Surveillance for Infections
Highlights
Policy Statement
The Infection Preventionist will conduct ongoing surveillance for Healthcare-Associated
Infections (HAIs) and other epidemiologically significant infections that have substantial
impact on potential resident outcome and that may require transmission-based precautions
and other preventative interventions.
Policy Interpretation and Implementation
The Surveillance of Infections
Purpose of Surveillance of
Infections
1.
The purpose of the surveillance of infections is to identify both individual cases
and trends of epidemiologically significant organisms and Healthcare-Associated
Infections, to permit interventions, and to prevent future infections.
Criteria
2.
The criteria for such infections are based on the current standard definitions of
infections.
Infections to be Included in
Surveillance
3.
Infections that should be included in routine surveillance include those with:
a. Evidence of transmissibility in a healthcare environment;
b. Available processes and procedures that prevent or reduce the spread of
infection;
c. Clinically significant morbidity or mortality associated with infection (e.g.,
pneumonia, UTIs, C. difficile); and
d. Specific pathogens that are associated with serious outbreaks. (e.g., invasive
Streptococcus Group A, acute viral hepatitis, norovirus, scabies, influenza).
Infections that Could be
Considered for Surveillance
4.
Infections that may be considered in surveillance include those with:
a. Limited transmissibility in a healthcare environment; and
b. Limited prevention strategies.
Monitoring Residents for
Signs/Symptoms of
Infection
5.
Nursing Staff will monitor residents for signs and symptoms that may suggest
infection, according to current criteria and definitions of infections, and will
document and report suspected infections to the Charge Nurse as soon as possible.
Reporting Suspected
Outbreak
6.
If a communicable disease outbreak is suspected, this information will be
communicated to the Charge Nurse and Infection Preventionist immediately.
Identification/Confirmation
of Cultures
7.
When infection or colonization with epidemiologically important organisms is
suspected, cultures may be sent, if appropriate, to a contracted laboratory for
identification or confirmation. Cultures will be further screened for sensitivity to
antimicrobial medications to help determine treatment measures.
Determination of Lab Tests/
Special Precautions/
Treatment Plan
8.
The Charge Nurse will notify the Attending Physician and the Infection
Preventionist of suspected infections. The Infection Preventionist and the
Attending Physician will determine if laboratory tests are indicated, and whether
special precautions are warranted. The Infection Preventionist will determine if the
infection is reportable. The Attending Physician and interdisciplinary team will
determine the treatment plan for the resident.
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© 2001 MED-PASS, Inc. (Revised April 2013)
Data Collection
Consultation of Infection
Control/Epidemiology
Specialist
9.
If transmission-based precautions or other preventative measures are implemented
to slow or stop the spread of infection, the Infection Preventionist will collect data
to help determine the effectiveness of such measures.
10.
When transmission of Healthcare-Associated Infections continues despite
documented efforts to implement infection control and prevention measures, the
appropriate state agency and/or a specialist in infection control and epidemiology
will be consulted for further recommendations.
Gathering Surveillance Data
Personnel Authorized to
Gather/Interpret Data
1.
The Infection Preventionist or designated infection control personnel is responsible
for gathering and interpreting surveillance data. The QA&A Committee may be
involved in interpretation of the data.
Indicators of HealthcareAssociated Infections
2.
The surveillance should include a review of any or all of the following information
to help identify possible indicators of infections:
a.
b.
c.
d.
e.
f.
g.
h.
i.
Laboratory Reports That
Merit Further Evaluation
3.
Laboratory records;
Skin care sheets;
Infection control rounds or interviews;
Verbal reports from staff;
Infection surveillance sheets;
Temperature logs;
Pharmacy records;
Antibiotic Review; and
Transfer log/summaries.
If laboratory reports are used to identify relevant information, the following
findings merit further evaluation:
a. All positive blood cultures;
b. All positive wound cultures that do not just represent surface colonization;
c. Urine culture results combined with urinalysis results that suggest infection,
and corresponding signs and symptoms are present;
d. An appropriately collected positive sputum culture;
e. Other cultures with pathogens (i.e., stool culture, eye cultures, etc.); and
f. All cultures positive for Group A Streptococcus.
Prioritizing Reports
4.
After removing duplicates and negative reports, prioritize the reports as follows:
a. Multidrug-resistant reports (All multidrug-resistant reports require immediate
attention. Ensure that appropriate precautions, if needed, are in place. If this is
a new or unexpected report notify the Administrator, Director of Nursing
Services, and Medical Director.);
b. Blood cultures;
c. Wound cultures if there are corresponding signs and symptoms that indicate
infection;
d. Appropriately collected positive sputum cultures;
e. Urine cultures combined with urinalysis results that show a urinary tract
infection and corresponding signs and symptoms of infection are present; and
f. Other positive cultures (i.e., eye cultures).
