Basic HAI Surveillance

by Dr. Arthur Dessie E. Roman

1. 1
SURVEILLANCE
OF HAIs
Name of Speaker
Date and venue
@gonnabedess
@gonnabedess
Philippine Hospital Infection Control Society, Inc.
Case
From 29 December 1988 to 21 January 21
1989, B. cepacia was isolated from
1. PF of 4 patients on PD (peritonitis)
2. Blood of two patients at another
children's hospital
March 03, 1989 / 38(8);133-134
Philippine Hospital Infection Control Society, Inc.

2. 2
Case
Philippine Hospital Infection Control Society, Inc.
OUTLINE
Definition of Surveillance
Goals of Surveillance
Components of Surveillance
Steps in Surveillance of Nosocomial
Infection
Philippine Hospital Infection Control Society, Inc.

3. 3
Disclaimer
This lecture is intended to overwhelm
provide you with an overview about
surveillance NOT to teach you the
specific steps to conduct it
Philippine Hospital Infection Control Society, Inc.
SURVEILLANCE
“The ongoing systematic collection, analysis
and interpretationof healthcare data
essential to the planning, implementation,
and evaluation of public health practice,
closely integrated with the timely
disseminationof these data to those
contributing data or to other interested groups
who need to know.”
Lennox K. Archibald and Walter J. Hierholzer, Jr.
C. Gen Mayhall’s Hospital Epidemiology and Infection Control.
4
th
Edition. 2011
Philippine Hospital Infection Control Society, Inc.

4. 4
SURVEILLANCE
“…is used to identify nosocomial
infections and other adverse events that
may be prevented…”
Philippine Hospital Infection Control Society, Inc.
SURVEILLANCE
“…is used to establish endemic rates
of health-related events or
diseases…”
Philippine Hospital Infection Control Society, Inc.

5. 5
Goals of Surveillance
to define endemic rates
to identify increases in infection rates
to identify specific risks
to inform hospital personnel of the risks
of the cares or procedures they provide
■to apply targeted interventions and to
evaluate their effect in an ongoing system
(Mintjes-de Groot AJ 2000)
Philippine Hospital Infection Control Society, Inc.
OUTLINE
Definition of Surveillance
Goals of Surveillance
Components of Surveillance
Steps in Surveillance of Nosocomial
Infection
Philippine Hospital Infection Control Society, Inc.

6. 6
COMPONENTS
OF
SURVEILLANCE
Kenrad E. Nelson and Carolyn Masters Williams.
Infectious Disease Epidemiology: Theory and Practice, 3
rd
edition. 2013.
“The building blocks of surveillance
comprise:
1.collecting relevant datasystemically for a
specified purpose and during a defined period
of time,
2.managing and organizingthe data,
3.analyzingand interpretingthe data and
4.communicatingthe results to those empowered
to make beneficial changes…”
Philippine Hospital Infection Control Society, Inc.

7. 7
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
5
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’ The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined
period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
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organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’ The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined
period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
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period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’
The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined period of time, managing and
organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial changes…
Xy = a+b+c ; y= mc –rta’ The The building blocks of surveillance comprise collecting relevant data syste mically for a specified purpose and during a defined
period of time, managing and organizing the data, analyzing and inte rpreting the data and communicating the results to those empowered to make beneficial
5
Definition
Use standardized written case definitions to
ensure precise surveillance. Where available
and applicable, use previously published,
validated definitions.
For accurate and valid comparisons of data,
use the same definitions over time.
Philippine Hospital Infection Control Society, Inc.

8. 8
Collection
Know your population to determine which
subset requires targeting
Assess your capability to identify your method
of data collection
Data Management
Combine only homogenous data
–Always qualify and describe your data source
–May apply risk stratification to ensure homogeneity
Comparisons are valid only if all contributors
to the data have:
–used the same surveillance intensity
–used similar data collection methods
–applied the same surveillance definitions
–addressed differences in populations/case mix
–stratified data as appropriate

9. 9
Data Management
Note that rates can be accurate and
consistent but still not useful or
interpretable if the numerator is too
small (infrequent event) or the
denominator is of inappropriate size
(usually too small).
Communication
Timely
Simple and understandable
Relayed to the relevant persons

10. 10
OUTLINE
Definition of Surveillance
Goals of Surveillance
Components of Surveillance
Steps in Surveillance of
Nosocomial Infection
STEPS IN SURVEILLANCE
FOR NOSOCOMIAL
INFECTIONS

11. 11
STEPS IN SURVEILLANCE
FOR HAIs
1.Identify Surveillance Strategy
2.Data collection
3.Case-Finding Method
4.Consolidation and Tabulation
5.Calculating Rates
6.Analysis and Interpretation
7.Validation
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Philippine Hospital Infection Control Society, Inc.

