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TargetedSurveillanceforNosocomialInfections

BarbaraM.Soule,RN,MPA,CICChineseSocietyforNosocomialInfectionsJuly4-5,2004Suzhou,China1IC

Practitioner(ICP)Activities

SurveillanceProgramManagementEducationMiscellaneousOutbreakInvestigationConsultation2

SurveillancehasanEpidemiologicfoundationStudythedistributionofproblemsandeventswithinadefined(targeted)populationatriskfordevelopingspecificinfectionsinorder

toplan&implementinterventions.33KeySurveillanceMethods

Hospital-wideTraditionalSurveillance Allinfections–complete-timeconsuming LimitstimeforinterventionsPeriodicSurveillance

Selectedinfectionsorpopulationsperiodicallyovertime Misssomeinfections

TargetedSurveillance4Advantages/DisadvantagesAdaptedfromPottingeretal&Gaynesetal.5TargetedSurveillance6CDC’sNationalNosocomialInfectionsSurveillance(NNIS)SystemTargets:NNISSystemAURICUHRNSurgicalPatientAntimicrobialUseandResistanceIntensiveCareUnit(Adult/Pediatric)HighRiskNursery(NICU)RiskadjustedSSIsbyProcedures7YourHospitalSurveillanceSystemTargets:YourHospitalVAPICUBSISSIVentilator-AssociatedPneumoniaMedical/SurgicalICUsIntensiveCareUnit(Pediatric)PrimaryBloodStreamInfectionsPrimaryOrthopedicNeurosurgicalorCABGProcedures8Whichinfectiontotarget?

FocusonpatientsathighriskforHAIPatientcareareasICU’s,cardio-thoracicsurgery,cancerwardSpecificpopulationsneonates,transplantpatients,hemodialysisptsProcedures/DevicesCTsurgery,centralvascularlines,ventilatorsOrganismsofepidemiologicimportance

–MRSA,VRSA9TargetedSurveillancefor

OutcomesPrimaryBloodstreaminfectionsVentilator-associatedpneumonia,SurgicalsiteinfectionsMRSA,VREinfectionsVascularaccessinfectionsinhemodialysispatientsSharpsinjuriesinhealthcareproviders.10TargetedSurveillanceforProcessesHepatitisBimmunityratesinpersonnelPersonnelcompliancewithprotocols-isolationprecautions,Sterilizationqualityassurancetesting,EffectiveenvironmentalcleaningAntimicrobialprescribingandadministration11Howtoimplementtargetedsurveillance

12StepOne

ICPandMDreviewMicrobiologyreportsdailyReviewpastsurveillancedataperiodicallyDevelopalistofthepotentialinfectionsorpopulationsfortargetedsurveillance

13StepTwoInfectioncontrolteamselectsnosocomialinfectionstotargetbasedononeormoreofthefollowingcriteria:

14CriteriaforSelectingProcessesorOutcomesforTargetedSurveillance

ICprogramobjectivesFrequencyorlevelofriskofinfectiouscomplicationsfor area patientpopulation procedure serviceMorbidity,Mortality,CostPossibilityforprevention15StepThree

ICPperformschartreviewsontheinfection-relatedprocessesoroutcomesidentifiedinStepTwousingstandardized,consistent,approveddefinitions.ConsistentintensityandthoroughnessofsurveillanceovertimeSamedefinitionsovertime

16TargetedSurveillance:

AMeanstoanEndCollectonlynecessarydataArriveatmeaningfulinformation17SoYouCan:DevelopmeaningfulinterventionsDOsomethingtoreduceinfectionsImprovepatientcare!18TheCycleforSuccessThroughTargetedSurveillanceIsthereanimportantproblem?

What,why?

Multidisciplinary Teams

2.Describeandunderstandtheproblem?TargetedSurveillance

3.Howtoaffectchange?

Multidisciplinary Teams

Education Feedback Newprotocols Newproducts4.Dothechangeswork?

Remeasure

Adaptedfrom:RichardsC,etal.EmergInfectDis200119NLMIgnazSemmelweisTargetedSurveillanceAndInterventionForPuerperalSepsis20TargetedSurveillanceforaProcessTimingofAntibioticProphylaxisforSurgicalSiteInfectionNLMArchives211.IsThereanImportantProblem?Inappropriatesurgicalprophylaxisisamajorinfectionriskexposespatienttounnecessarytoxicityincreasesantimicrobialresistanceexcessdosesorinappropriatespectrumantibioticsdonotreducetheincidenceofsurgicalwoundinfection22“Ideal”ProphylaxisIdealantibioticforprophylaxisactiveagainstpathogensmostlikelytocontaminatewoundadequateconcentrationsduringpotentialcontaminationadministeredforashorttimetoreducecomplications,resistance,andcost23TargetedProcessSurveillance

TimingofPerioperativeAntimicrobialProphylaxisClassenDC,etal.Thetimingofprophylacticadministrationofantibioticsandtheriskofsurgical-woundinfection.NEnglJMed1992;326:281IncisionHoursbeforeincisionHoursafterincisionAntibioticAdministered24Timingof

PerioperativeAntimicrobialProphylaxisClassenDC,etal.Thetimingofprophylacticadministrationofantibioticsandtheriskofsurgical-woundinfection.NEnglJMed1992;326:281252.PerformTargetedSurveillanceforThisProblem

1)Proportionofpatientswhoreceiveprophylacticantibioticswithin1hourbeforesurgicalincision

#antibiotics1hour#surgerieswithantibiotics26PerformTargetedSurveillanceforThisProblem

2)Proportionofpatientswhoseantibioticswerediscontinuedwithin24hoursofthesurgeryendtime

#discontinuew/I24hours#surgeriesreceivingantibiotics27PossibleSurgicalProcedurestoDetermineTimingofAntibioticProphylaxisCABGColonsurgeryHipandkneearthroplastyAbdominalandvaginalhysterectomyVascularsurgery(e.g.,peripheralvascularsurgery)283.ToAffectChangeMultidisciplinaryTeamtolookatantibioticdeliverysystem:currentanddesiredRedesignsystemfortimelyABdeliveryMakeantibioticaccessibleEducatenursingandoperating

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