Book
Surveillance of Healthcare associated Infections in Healthcare Facilities
- Executive Summary
Healthcare-associated infection (HAI) surveillance programs play a crucial role in enabling healthcare organizations to assess the effectiveness of current practices, provide timely feedback to clinicians, and promote practice improvement to enhance patient outcomes. Surveillance is a fundamental component of any infection prevention and control program, as well as a key element in patient safety initiatives. It involves the systematic process of collecting, organizing, analyzing, interpreting, and disseminating data to support the planning, implementation, and evaluation of healthcare delivery, alongside ensuring the quality and safety of patient care. The primary goal of surveillance in infection prevention and control is to identify sentinel events, monitor HAIs, and report findings to relevant stakeholders, including the Infection Prevention and Control (IPC) Service.
It is not feasible to conduct facility-wide surveillance for all events; therefore, surveillance is often targeted with a focus on specific events, processes, organisms, medical devices or high-risk patient populations. Healthcare associated infections surveillance programs may focus on:
- specific sites of infection (e.g. bloodstream, surgical sites)
- specific populations (e.g. neonates, healthcare worker occupational exposure to blood and body substances)
- specific organisms or types of organisms (e.g. MDRO, Clostridium difficile, RSV, Rotavirus)
- in specific locations in the healthcare facility or community (e.g. intensive care unit, neonatal intensive care unit, long-term care facility ).
|
Recommendations |
|
Monitor the incidence of epidemiologically-important organisms and targeted HAIs that have substantial impact on outcome and for which effective preventive interventions are available; use information collected through surveillance of high-risk populations, procedures, devices and highly transmissible infectious agents to detect transmission of infectious agents in the healthcare facility (Strong Recommendation) |
|
Apply the following epidemiologic principles of infection surveillance: Use standardized definitions of infection - Use laboratory-based data - Collect epidemiologically-important variables (e.g., patient locations and/or clinical service in hospitals, population-specific risk factors [e.g., low birth-weight neonates], underlying conditions that predispose to serious adverse outcomes) - Analyze data to identify trends that may indicate increased rates of transmission - Provide feedback information on trends in the incidence and prevalence of HAIs, probable risk factors, and prevention strategies and their impact to the appropriate healthcare providers, organization administrators, and as required by local and state health authorities (Strong Recommendation) |
|
Steps should be taken in hospitals to ensure that case definitions are consistently and accurately applied. (Strong Recommendation) |
|
Active surveillance should be used for surveillance programs in hospitals because of the higher sensitivity associated with this approach to case finding. (Strong Recommendation) |
|
Use standardized methodology for performing device associated infections surveillance; the number of infections per 1,000 device days or device utilization ratio (Strong Recommendation) |
|
Rates of device-associated infection that are adjusted for duration of exposure to the device should be calculated. (Strong Recommendation) |
|
Perform surveillance for SSI. (Strong Recommendation) |
|
Develop and implement strategies to reduce risks for transmission and evaluate effectiveness. (Strong Recommendation) |
|
When transmission of epidemiologically-important organisms continues despite implementation of infection prevention and control strategies, obtain consultation from persons with infection prevention and control, infectious disease, healthcare epidemiology knowledge to review the situation and recommend additional measures for control. (Strong Recommendation) |
|
The surveillance process implemented in a facility (e.g., application of case definitions, case finding and communication methods) should be regularly reviewed and modifications made as needed. At least annually, the outcomes of surveillance systems (i.e., reductions to the risk of infection) should be reviewed and system objectives re-aligned as required. (Strong Recommendation) |
|
Review periodically information on community or regional trends in the incidence and prevalence of epidemiologically-important organisms as per Egyptian Law and Regulation of Preventive Sector of Ministry of Health (including in other healthcare facilities) that may impact transmission of organisms within your facility. (Good Practice Statement) |
|
Calculate and analyze prevalence and incidence rates of targeted MDRO infection in populations at risk (Strong Recommendation) |
|
Include only one isolate per patient, not multiple isolates from the same patient, when calculating rates (Good Practice Statement) |
|
Increase the frequency of compiling and monitoring antimicrobial susceptibility summary reports for a targeted MDRO as indicated by an increase in incidence of infection or colonization with that MDRO. (Good Practice Statement) |
|
Monitor trends in the incidence of target MDROs in the facility over time using appropriate statistical methods to determine whether MDRO rates are decreasing and whether additional interventions are needed. (Strong Recommendation) |
|
In all healthcare organizations, establish systems to ensure that clinical microbiology laboratories (in-house and out-sourced) promptly notify infection control staff when a novel resistance pattern for that facility is detected. (Strong Recommendation) |