12. 12
Surveillance Strategies for
Case Findings
Scope of
infection control
program
Patient or
Laboratory -
based
Active
vs
Passive
Retrospective
vs
Prospective
or concurrent
Methods
of
Surveillance
Methods of Surveillance
1.Hospital-wide Surveillance
(Traditional)
2.Limited Periodic Surveillance
3.Prevalence Surveillance
4.Targeted Surveillance : unit / site
specific / rotational
5.Objective/Priority Based Surveillance
Philippine Hospital Infection Control Society, Inc.

13. 13
1. Hospital-Wide Surveillance
(TRADITIONAL)
Advantage
MOST comprehensive
method
collects data on all
infection, sites, units
establishes baseline
infection rates
recognizes outbreaks
early
identifies clusters
increase visibility of
infection control
professional (ICP)
Disadvantage
expensive, labor intensive
labor , time-consuming,
yields excessive data
leaves little time to
analyze data and initiate
changes (no definite
management objective)
detects infections that can
not be prevented
Overall infection rate not
valid for interhospital
comparison
2. Limited Periodic Surveillance
Advantage
increases efficiency of
surveillance
liberates ICP to perform
other activities
utilized resources more
effectively
reduces time spent
doing surveillance by
45%
Disadvantage
provides data only
during periods in which
surveillance is
conducted
may miss cluster or
outbreaks during
nonsurveyed periods

14. 14
3. PREVALENCE
SURVEILLANCE
ADVANTAGE
documents nosocomial
infection trends identifies
risk factors
relatively quick and
inexpensive
identifies areas that need
additional surveillance
DISADVANTAGE
data collection may be
tedious
must collect data in short
time period
data are restricted to a
specified time period
cannot compare
prevalence rate with
incidence rates
few studies on prevalence
rates published
may miss clusters or
outbreaks
4. Targeted Surveillance
Advantage
focus on patient at risks; on infections
with known control measures to reduce
infection risk
concentrates limited resources on high-
risk areas
can determine valid denominator
Philippine Hospital Infection Control Society, Inc.

15. 15
4. Targeted Surveillance
Advantage
requires less personnel and
liberates ICP to perform other
activities
increases efficiency of surveillance
flexible -can be mixed with other
methods
Philippine Hospital Infection Control Society, Inc.
4. Targeted Surveillance
Disadvantage
no baseline rates in other units
collects data only for targeted
patients at risk
can miss clusters or outbreaks in
nonsurveyed areas or populations
Philippine Hospital Infection Control Society, Inc.

16. 16
4. Targeted Surveillance :
ROTATING
Advantage
less expensive
less time-consuming
less personnel
all areas of hospital
surveyed
Disadvantage
can miss clusters of
infection
Philippine Hospital Infection Control Society, Inc.
Objective / Priority Based
Surveillance
Advantage
adaptable to
hospital with special
interest and
resources
focuses on specific
problems of the
individual institution
Disadvantage
no baseline rates of
infection
may miss clusters /
outbreaks

17. 17
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Philippine Hospital Infection Control Society, Inc.
Sources of Data for
Surveillance
Laboratory-based
Information
Patient-based
Information
Other departments ,
services or agencies

18. 18
Sources of Data for
Surveillance
Patient-based Information
Patient examination
Clinical ward rounds
Sources of Data for
Surveillance
Patient-based
Information
Patient examination
Clinical ward rounds
Culture
organism
antimicrobial
susceptibility
pattern
Clinical Data
fever
p.e. findings
x-ray results
Predisposing
factors
surgery
chemotherapy
antibiotics
steroids
underlying disease
Exposure factor
Patient’s name
Age
Sex
Hospital number
Ward service
Admission data
Infection onset
data

19. 19
Sources of Data for
Surveillance
Patient-based
Information
Patient examination
Clinical ward rounds
Communication with staff
Patient medical record
–Medication records
–Temperature records
–Radiology reports
–Laboratory reports
Kardex review
Sources of Data for
Surveillance
Patient-based
Information
Patient examination
Clinical ward rounds
Communication with staff
Patient medical record
Kardex review
Treatments, Wound dressing
changes
Intravenous fluids, Antibiotics
Urinary catheter, Surgery
Isolation precautions

