HAI SURVEILLANCE DR. DIVYA GUPTA PART 1.pdf

Healthcare associated infections

1. HAI
SURVEILANCE
DR. DIVYA GUPTA
JR1 MICROBIOLOGY

2. AT END OF SESSION WE WOULD KNOW:
§DEFINATION OF HAI SURVEILLANCE
§OBJECTIVES
§CLASSIFICATION OF SURVEILLANCE
§METHODS USED FOR HAI SURVEILLANCE
§THECENTERS FOR DISEASE CONTROL AND PREVENTION(CDC)
§NATIONAL HEALTHCARE SAFETY NETWORK (NHSN)
§CAUTISURVEILLANCE

3. HAI SURVEILLANCE
DEFINATION
The Continuous and systematic
Øcollection,
Øanalysis & interpretation,
Øtimely reporting of reliable
data on the occurrence and
spread of healthcare-
associated infections (HAIs)

4. OBJECTIVES
The main objectives of HAI surveillance include:
üEndemic or baseline HAI rates: To determine the endemic rates
of HAls. An outbreak can be identified when its higher than the
endemic rate.
üComparison: It helps in comparing HAI rates within and in
between hospitals which is useful for long-term trend analysis of
HAIs in the hospitals.
üRoot cause analysis: Identifies the problem area and find out
the breakdown in infection control measures so that the
appropriate corrective measures are implemented subsequently.

5. üFeedback: Provides timely feedback to the clinicians;
thus, reinforcing and convincing them to adapt to the
recommended infection control practices.
üDefending malpractice claims: Infection control records are
often helpful in defending against hospital malpractice
claims.
üFulfilling the accreditation agency criteria : National
Accreditation Board for Hospitals (NABH).

6. CLASSIFICATION

8. It is an individual event-based surveillance, which
detects major breach in the hospital's efforts to
prevent HAIs and warrants individual investigation.
It covers all the patients of the hospital with similar
risks and records all type of infection related events.
E.g. Group B Salmonella food poisoning in
hospitalized patient, transfusion transmitted hepatitis
B virus.
E.g. CAUTI rate
It does not capture all type of events; but only the
most serious problems. So, not commonly seen.
This is the widely practiced surveillance system for
infection control.
Denominator data is usually not required in this type
of surveillance.
It requires both a numerator, (i.e., HAI) and denominator
i.e. number of patients or days of exposure to the risk).

9. Outcome SurveillanceProcess Surveillance
vIt involves surveillance of the outcome
parameters.
vUsed in large hospitals >200 beds with higher
adverse outcomes
vThis involves surveillance of the factors that lead to an
outcome.
vUsed in small hospitals <200 beds with less adverse
outcomes
Examples of outcome surveillance include:
HAI surveillance.
Mortality or morbidity rate.
Needle stick injury surveillance program.
Examples of process surveillance include:
Hand hygiene audit
Personal protective equipment (PPE) usage audit

Determines the magnitude of the problem but does
not provide any information regarding the factors
that might be contributing to the problem.
Eg:
surgical-site infection rate adjusted to type of wound
class present
It does not require risk adjustment in contrast to outcome
surveillance.

10. METHODS USED FOR HAI
SURVEILLANCE

11. METHODS
USED FOR
HAI
SURVEILLANCE
BASED ON PREVALANCE
SURVEY
üPOINT PREVALANCE
SURVEY
üPROSPECTIVE INCIDENCE
SURVEY
BASED ON POPULATION
COVERAGE
üHOSPITAL WIDE HAI
SURVEILLANCE
üTARGATED HAI
SURVEILLANCE
OTHER METHODS
üROTATION BASED
üRISK FACTOR BASED
üOUTBREAK BASED
BASED ON SURVEILLANCE
TEAM
üWARD LIASION SURVEILLANCE
üLABORATORY BASED
SURVEILLANCE
üLABORATORY BASED WARD
SURVEILLANCE
üLABORATORY BASED WARD
LIASION SURVEILLANCE

12. THECENTERS FOR DISEASE CONTROL
AND PREVENTION(CDC)

13. TheCenters for Disease Control and Prevention(CDC) is
thenational public health agencyof the United States.
§It is aUnited States federal agencyunder theDepartment of
Health and Human Services, and is headquartered
inAtlanta,Georgia.
§Main goals:
Ø Protection ofpublic healthand safety through the control and
prevention of disease, injury, anddisabilityin the US and
worldwide.
ØThe CDC focuses national attention on developing and applying
disease control and prevention.

