Brad Cookson, M.D., Ph.D.

Epidemiology and Infection Control

Micro442

1. Epidemiology: examine associations between exposure variable(s) and health outcome(s) - Association vs causation - Causation is an interpretation - Most diseases have multifactorial pathogenesis - Conjunction of two variables in time and space - Exposure precedes the effect Ignaz Semmelweis (1847) - Hungarian obstetrician in Vienna Austria - Pathologist dies: scalpel wound during post-mortem exam (woman died from puerperal sepsis) - Pathologists illness resembled that of women with puerperal sepsis - Scalpel and physicians hands contaminated - Introduced chlorinated lime hand washing - Drastic improvement in maternal mortality John Snow (1854) - Epidemic cholera in London (cause unknown at the time) - Miasma theory for cholera and plague: bad air - Careful observation and documentation Bradford Hill (1965) - Strength - Consistency - Specificity - Temporality - Biological Gradient - Plausibility - Coherence - Experiment - Analogy 2. The modern investigation: 1. Establish the presence of an outbreak 2. Define and identify cases 3. Describe persons with the disease 4. Develop a hypothesis 5. Test your hypothesis 6. Refine your hypothesis Some like it hot: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5734a1.htm http://www.cdc.gov/salmonella/saintpaul/jalapeno/epidemic_curve.html 3. Molecular Epidemiology: Finger print organisms; employ relevant molecular chronometer(s) - PFGE - RFLP - Selected gene sequencing; genome sequencing; recall evolutionary clock - Establish relationship among patients without traditional epidemiological links 1. 2. 3. 4. 5. 6. Define and identify cases Describe persons with the disease Establish the presence of an outbreak Develop a hypothesis Test your hypothesis Refine your hypothesis

4. Infection Control - Protect patients - Protect healthcare workers - Do both cost effectively Impact: - ~ Millions of nosocomial infections/yr - ~25% nosocomial infections occur in ICU - Infection increases length of stay - Nosocomial infection contribute ~ 20% of costs in ICU - Causes ~thousands of deaths/yr - 5th leading cause of death in acute care hospitals - Total cost: billions/yr !! Pathogenesis: - Direct contact - Body surface to body surface - Usually between patient and provider - Also between patients - Indirect contact - Transmission through intermediate - Needle stick or other medical equipment - Droplets - Respiratory - Gastrointestinal - Genitourinary - Particle size - Contaminate surface(s) - Airborne dissemination - UTI, BSI, SSI, Pneumonia - Risk factors - Time/place in health care organization(s) - Indwelling devices, e.g., catheters - Disruption of normal host protection, e.g., invasive procedure - Exposure to antimicrobials: type, duration, number of agents - Age - Underlying illness - Immune status - Facility construction/renovation Infection Control Team - Collection and analysis of data - Surveillance with feedback to staff - Enforcing preventative practices - Include physician leadership and clinical microbiology laboratory SENIC (1980): Study on the Efficacy of Nosocomial Infection Control - utilize Infection Control Team - 32% reduction in four most common HAI Abbreviations: reviewed in class (or use Google) Participation Points: fill out the catalyst evaluation you will be receiving