20. 20
Sources of Data for
Surveillance
Laboratory-based
Information
Patient-based
Information
Bacteriology, Mycology,
Parasitology, Serology , Virology
and Pathology reports
Antimicrobial susceptibility
patterns
Sources of Data for
Surveillance
Laboratory-based
Information
Patient-based
Information
Other departments , services or agencies
Admission department
Operating suite
Emergency Department
Outpatient clinics
Risk Control (for
incident reports and
other data)
Employee health

21. 21
Sources of Data for
Surveillance
Laboratory-based
Information
Patient-based
Information
Other departments , services or agencies
Home-care agencies
Multicenter surveillance systems (e.g. NNIS)
Local and state health departments (e.g.
MMWR)
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Philippine Hospital Infection Control Society, Inc.

22. 22
CASE-FINDING
METHODS
TOTAL CHART REVIEW
SELECTIVE MEDICAL RECORD
REVIEW BASED ON :
–Laboratory Reports, Kardex screening,
Fever, Antibiotic use, Fever and
Antibiotic use, Readmission, Autopsy
reports, Ward Liason surveillance,
Laboratory-based and ward-liason
surveillance, risk-factor-based
surveillance
METHOD DEFINITION Sensitivity Estimated
Time(Hrs)
/500 beds
Total Chart ReviewReview all patient 0.74-0.94 35.7-53.6
medical records
Selective Medical Record
Review based on:
Laboratory reportsmicrobiology reports to0.77-0.91 23.2
identify pts with (+)
cultures
CASE FINDING
METHODS

23. 23
CASE FINDING
METHODS
METHOD DEFINITION Sensitivity Estimated
Time(Hrs)
/500 beds
Selective Medical Record
Review based on:
Kardex screening Patient Kardex to det.0.75-0.94 14.3-22.3
patients at risk for infxn
Fever Temperature record to0.09-0.56 8
ident. pts with T>37.8C
Antibiotic use Medication record to 0.57 14.3
ident. pts receiving abs
CASE FINDING
METHODS
METHOD DEFINITION Sensitivity Estimated
Time(Hrs)
/500 beds
Selective Medical Record
Review based on:
Fever and Ab use Temp record to ident. 0.70 13.4
pts with T>37.8 and med
rec. to ident. Pts on Abs
Readmission admission record for pts0.08 -------
readmitted with infection
Autopsy report (AR)AR to ident. pts w/ infxn 0.08 0.53

24. 24
CASE FINDING
METHODS
METHOD DEFINITION Sensitivity Estimated
Time(Hrs)
/500 beds
Selective Medical Record
Review based on:
Ward Liason Surv. Pts reported by nursing0.62 17.6
(WLS) staff to have an infection
Laboratory-based andMicrobiology reports to0.76-0.8931.8
Ward Liason Surv. Ident. Pts with (+) culture
and pts reported by nurses
Risk-Factor-based S.Nursing rep and Med rec. 0.50-0.8932.4
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation

25. 25
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
SURVEY
Incidence Rate (I)
No. of infections acquired in a month
No. of patients discharged in a month
=

26. 26
SURVEY
Prevalence Rate (P)
No of infections (ACTIVE) in
hospitalized patients at the time of the
survey
No. of patients present at the time of the
survey
=
Device-related infections
No. of infections
(CAUTI, MV, CLABSI)
No. of device days
X 1000
Philippine Hospital Infection Control Society, Inc.

27. 27
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Philippine Hospital Infection Control Society, Inc.
Data Analysis and
Interpretation
Significant change in current rates
Monitor both rate and pattern of
endemic disease (significant fluctuation)
Tabulated data and analysis should be
distributed
Examine how component parts relates
Chi-square, Fisher’s test, Student T-test
Philippine Hospital Infection Control Society, Inc.

28. 28
STEPS IN SURVEILLANCE
FOR HAIs
Identify Surveillance Strategy
Data collection
Case-Finding Method
Consolidation and Tabulation
Calculating Rates
Analysis and Interpretation
Validation
Philippine Hospital Infection Control Society, Inc.
VALIDATION
Key aspect of surveillance to assure
accuracy of data collection while being
efficient and cost-effective
Philippine Hospital Infection Control Society, Inc.

