r a l lin e s ? Yes No * D id n’t as k * If “ N o ” , w a s th is p r o c e d u r e s u p e rv is e d b y s om e on e w ith le a s t f iv e ( 5 ) c e n t r a l lin e s e x p e r ie n c e ? Ye s No Did n’t a s k B a r r ie r p r e c a u t io n s ( c h e c k a n y u s e d ) : S t er ile glov es S te r il e g o w n Ma sk S te r i le to w e l s D e s c r ib e th e le v e l o f t r a in in g o f t he p e r s o n w h o a c t u a ll y in s e r t e d t h e lin e ? M e d i c a l S tu d e n t In te r n ( P G Y -1 ) R e s i d e n t (P G Y - 2 + ) F ellow H o w m a n y d if f e r e n t ne e d le s t ic k s d id t h e p a tie n t r e c e iv e ( n u m b e r o f s k in b r e a k s ) ? 1 2 3 4 5 6+ U n k no w n W a s t h e s t e r ile f ie ld m a in t a in e d t h r o u g h ou t th e e n t ir e p r o c e d u r e ? Yes P r e - in s e r tio n s k in p r e p (c h e c k a n y u s e d ) : A lc o ho l B e ta d i n e (p o v i d o n e -i o d i n e ) F ull bo dy dr a pe A tte n d i n g N u r s e P ra c ti ti o n e r O th e r ( s p e c i fy ) : C h lo r h e x i d i n e D e s c r ib e th e c ir c u m s t a n c e s u n de r w h ic h t h is lin e w a s p la c e d : No n- e m e r ge nt E m e r g e n t ( l i fe - th r e a te n i n g o r c o d e s i t u a ti o n ) F o llo w - u p C X R : O r d e re d C X R f in d in g s (c h e c k a ll t h a t a p p ly ) : N o p n e u m o th o r a x C a t h e te r i n g o o d p o s i t io n T y p e o f d re s s in g : B io - oc c lus iv e D r e s s in g a p p lie d b y : Nu r s e P a t ie n t to le r a t e d t he p r oc e d u r e w e ll? C o m p lic a tio n s ? No ne No P r e -e x i s ti n g i n fe c ti o n N o t o r d e r e d ( s p e c i fy r e a s o n ): P n e u m o t h o r a x (d e s c r i b e a c ti o n t a k e n ): C a th e te r p o s i ti o n a d ju s te d ( d e s c r i b e ) : G a uz e O th e r ( s p e c i fy ) : P r o c e d u r a li s t Ye s P l a c e m e n t u n s u c c e s s fu l O th e r ( s p e c i fy ) : No C o m m e n ts : O th e r ( d e s c ri b e ) : P l e a s e f ile p a g e 2 in p a t ie n t s c h a r t a n d r e t u r n t o p f o r m t o t h e de s ig n a te d lo c a t io n i n th e IC U . S ig n a t u r e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 12/31/2013 D a t e : _ _ __ __ _ __ __ _ __ __ _ ٢٦
  • 27. SURVEILLANCE DATA ANALYSIS 1. Incidence rate: This rate is a measure of the frequency with which an event occurs in a population over a defined time period. The numerator is the number of new cases that occur during the defned time period, and the denominator is the population at risk. 2. Prevalence rate: This rate is the proportion of persons in a population who have a particular disease or condition (new and previously existing) at a specified point in time or over a specified period of time. Note: Attack rate is a type of incidence rate used to measure the frequency of new cases of a disease or condition in a specifc population during a given (short) period of time and is expressed as a percentage. 12/31/2013 ٢٧
  • 28.  Incidence = new cases x constant (1000) population at risk  Prevalence = existing cases x constant(1000) population at risk 12/31/2013 28
  • 29. SURVEILLANCE DATA ANALYSIS  Measures of Frequency: 1. Rate: an expression of the frequency with which an event occurs in a defined population; for example, the CLABSI incidence rate is 5.3 per 1,000 CL-days 2. Ratio: the value obtained by dividing one quantity by another; for example, the ratio of females to males is 2:1 3. Proportion: a type of ratio in which the values in the numerator are included in(i.e., are a subset of) the denominator; for example, 33% of the population is in risk category 1 12/31/2013 ٢٩
  • 31. Population at risk  Patient days / residents days  Device days   central line days  ventilator days  Foley catheter days  Procedures performed 12/31/2013 31
  • 32.  HAIs cases-SSI, VAP, CLABSI, CAUTI.  Positive blood cultures  Positive VRE  Positive MRSA  Patients on vancomycin 12/31/2013 32
  • 33. Calculating Rates CLABSI Infection Rate = No. of HAIs associated with Central Line x 1000 No. of Central Line days Utilization Ratio of Central Line = No. of days of the Central Line used Total no. of patient days 12/31/2013 ٣٣
