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Questions
Frequency
Severity
Cost
Preventability
Communicability
Methodologic Issues
Goals
Causal pathway
Information needs
Data sources, methods
Case definition
Evaluation: Balance of attributes
Interpretation of data
Interpretation of Data
Issues to Consider
Source of data
Reliability of diagnosis
Potential biases in detection/diagnosis
Definition of a case
Completeness of data
Reporting bias
Consistency in data collection
Completeness
Context
Surveillance in the Healthcare Setting:
Objectives
Systematic
Ongoing
Data Collection
Analysis
Interpretation
Dissemination
Action
Surveillance in the Healthcare Setting
Data must be
Collected
Validated
Analyzed
Interpreted
Disseminated in a timely manner
Targets
Infection prevention
Performance improvement
Patient safety
Public health activities
Adapted from: Glenister HM, Taylor LJ, Bartlett CLR, et al. An evaluation of surveillance methods for detecting infections in hospital inpatients.
Journal of Hospital Infection 1993; 23:229-42.
Various Methods of Surveillance Used in Infection
Control
Strategy Pros Cons
Incidence Provides data on infections Expensive and labor intensive
due to all organisms, on all
infection sites, and on all units Large amounts of data
Identifies clusters collected with little time for a
analysis
Establishes baseline infection
rates No defined prevention
objectives
Allows outbreaks to be
recognized early Difficult to develop
interventions
Identifies risk factors Not all infections are
preventable
Prevalence Inexpensive Over-/underestimates
infection rates; does not
Efficient use of time; can be capture data on relevant
done periodically differences
Disadvantages:
No information on what factors contribute to the
problem
No internationally agreed definitions on surveillance
Most commonly used: CDC/NHSN (USA) and ECDC (Europe)
Assumes availability of good diagnostic laboratory support
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Types of Surveillance: Process Surveillance
Disadvantages:
Reliability of data
Good compliance does not equate with effectiveness
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Example of Outcome vs. Process Surveillance
Maximum
Hand Skin Barrier
Hygiene Disinfection Precautions
Daily
Optimal Review
catheter site
selection
Adapted from Damani, N. Manual of Infection Prevention and Control, Third Edition.
New York: Oxford University Press, 2012.
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Recommended Minimum Elements in a Data Set
for Surveillance
Medical treatment/procedures
– At time of infection
– Underlying medical risk factors, clinical outcome, assessment of
whether the incident was preventable
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Linelist: Example
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Considerations
Identify resources
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Summary
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Summary (continued)
Analyze data
Tokars JI, Richards C, Andrus M, et al. The Changing Face of Surveillance for Health
Care—Associated Infections. Clinical Infectious Diseases 2004; 39: 1347-52.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care—
associated infection and criteria for specific types of infection in the acute care
setting. American Journal of Infection Control 2008; 36:309-32.
Haley RW, Culver DH, White JW, et al. The efficacy of infection surveillance and
control programs in preventing nosocomial infection in US hospitals. (SENIC study).
American Journal of Epidemiology 1985; 121(2):182-205.
Lee TB, Montgomery OG, Marx J, et al. Recommended practices for surveillance:
Association for Professionals in Infection Control and Epidemiology (APIC), Inc.
American Journal of Infection Control 2007; 35(7):427-40.
Count
Ratio
Proportions
Rate
EPIDEMIOLOGIC MEASURES
Measures of frequency
Incidence
Prevalence
Interrelationship between incidence and
prevalence
COUNT
Incidence
Prevalence
MEASURES OF DISEASE FREQUENCY
Ranges from 0 to
WHAT DENOMINATOR DATA TO COLLECT?
(3/10 = 0.3 * 100 = 30/30 days = 1 = incidence for one day per 100
people)
ATTACK RATE
Attack rate:
Number of new and recurrent cases in a specified time period
X 100
Population at risk for same time period
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PREVALENCE
Point Prevalence = C / N
P = 15/150 = 10%
PERIOD PREVALENCE
Period Prevalence = [C + I] / N
Useful for:
Assessing the health status of a population.
Planning health services.
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