29. 29
VALIDATION
Concurrent surveillance
MD / Nurse Epidemiologist (Gold
Standard)
Prospective / Retrospective Review of
Charts
Examine the chart, microbiologic data
Various unit / staggered interval
Philippine Hospital Infection Control Society, Inc.
OUTLINE
Definition of Surveillance
Goals of Surveillance
Components of Surveillance
Steps in Surveillance of HAIs

30. 30
Thank you!
ANTIBIOTIC
POLICIES

31. 31
OUTLINE
Goals of antibiotic policy
Difficulties in formulating
antibiotic policies
Selected policies on
antibiotic usage
GOALS
To promote rational antibiotic use
To prevent or delay emergence of
resistant bacterial strains

32. 32
Difficulties in Formulating
Antibiotic Policies...
bacterial population differ
antibiotic resistance pattern differ
clinical choice varies
availability of antibiotics
cost of antibiotic varies
route of antibiotic varies
Antimicrobial Agent Team
Functions :
Selection of Antimicrobial
agent -> Formulary
Educational Programs

33. 33
1.Restriction of
antibiotic use
ANTIBIOTIC POLICIES
Classification of Antibiotics
Non-Restricted
issuance of these antibiotics does not
require approval of Infectious Disease
Consultants or ID Fellows, but their use
should be based on sound clinical
judgement
Examples: erythromycin, penicillin V,
co-trimoxazole, amoxicillin, tetracycline,
chloramphenicol
Adapted from:
UP-PGH HICCU Antibiotic Policy

34. 34
Classification of Antibiotics
Restricted
issuance of these antibiotics require
approval of an Infectious Disease
Consultants or ID Fellows
Examples: amoxicillin-clavulanic acid,
gentamicin, clindamycin , cefoxitin etc.
Adapted from:
UP-PGH HICCU Antibiotic Policy
Classification of Antibiotics
Very Restricted
issuance of these antibiotics require
approval of Infectious Disease
Consultants .
Only very limited stocks should be
made available in the pharmacy
Adapted from:
UP-PGH HICCU Antibiotic Policy

35. 35
Classification of Antibiotics
Very Restricted
indicated for treatment of life-
threatening infections documented by
culture and sensitivity test, indicating
resistance to other effective and less
expensive antibiotics
Example: vancomycin, imipenem-
cilastatin, amphotericin B, amikacin etc.
Adapted from:
UP-PGH HICCU Antibiotic Policy
1.Restriction of
antibiotic use
2.Limited
susceptibility
reporting
ANTIBIOTIC POLICIES

36. 36
OSPITAL NG STA. CRUZ
Name: Juan de la Cruz Age: 35 yrs oldSex: MaleRoom Number: Room 322 Bed A
Hospital Number: 2004-000456 Attending Physician:Dr. Jose De La Rosa
Specimen: Blood A and B Date Submitted: July 1, 2004 Date Reported: July 5, 2004
Organism: Positive growth of Salmonella typhi
S I R S I R
Amoxicillin Ertapenem
Amoxicillin-Clavulanic acid Imipenem-Cilastatin
Ampicillin X Meropenem
Ampicillin-Sulbactam Aztreonam
Cefoperazone-Sulbactam Ciprofloxacin X
Ticarcillin-Clavulanid acid Gentamicin
Piperacillin-Tazobactam Tobramycin
Cephalothin Netilmycin
Cefuroxime Amikacin
Cefoxitin Erythromycin
Ceftriaxone X Trimethoprim-Sulfamethoxazole X
Ceftazidime Tetracycline
Cefepime Clindamycin
Cefpirome Chloramphenicol X
Vancomycin
Legend: S= sensitive, I= intermediate, R= resistant
OSPITAL NG STA. CRUZ
Name: Juan de la Cruz Age: 35 yrs oldSex: MaleRoom Number: Room 322 Bed A
Hospital Number: 2004-000456 Attending Physician:Dr. Jose De La Rosa
Specimen: Blood A and B Date Submitted: July 1, 2004 Date Reported: July 5, 2004
Organism: Positive growth of Salmonella typhi
S I R S I R
Amoxicillin Ertapenem
Amoxicillin-Clavulanic acid Imipenem-Cilastatin
Ampicillin X Meropenem
Ampicillin-Sulbactam Aztreonam
Cefoperazone-Sulbactam Ciprofloxacin
Ticarcillin-Clavulanid acid Gentamicin
Piperacillin-Tazobactam Tobramycin
Cephalothin Netilmycin
Cefuroxime Amikacin
Cefoxitin Erythromycin
Ceftriaxone Trimethoprim-Sulfamethoxazole X
Ceftazidime Tetracycline
Cefepime Clindamycin
Cefpirome Chloramphenicol X
Vancomycin
Legend: S= sensitive, I= intermediate, R= resistant

