Surveillance of Healthcare associated Infections in Healthcare Facilities

●      Active Surveillance for Health Care-associated Infections: The direct and vigorous search for information on the occurrence of health care-associated infections in order to detect a change or trend in incidence rate. This is in contrast to passive surveillance, where data are not actively solicited.

●      Device Utilization Ratio (DUR): The device utilization ratio is the number of device-days per number of patient-days in a given period. This is a measure of the total patient-days in which a high-risk device was used and can be used as a marker for risk of infection.

●      Epidemiologically important pathogens: Infectious agents that have one or more of the following characteristics:

-        A propensity for transmission within healthcare facilities based on published reports and the occurrence of temporal or geographic clusters of ≥2 patients, (e.g., VRE, MRSA and MSSA, Clostridium difficile, norovirus, RSV, influenza, Rotavirus, Enterobacter spp; Serratia spp., group A Streptococcus). However, for group A streptococcus, most experts consider a single case of healthcare-associated disease a trigger for investigation and enhanced control measures because of the devastating outcomes associated with HAI group A streptococcus infections. For susceptible bacteria that are known to be associated with asymptomatic colonization, isolation from normally sterile body fluids in patients with significant clinical disease would be the trigger to consider the organism as epidemiologically important.

-    Antimicrobial resistance implications:

o   Resistance to first-line therapies (e.g., MRSA, VRE, VISA, VRSA, ESBL-producing organisms).

o   Unusual or usual agents with unusual patterns of resistance within a facility, (e.g., the first isolate of Burkholderia cepacia complex or Ralstonia spp. in non-cystic fibrosis patients or a quinolone-resistant strain of Pseudomonas in a facility.

o   Difficult to treat because of innate or acquired resistance to multiple classes of antimicrobial agents (e.g., Stenotrophomonas maltophilia, Acinetobacter spp.).

-    Associated with serious clinical disease, increased morbidity and mortality (e.g., MRSA and MSSA, group A streptococcus); or

-    A newly discovered or reemerging pathogen. The strategies described for MDROs may be applied for control of epidemiologically important organisms other than MDROs.

●    Hand hygiene: A general term that applies to any one of the following:

−     Handwashing with plain (non-antimicrobial) soap and water);

−     Antiseptic hand rub (waterless antiseptic product, most often alcohol-based, rubbed on all surfaces of hands); or

−     Surgical hand antisepsis (antiseptic hand wash or antiseptic hand rub performed preoperatively by surgical personnel to eliminate transient hand flora and reduce resident hand flora).

●  Healthcare-associated infection (HAI): An infection that develops in a patient who is cared for in any setting where healthcare is delivered (e.g., acute care hospital, chronic care facility, ambulatory clinic, dialysis center, surgy center, long term home care) and is related to receiving health care (i.e., was not incubating or present at the time healthcare was provided). In ambulatory and home settings, HAI would apply to any infection that is associated with a medical or surgical intervention performed in those settings.

●  Incidence: The frequency with which an event occurs in a population over a defined time period.

● Infection Risk: The probability that a patient/resident will acquire an infection based on the characteristics of the individual, the inherent risks associated with a procedure, or other factors that might put the individual at risk for a health care-associated infection.

●  Multidrug-resistant organisms (MDROs): In general, bacteria (excluding M. tuberculosis) that are resistant to one or more classes of antimicrobial agents and usually are resistant to all but one or two commercially available antimicrobial agents (e.g., MRSA, VRE, extended spectrum beta-lactamase [ESBL]-producing or intrinsically resistant gram-negative bacilli).

●  Periodic Surveillance for Health Care-associated Infections: Surveillance undertaken over a specified time interval (e.g., one month each quarter) in a health care setting. Some infection prevention and control programs will conduct surveillance on one or more units for a period of time and then shift to another unit or group of units. This rotation provides a less costly method to collect information on all high-risk patient care areas.

● Rate: It is the occurrence of an event in a specific population during a defined time period. Calculation of rates requires that the event (the numerator, e.g., a specific HAI) can be identified, and that the population at risk of acquiring or developing the HAI (the denominator) can similarly be enumerated.

●  Ratio: It is a fraction, obtained by dividing one quantity (the numerator) by a second quantity (the denominator); the numerator may or may not be included in the denominator.

●  Risk Stratification: A process to control for differences in the underlying risk factors for infection. Risk stratification involves calculating separate rates for patients/residents with similar susceptibilities to health care-associated infections, or those in the same category of risk (e.g., surgeon-specific infection rates).

●   Surveillance: The systematic, ongoing collection, collation and analysis of data with timely dissemination of information to those who require it in order to take action