14. §The Centers for Disease Control and Prevention (CDC)
provides detailed guidelines for laboratories to ensure
safety, accuracy, and compliance with regulatory
standards.
§cover various aspects, including
Ø Safe laboratory practices
Ø Biosafety levels
Ø Quality control
ØEquipment maintenance.

15. NATIONAL HEALTHCARE SAFETY
NETWORK SURVEILLANCE

16. §The HAI surveillance systems that are commonly used
worldwide are
§ (i) National healthcare safety network (NHSN), CDC,
USA
§(ii) European Centre for Disease Prevention and
Control (ECDC).

17. National Healthcare Safety Network
(NHSN)
vNHSN division of CDC, USA is the most well-established and accepted
surveillance system worldwide, including India.
vIt is a secured internet-based surveillance system, that provides guideline for
the surveillance of HAIs.
vThe patient safety module of NHSN objectively defines the HAI surveillance
criteria for various HAI types along with the collection forms.
ØCatheter-associated urinary tract infections (CAUTI)
ØCentral line-associated blood stream infection (CLABSI)
ØVentilator-associated events (VAE)
ØSurgical-site infection (SSI)

18. OBJECTIVE:
The NHSN has made the HAI surveillance criteria and
the common terminologies very objective:
Ø In order to reduce subjectivity during data collection
ØTo maintain uniformity across hospitals.
Ø HAI data generated can be used for inter-institutional
comparison.

19. ENROLLMENT TO NHSN:
ØThe healthcare facilities of USA are enrolled to NHSN,
CDC.
Ø They submit their HAl data on a monthly basis to
NHSN.
Ø It allows CDC to use the data to create national
benchmarks of HAI rates and for inter-institutional
comparison.

20. DATA SUBMISSION TO NHSN:
§Data entered into NHSN may represent either "in-plan" or "off-
plan" surveillance:
ØOnly in-plan surveillance
Data are included in NHSN annual reports or other NHSN
publications.
ØOFF-PLAN SURVEILLANCE
done for facility which conducts surveillance only for internal use.
It makes no commitment to follow the NHSN protocol and such data
are not included in NHSN annual reports or publications.

21. INDIAN SCENARIO
§ In Indian scenario, a system close to "off-plan" surveillance
has been adapted by many hospitals such as
§All India Institute of Medical Sciences (AIMS), New Delhi;
§Jawaharlal Institute of Postgraduate Medical Education and
Research (JIPMER), Pondicherry, etc.
§These hospitals follow the NHSN criteria to conduct HAI
surveillance.
§However, they neither submit their data online to NHSN nor
form a part of NHSN annual report.

22. INDIAN COUNCIL OF MEDICAL RESEARCH(ICMR)
§India along with CDC is working towards establishing a national HAI
surveillance network in India which will help in creating national
benchmark of HAI rates.
§ There are various NHSN surveillance criteria for major HAI types:
v Catheter associated urinary tract infection surveillance(CAUTI)
vCentral line- associated bloodsteam infection surveillance
(CLABSI)
vVentilator associated events (VAE) AND Pneumonia
surveillance(PNEU)
vSurgical site infection surveillance

23. CATHETER ASSOCIATED
URINARY TRACT INFECTION
SURVEILLANCE(CAUTI)

24. CATHETER-ASSOCIATED URINARY TRACT INFECTION
§(CAUTI) is the most common HAI, accounting for up to 40% of all
HAls.
•Approximately 12-16% of adult inpatients are on indwelling urinary
catheter at some point of time during their hospitalization.
•The risk of acquiring CAUTI increases by 3-7% with each day of
urinary catheterization.
•Therefore, surveillance of catheterized patients for CAUTI is of
paramount importance.

25. CAUTI RATE
§CAUTI rate = Number of CAUTI cases × 1,000
Number of urinary catheter days

26. §For surveillance purpose, UTI is classified into
§Symptomatic UTI (SUTI-1) in patients >1 year age: This further
classified into:
vCatheter-associated SUTI (la)
vNon catheter-associated SUTI (1b)
•Symptomatic UTI (SUTI-2) in patients ≤1 year age: This is further
classified into:
ØCatheter-associated SUTI-2
ØNon-catheter-associated SUTI-2
•Asymptomatic bacteremic UTI (ABUTI):This is further classified into:
ØCatheter-associated ABUTI
ØNon catheter-associated ABUTI.

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