37. 37
1.Restriction of
antibiotic use
2.Limited
susceptibility
reporting
3.Concurrent
monitoring of
antibiotic usage
ANTIBIOTIC POLICIES
Methods to Evaluate
Antimicrobial Use in Hospital
A. PATTERN OF USE OF ANTIBIOTICS
BY MEDICAL STAFF
Review current practices for selected
indications
–prophylactic antibiotics in surgery
–antibiotics for specific infections
Gross utilization data based on pharmacy
record

38. 38
Methods to Evaluate
Antimicrobial Use in Hospital
A. PATTERN OF USE OF ANTIBIOTICS
BY MEDICAL STAFF
Survey of usage on individual services
Survey of routine orders for prophylaxis in
surgery
Survey of orders for specific infectious dse
Case review by independent cases
Guidelines for audit
Methods to Evaluate
Antimicrobial Use in Hospital
B. TRENDS
identify yearly purchase
identify consumption of
–each agent
–each group drugs (cephalosporins, etc.)
–each class (antibacterial, etc.)

39. 39
Methods to Evaluate
Antimicrobial Use in Hospital
C. DATA
number of units (grams), cost for each agent
number of patients treated with each drug
1.Restriction of
antibiotic use
2.Limited
susceptibility
reporting
3.Concurrent
monitoring of
antibiotic usage
4.“Audit of Use”
ANTIBIOTIC POLICIES

40. 40
ANTIBIOTIC AUDIT
Some Practices that warrant auditing…
orders for antibiotics in the absence
of minimal diagnostic procedures
concurrent use of more than 2
antibiotics
use of more than 5 antibiotics during
a single hospitalization
continuous treatment with
antimicrobial agents for more than 21
days
ANTIBIOTIC AUDIT
Some Practices that warrant auditing…
use of parenteral drugs when
identical oral preparation can be
used
prophylactic use in surgery for >48
hours
procedure for which prophylaxis is
NOT an accepted practice

41. 41
ANTIBIOTIC AUDIT
Some Practices that warrant auditing…
use of aminoglycosides without
obtaining a measure of renal function
use of antibiotics in afebrile patients
with indwelling catheter
1.Restriction of
antibiotic use
2.Limited
susceptibility
reporting
3.Concurrent
monitoring of
antibiotic usage
4.“Audit of Use”
5.“Automatic” Stop
Order
ANTIBIOTIC POLICIES

42. 42
EMPIRIC THERAPY
treatment of suspected serious or
life-threatening infection pending
results of culture and sensitivity
tests
Initial dose may be issued for 24
hrs BUT subsequent doses will
need approval of the Antimicrobial
Agent Team
Antimicrobial Agent Team
Composition :
Infectious disease physician
Infection control practitioner
Clinical Microbiologist
Clinical Pharmacists
Example: Philippine General Hospital (PGH)
Antibiotic Surveillance and Control Team
(Infectious Disease Consultants and Fellows)

43. 43
DEFINITIVE THERAPY
Treatment of serious or life-threatening
infection documented by culture and
sensitivity tests
a 7-day automatic stop ordershall be
implemented
PROPHYLAXIS USE
use to prevent infectious complications
in high risk setting
–Aminoglycosides : Netilmycin
–Cephalosporins : Cephalothin , Ceftriaxone
–Pen with BLI : Amoxiclav or Ampicillin-
sulbactam
–Quinolones : Ciprofloxacin
–Anaerobic Infection : Metronidazole,
Clindamycin

44. 44
1.Restriction of
antibiotic use
2.Limited
susceptibility
reporting
3.Concurrent
monitoring of
antibiotic usage
4.“Audit of Use”
5.“Automatic” Stop
Order
6.Hospital Formulary
ANTIBIOTIC POLICIES
HOSPITAL FORMULARY
Lists the indication
for which the
antibiotics are
required
List the categories
of antibiotics
List the antibiotics
that are similar in
spectrum, safety,
kinetics

45. 45
HOSPITAL FORMULARY
Draft an antibiotic policy
Discuss the draft policy
with the clinicians
When policy has been
agreed, inform
Microbiology section
and Pharmacy
Enter the policy in the
hospital formulary
Review the policy
periodically
ありがとう(JP) Thank you (En)
Arigatou