Targeted Surveillance for Nosocomial Infections,Barbara M. Soule, RN, MPA, CICChinese Society for Nosocomial Infections July 4-5, 2004 Suzhou, China,2,IC Practitioner (ICP) Activities,Surveillance,Program Management,Education,Miscellaneous,Outbreak Investigation,Consultation,3,Surveillance has an Epidemiologic foundation,Study the distribution of problems and events within a defined (targeted) population at risk for developing specific infections in order to plan & implement interventions.,4,3 Key Surveillance Methods,Hospital-wide Traditional SurveillanceAll infections complete- time consumingLimits time for interventionsPeriodic SurveillanceSelected infections or populations periodically over timeMiss some infectionsTargeted Surveillance,5,Advantages/Disadvantages,Adapted from Pottinger et al & Gaynes et al.,Targeted Surveillance,7,CDCs National Nosocomial Infections Surveillance (NNIS) System Targets:,NNIS System,AUR,ICU,HRN,Surgical Patient,Antimicrobial Use and Resistance,Intensive Care Unit (Adult/Pediatric),High Risk Nursery (NICU),Risk adjusted SSIs by Procedures,8,Your Hospital Surveillance System Targets:,Your Hospital,VAP,ICU,BSI,SSI,Ventilator- Associated Pneumonia Medical /SurgicalICUs,Intensive Care Unit (Pediatric),Primary Blood Stream Infections,Primary Orthopedic Neurosurgical or CABG Procedures,9,Which infection to target?,Focus on patients at high risk for HAI Patient care areas ICUs, cardio-thoracic surgery, cancer ward Specific populations neonates, transplant patients, hemodialysis pts Procedures / Devices CT surgery, central vascular lines, ventilators Organisms of epidemiologic importance MRSA, VRSA,10,Targeted Surveillance for Outcomes,Primary Bloodstream infections Ventilator-associated pneumonia, Surgical site infections MRSA, VRE infections Vascular access infections in hemodialysis patients Sharps injuries in healthcare providers.,11,Targeted Surveillance for Processes,Hepatitis B immunity rates in personnel Personnel compliance with protocols - isolation precautions, Sterilization quality assurance testing, Effective environmental cleaning Antimicrobial prescribing and administration,12,How to implement targeted surveillance,13,Step One,ICP and MD review Microbiology reports daily Review past surveillance data periodically Develop a list of the potential infections or populations for targeted surveillance,14,Step Two,Infection control team selects nosocomial infections to target based on one or more of the following criteria:,15,Criteria for Selecting Processes or Outcomes for Targeted Surveillance,IC program objectives Frequency or level of risk of infectious complications for areapatient population procedure service Morbidity, Mortality, Cost Possibility for prevention,16,Step Three,ICP performs chart reviews on the infection-related processes or outcomes identified in Step Two using standardized, consistent, approved definitions. Consistent intensity and thoroughness of surveillance over time Same definitions over time,17,Targeted Surveillance: A Means to an End,Collect only necessary data Arrive at meaningful information,18,So You Can:,Develop meaningful interventions DO something to reduce infections Improve patient care!,19,The Cycle for Success Through Targeted Surveillance,Is there an important problem?What, why?Multidisciplinary Teams,2. Describe and understand the problem? Targeted Surveillance,3. How to affect change?Multidisciplinary TeamsEducationFeedbackNew protocolsNew products,4. Do the changes work?Remeasure,Adapted from: Richards C, et al. Emerg Infect Dis 2001,20,NLM,Ignaz SemmelweisTargeted Surveillance And Intervention For Puerperal Sepsis,21,Targeted Surveillance for a Process,Timing of Antibiotic Prophylaxis for Surgical Site Infection,NLM Archives,22,1. Is There an Important Problem?,Inappropriate surgical prophylaxis is a major infection risk exposes patient to unnecessary toxicity increases antimicrobial resistance excess doses or inappropriate spectrum antibiotics do not reduce the incidence of surgical wound infection,23,“Ideal” Prophylaxis,Ideal antibiotic for prophylaxis active against pathogens most likely to contaminate wound adequate concentrations during potential contamination administered for a short time to reduce complications, resistance, and cost,24,Targeted Process Surveillance Timing of Perioperative Antimicrobial Prophylaxis,Classen DC, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281,Incision,Hours before incision,Hours after incision,Antibiotic Administered,25,Timing of Perioperative Antimicrobial Prophylaxis,Classen DC, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281,26,2. Perform Targeted Surveillance for This Problem,1) Proportion of patients who receive prophylactic antibiotics within 1 hour before surgical incision# antibiotics 1 hour# surgeries with antibiotics,