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© 2001 MED-PASS, Inc. (Revised April 2013)
Purpose of Surveillance
System
5.
In addition to collecting data on the incidence of infections, the surveillance system
is designed to capture certain epidemiologically important data that may influence
how the overall surveillance data is interpreted; for example, focused surveillance
data may be gathered for residents with a high risk for infection or those with a
recent hospital stay.
Collection of Data
6.
Collect the following data as appropriate:
a. Identifying information (i.e., resident’s name, age, room number, unit, and
Attending Physician);
b. Diagnoses;
c. Admission date, date of onset of infection (may list onset of symptoms, if
known, or date of positive diagnostic test);
d. Infection site (be as specific as possible, e.g., cutaneous infections should be
listed as “pressure ulcer, left foot,” pneumonia as “right upper lobe,” etc.);
e. Pathogens;
f. Invasive procedures or risk factors (i.e., surgery, indwelling tubes, Foley, etc.,
fractured hip, malnutrition, altered mental status, etc.);
g. Pertinent remarks (additional relevant information, i.e., temperatures, other
symptoms of specific infection, white blood cell count, etc.). Also, record if the
resident is admitted to the hospital, or expires; and
h. Preventive measures and comments (interventions and steps taken that might
have decreased risk, or would do so in the future [i.e., barrier techniques,
efforts to prevent immobilization, appropriate handwashing, resident noncompliance, etc.]).
Determination of Infection
7.
Using the current suggested criteria for Healthcare-Associated Infections,
determine if the resident has a Healthcare-Associated Infection.
Healthcare-Associated
Infections Worksheet
8.
Organize the data in the Healthcare-Associated Infections Worksheet. Indicate in
the appropriate column the number of infections that correspond to the pathogenic
organism and site of infection.
Identify Predominant
Organisms
9.
Identify predominant organisms or sites of infection among residents in the facility
or in particular units.
Comparison of Current Data
to Previous Data
10.
Compare incidence of current infections to previous data to identify trends and
patterns. Use an average infection rate over a previous time period (for example, 6
months or a year) as the baseline. Compare subsequent rates to the average rate to
identify possible increases in infection rates.
Monthly Infection Report
for All Nursing Units
11.
Using the Monthly Infection Report for All Nursing Units, enter the number of
infected residents and number of infections in appropriate columns.
Calculating Infection Rates
Calculating Monthly
Infection Rate
1.
Obtain the month’s total resident days from the business office. The following data
is used as the denominator to calculate the monthly infection rate:
a. Total resident days (daily census of each day in the designated time period
added together).
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© 2001 MED-PASS, Inc. (Revised April 2013)
Incidence Rate Calculations
2.
To determine the incidence rate for the facility, divide the number of new
healthcare associated infections for the month by the total resident days for the
month (obtained from the business office) X 1000. This is not a percentage but
may be described as ______# of HAIs per 1000 resident days.
Example:
Total number of new infections for the month
Total resident days for the month
Infections per 1000 resident days
16
3025
16 ÷ 3025 x 1000 = 5.3
Interpreting Surveillance Data
Analyzing Surveillance
Data
1.
Analyze the data to identify trends. Compare the rates to previous months in the
current year and to the same month in previous years, to identify seasonal trends.
Consider how increases or decreases might relate to recent process changes, events,
or activities in the facility (i.e., change in handwashing preparations, increased
turnover in personnel or residents, etc.). These, of course, are not necessarily the
reason for the change. However, trends should be monitored. If the infection rates
rise each month over a period of six (6) months, additional advice is warranted.
Review of Surveillance
Data by Infection Control
Committee
2.
Surveillance data will be provided to the Infection Control Committee regularly.
The Infection Control Committee will determine how important surveillance data
will be communicated to the Physicians and other providers, the Administrator,
nursing units, and the local and State Health Departments.
References
OBRA Regulatory
Reference Numbers
Survey Tag Numbers
Related Documents
Policy
Revised
483.65(a)
F441
Healthcare-Associated Infections, Identifying
Healthcare-Associated Infections Worksheet – Sites and Pathogens (Appendix A)
Infection Report Form (CP1817) (Appendix A)
Line Listing, Monthly Infection Report for Individual Nursing Units (Appendix A)
SHEA/CDC Position Paper: Surveillance Definitions of Infections in Long-Term Care
Facilities: Revisiting the McGeer Criteria (Appendix A)
Date:________________
By:__________________
Date:________________
By:__________________
Date:________________
By:__________________
Date:________________
By:__________________
© 2001 MED-PASS, Inc. (Revised April 2013)