IPAC PANA April 28, 2015 Sandra Callery RN MHSc CIC
World Youth Day - Toronto 2002
World Youth Day Downsview Park 2002
#1 issue =Heat-related illness. A rehydration ward was established on-site (300 beds) and most cases were managed on-site. Detected early onset of cases and initiated a rapid and successful response. Lines of communication and collaboration between emergency medical services and volunteer medical staff on-site had been established beforehand. Surge capacity was planned for and volunteers on standby were brought in when required.
Toronto SARS Concert 2003
Detect clusters of syndromes: Influenza like illness (ILI) and other respiratory illnesses Gastrointestinal (GI) illnesses These illnesses would be beyond what would normally be expected in the population for a similar period of time.
Traditional surveillance which includes clinical diagnosis is neither complete nor timely enough to allow for the most effective public health intervention efforts. For example, most individuals with symptoms of influenza-like illness (ILI) often do not present for medical care, and thus are not eligible for laboratory testing or clinician diagnosis.
Syndromic surveillance uses existing healthrelated data that are independent of a confirmed diagnosis and signals for further public health response. These data also capture individual behaviours that occur following the onset of disease symptoms such as absences from school or work. PIDAC - 2012
Specificity Sensitivity
Many public health jurisdictions have begun monitoring a variety of syndromic surveillance data sources in the past decade
Absenteeism (employee; school) Pharmacy sales (over the counter and prescriptions) Emergency department chief complaint 911 calls and EMS data Medical record ICD codes by community health care providers On-line sources Sentinel community health care providers Tele health
Surveillance is the systematic, ongoing collection, collation and analysis of data with timely dissemination of information to those who require this information in order to take action. The actions usually relate to improvements in prevention or control of the condition. PIDAC - Best Practices for Surveillance of Health Care-associated Infections in Patient and Resident Populations, July 2014
7 to 60% Reductions in the rates of nosocomial infections following the implementation of surveillance programs. ~70% of nosocomial infections are preventable
Steps IX. Evaluate surveillance system Surveillance Planning Steps I. Assess the population II. Select the outcome or process for surveillance III. Use Surveillance definitions Evaluation Data Collection Steps IV. Collecting surveillance data Communication Steps VIII. Communicate and use surveillance information Interpretation Analysis Steps VII. Interpret surveillance rates Steps V. Calculate and analyze surveillance rates VI. Apply risk stratification methodology
What is the most risky procedure or intervention that we perform on site? What intervention has historically caused adverse outcomes such as infection? Requires readmission or a longer length of stay? Who are our partners for interventional and surgical procedures? What rates are we mandated to report?
? Urinary tract infections in LTC residents with indwelling catheters? Pneumonia (in LTC) and Ventilator associated pneumonia (in acute care)? Antibiotic resistant organisms? Surgical site infections targeted procedures? Line related blood stream infections
Screening tool completed daily and picked up by IP&C/ or emailed or faxed to IP&C New onset of nausea, vomiting and diarrhea
Compliance calculated monthly by unit and reported quarterly: Number of days tool completed Number of days in the month X 100 100% 80% 60% 40% 20% 0% Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit Unit 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 January February March
Monitoring communicable and reportable diseases Monitoring and reporting clusters of staff illness such as Norovirus like symptoms or influenza like illness. Measure vaccine compliance.
Outbreak
Quarterly summary line listing of respiratory and gastrointestinal outbreaks shared with facility Outbreak Units Start date End date Duration (days) Type Causative agent # Resident Cases Unit 2 March 26 April 6 11 Gastro Norovirus 7 4 # Staff Cases Unit 1 March 30 April 11 13 Respiratory Influenza B 8 0
Keeping a low threshold for Declaring Outbreaks
Measles Outbreak Epi Curve December 2014 January 2015 39 cases primary Disney 1 case California who reports Department visiting Disney of Public outside Health of initial Immunization time period Branch
Quarterly report by facility of hand hygiene compliance (%) Includes Trends by quarter HH Compliance (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 51% 54% 74% 54% 65% 73% 85% 87% 86% 87% 94% 89% 88% 89% 88% 86% 88% 82% 89% 92% 90% Nov 07-Feb 08 Aug -Oct 09 Nov 08-Mar 09 July -Aug 09 Q3 2009-10 Q4 2009-10 Q3 2010-11 Q4 2010-11 Q2 2011-12 Q3 2011-12 Q4 2011-12 Q1 2012-13 Q2 2012-13 Q3 2012-13 Q4 2012-13 Q1 2013-14 Q2 2013-14 Q3 2013-14 Q4 2013-14 Q1 2014-15 Q2 2014-15
Includes Compliance Moment Unit Type of Healthcare worker (nurse, physician, allied health, support staff) HH Compliance (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 83% HH by Moment 100% 93% 90% 50% HH Compliance (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HH by Profession 90% 79% Nursing Medical Staff Staff 100% Allied Support Health Staff Staff 90% 90% LTC Average
Regular HH audits anonymous, include all HCWs, immediate feedback
Norovirus Gastroenteritis Fecal-oral transmission, via contaminated hands Norovirus outbreaks common in LTC Standard approach to environmental cleaning Norovirus outbreak in SB LTC Jan 15 Feb 18, 2009 Regular hand hygiene audits in SB LTC Objective: analyze relationship between outbreak impact and HH compliance
Unit Attack Rate vs HH Compliance 100 90 HH Compliance/Attack Rate (%) 80 70 60 50 40 30 20 10 0 A B C D E F G H I Unit Attack Rate (%) Unit Unit HH Compliance (%)
Unit Attack Rate vs Unit HH Compliance 60 unit attack rate (%) 40 20 y = -0.5079x + 42.829 R 2 = 0.5547 0 0 20 40 60 80 100 HH compliance (%) HH and AR inversely related ( HH AR) (statistically significant p=0.001)
Syndromic surveillance Tells you where you are heading.. Prospective surveillance Tells you what is happening now.. Retrospective surveillance Tells you where you have been..