  • 34. Calculating Rates CAUTI Infection Rate = No. of HAIs associated with Urinary Catheter 1000 No. of urinary catheter days Utilization Ratio of Urinary Catheter = No. of days of the Urinary Catheter Total no. of patient days 12/31/2013 ٣٤
  • 35. Calculating Rates VAP Infection Rate = No. of HAIs associated with ventilator x 1000 No. of ventilator days Utilization Ratio of Ventilator = No. of days of the catheter used Total no. of patient days 12/31/2013 ٣٥
  • 36. Calculating Rates SSI Rate by Type of Operation = No. of SSI in a specific type of operation x 100 Total no. of that operation 12/31/2013 ٣٦
  • 37. Surveillance Report 1.Define the event, population, setting and time period ( e.g. surgical site infections in patients undergoing coronary artery bypass graft in hospital A from January through December 2013 12/31/2013 ٣٧
  • 38. Surveillance Report 2. State the criteria used for defining a case (CDC criteria) 3. Specify the number of cases or events identified and the number in population studied (e.g. 2 surgical site infections in 179 total hip replacement procedures performed) 12/31/2013 ٣٨
  • 39. Surveillance Report 4. Explain the methodology used to identify cases (e.g., case reports from personnel and review of medical records and laboratory results. 12/31/2013 ٣٩
  • 40. Surveillance Report 5. Identify the statistical methods and calculations used, when appropriate (e.g., SSI Rate in April = # patients with SSI after selected operations in April/ Total # of selected operations performed in April x 1000) 12/31/2013 ٤٠
  • 41. Surveillance Report 6. State the purpose for conducting surveillance ( e.g., to reduce the rate of occurrence of an event). 7. Interpret the findings in a manner that is understandable to those who read the report. 12/31/2013 ٤١
  • 42. Surveillance Report 8. Describe any actions taken and recommendations made for prevention and control measures. 9. Identify the author and date of the report. 10. Identify the recipients of the report 12/31/2013 ٤٢
  • 43. Design an Interpretive Surveillance Report The report should be disseminated to those managers and healthcare providers in the organization who can use the findings to influence performance improvement activities. Monthly Surveillance Report 12/31/2013 ٤٣
  • 44. Data Display Tools Tables Bar Charts Histograms Pie Charts Run charts Statistical Process Control Charts 12/31/2013 ٤٤
  • 45. Graphic Analytical Analysis  Bar graph  Line graph  Pie graph 12/31/2013 ٤٥
  • 48. Tables, Graphs, and Charts  Complete Title describing the contents  Limited information  Labels describe the content Make it concise and easily readable  If you use codes, abbreviations, or symbols, use footnotes to explain Monthly Surveillance Statistics 12/31/2013 ٤٨
  • 49. Why Analyze, Display and Report Data?          Tracking and Trending Trends/changes overtime Seasonal occurrences Outbreaks Sentinel events Benchmarking/ Comparison Compare to others Detects areas for improvement Use to improve performance 12/31/2013 ٤٩
  • 50. BENCHMARKING  Benchmarking is the process of comparing oneself to others who are performing similar activities, so as to continuously improve.  The National Healthcare Safety Network (NHSN)in the US is the oldest and most widely used network for benchmarking. 12/31/2013 ٥٠
  • 51. Requirement for Successful Benchmarking  Criteria for defining a case are standardized and up to date.  The population and time period for the study are well defined.  The surveillance methodology is standardized and consistently used by all of the participants over time.  Rates and ratios are calculated using the same numerators (number of cases) and denominators (population at risk).  All data collectors receive training on how to collect data and use a standardized form.  The facility and population that is compared is similar to the types of facilities and populations in an aggregate database used for external comparison NHSN Report 2010 12/31/2013 ٥١
  • 53. Teamwork and Effective Communication For Successive Surveillance Work 12/31/2013 ٥٣