HEALTHCARE ASSOCIATED INFECTION SURVEILLANCE

Policies and Procedures on Infection Control Ministry of Health Malaysia 9 Periodic Surveillance  Surveillance performed at specified intervals e.g. every three months; each time, the focus is on one specific infection site or on a definite patient population at increased risk of infection.  In another version, periodic surveillance is performed on one or several units for a specified time period and then shifts to another unit or units. By rotating from unit to unit, infection control specialists are able to survey the entire hospital during the year.  Advantage: leaves more time for other measures.  Disadvantage: protracted time required to accumulate sufficient data for establishing valid baselines. Prevalence studies  The number of active infections is counted over a specified time period. Active infections are defined as all manifest infections present at the time of the survey or patient is still under treatment for the infection.  Advantage: this is usually a quick method. It can provide adequate data on epidemiologically important infections within a facility and can serve as a basis for developing of future targeted surveillance.  Disadvantages: Results must be very carefully interpreted. Prevalence rates are usually higher than incidence rates  One cannot draw conclusions infection risk factors. It is important to choose the correct denominator.  This method can be useful for validating data from of total surveillance. Targeted :  The focus in this type of epidemiological surveillance is on patients at increased risk of nosocomial infections e.g: post-surgical patients, ICU patients, and patients receiving mechanical ventilation.  The denominator of the incidence rate formula should contain only data on patients belonging to the “high risk” group.  Infection risk indices can and must be used. Type of Surveillance Methods - “High risk” patients Policies and Procedures on Infection Control Ministry of Health Malaysia 10  Advantages: permits concentration of effort on areas where infection control measures may have the greatest effect and better use of limited resources; takers into account differences in infection risk for different patient populations.  Disadvantage: may miss clusters or outbreaks of infections not included in the surveillance program. Targeted :  This approach involves surveillance of infections at the same site bacteremia, UTI, LRI, SSI, etc. or caused by the same pathogen, usually one that is epidemiologically significant MRSA, Vancomycin- resistant Enterococcus species.  Advantage: permits concentration of efforts on those areas where control measures may be most effective.  Disadvantage: may miss clusters or outbreaks of infections not included in the surveillance program.  It is necessary to use the appropriate denominator

2.5 Data Collection

1. Collect essential data from lab forms of all MRO suspected HCAI clusters Refer ‘HCAI infection surveillance form’ in Appendix B. 2. Verify cases from the patient’s BHT and discussion with the doctor in-charge link- nurse ward sister. 3. Exclude non HCAI cases and complete the HCAI form. 4. All patients must be followed up and subsequent events must be recorded. 5. All data related to the investigations of an outbreak i.e. environment, patients, or staff should be documented.

2.6 Tabulation of Data

1. Daily group the suspected and confirmed cases according to type of MRO or infections 2. Special T-cards or boards can be used to monitor the cases daily patient location pathogen infection sites risk factors. 3. A SPCC Statistical Process Control Chart shall be use to monitor the trend of infections for certain organisms or site of infection. Measuring trend in percentage. 4. In house ‘Control Chart’ to monitor the number of infections with MRO. -pathogen type -infection site Type of Surveillance Methods