Surveillance and Epidemiological Investigation

Transcription

1 Surveillance and Epidemiological Investigation

2 Objectives The participant will be able to identify at least 4 types of data used for surveillance of infections. The participant will be able to define outbreak.

3 Interpretation of Surveillance Data Generate Analyze Validate

4 Interpretation of Surveillance Data Other Applications for the surveillance process 1. Non-Healthcare associated infections 2. Noninfectious events

5 Outbreak Investigations An outbreak is defined as an increase over the expected occurrence of an event: exception one case of an unusual disease. Pseudo-outbreak rise in test results without clinical disease

6 Components of Outbreak Investigation Confirm Alert Literature review Case definition Methodology Line list and epidemic curve Observation Consider environmental sampling Implement

7 Follow Up Investigation Refine case definition Continue case finding and surveillance Review control measures Consider analytical study Prepare and disseminate reports

8 Epidemic Curve Definition : Graph of cases occurring along a timeline - histogram

9 CDC Definitions of HAI An infection meeting the following criteria 1. Not present or incubating on admission 2. Develops during course of receiving treatment for other conditions 3. Incubating at time of admission related to previous hospitalization at the same facility or a procedure during a previous hospitalization 4. HCW infection acquired while performing their duties within a healthcare setting 5. Occur during care in any healthcare facility

10 Community vs Iatrogenic Community Present or incubating upon admission and not associated with a prior admission or procedure Iatrogenic arising as a result of actions or treatment of a provider Secondary condition arising from the treatment of a primary condition (?? HAI or Community Acquired)

11 CDC Definitions Standardized set of surveillance definitions which do not necessarily meet the same definition as clinical definitions.

12 Q & A Because of the potential for rapid spread, one confirmed case of this disease is considered an urgent public health situation, and the IP should immediately report suspected and confirmed cases to the health department a. Chickenpox b. Influenza c. Measles d. Legionnaires disease

13 Answer Because of the potential for rapid spread, one confirmed case of this disease is considered an urgent public health situation, and the IP should immediately report suspected and confirmed cases to the health department a. Chickenpox b. Influenza c. Measles d. Legionnaires disease

14 Q&A / Case Study During the month of October, 20 pts were admitted to the ICU and placed on ventilators for varying periods. 1. Pt A (79 Yr old) surgical pt had CVA during surgery 21 vent days 2. Pt B (68 Yr old) CABG pt on vent for 36 hrs post op 3. Pt C (52 Yr old) trauma pt on and off vent a total of 9 days during 2 weeks of treatment in ICU 4. Pt D (84 Yr old) CHF on the vent for 3 days 5. Pt E (4 Yr old) peds pt with pneumonia on vent 2 days 6. Total number of vent days was Total number of patient days was Pts A, B, C and E grew A. calcoaceticus from sputum cultures 9. Pt D had normal sputum culture on admission, but not further cultures in ICU collected 10. Pt D did grow A. calcoaceticus from sputum cultures after leaving ICU

15 Q&A In the early stages of an outbreak investigation, the first action the IP should take is: a. Notify his / her supervisor of the probable outbreak b. Notify attending MD of each pt of probable outbreak c. Report outbreak to infection prevention and control chair d. Develop a timeline with each pt admission date and culture date graphed.

16 In the early stages of an outbreak investigation, the first action the IP should take is: a. Notify his / her supervisor of the probable outbreak b. Notify attending MD of each pt of probable outbreak c. Report outbreak to infection prevention and control chair d. Develop a timeline with each pt admission date and culture date graphed.

17 Q&A While evaluating the C&S for each pt, the IP and micro director note all organisms are resistant to same antibiotics and Pt A is resistant to 2 additional antibiotics. Without knowing more information, what might you suspect about pt A s infection? a. Pt A probably has a different organism and source and therefore, is not part of an outbreak b. Four of the pts probably have the same organism in their infection c. Transmission of the organism has probably occurred from one pt to each of the other 4. d. Pt A may have developed additional resistance to antibiotics and may be part of an outbreak.

18 Answer While evaluating the C&S for each pt, the IP and micro director note all organisms are resistant to same antibiotics and Pt A is resistant to 2 additional antibiotics. Without knowing more information, what might you suspect about pt A s infection? a. Pt A probably has a different organism and source and therefore, is not part of an outbreak b. Four of the pts probably have the same organism in their infection c. Transmission of the organism has probably occurred from one pt to each of the other 4. d. Pt A may have developed additional resistance to antibiotics and may be part of an outbreak.

19 Q&A Which of the following would NOT be done to ascertain which patients might be linked to this potential outbreak? a. Request sputum on Pt D b. Request genotyping on all specimens c. Request A. calcoaceticus isolates be saved d. Request that all employees who cared for these pts have nares cultures

20 Answer Which of the following would NOT be done to ascertain which patients might be linked to this potential outbreak? a. Request sputum on Pt D b. Request genotyping on all specimens c. Request A. calcoaceticus isolates be saved d. Request that all employees who cared for these pts have nares cultures

21 Q&A An epidemic curve is an example of a: a. Pie chart b. Histogram c. Frequency polygon d. Semi-logarithmic scale line graph

22 Answer An epidemic curve is an example of a: a. Pie chart b. Histogram c. Frequency polygon d. Semi-logarithmic scale line graph

23 Q&A The IP classifies SSI by the CDC definition used for the NHSN system. The criteria for an organ space infection includes: 1. Purulent drainage from subcutaneous tissue surrounding the incision 2. Purulent drainage from a drain that is placed in a stab wound 3. An abscess found on radiologic examination 4. The incision is packed open with fluff gauze until the wound can heal from the inside out 5. Purulent drainage is noted coming from the incision after a second surgery in a week a. 1,2,3 b. 2,3 c. 4,5 d. 2,3,4

24 Answer The IP classifies SSI by the CDC definition used for the NHSN system. The criteria for an organ space infection includes: 1. Purulent drainage from subcutaneous tissue surrounding the incision 2. Purulent drainage from a drain that is placed in a stab wound 3. An abscess found on radiologic examination 4. The incision is packed open with fluff gauze until the wound can heal from the inside out 5. Purulent drainage is noted coming from the incision after a second surgery in a week a. 1,2,3 b. 2,3 c. 4,5 d. 2,3,4

25 Q&A The purpose of a post discharge surveillance program is to: a. Obtain a more accurate picture of the number of SSI b. Promote customer relations with surgical pts c. Conduct a performance improvement project that fulfills the requirements of the facility d. Perform a valuable research project

26 Answer The purpose of a post discharge surveillance program is to: a. Obtain a more accurate picture of the number of SSI b. Promote customer relations with surgical pts c. Conduct a performance improvement project that fulfills the requirements of the facility d. Perform a valuable research project

27 References Certification Study Guide: 6 th edition