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¤ Determine baseline rates of adverse events ² Healthcare-associated infections
² Falls
² Medication errors
¤ Detect changes in the rates or the distribution of these events
¤ Assess the efficacy of interventions
¤ Prospec2ve mul2-‐centre cohort study, from 1/96 to 12/00 in 37/50 hospitals par2cipa2ng in na2onal surveillance ² 21 920 opera2ons, with 885 (4%) SSIs
Geubels et al Intern J Qual Health Care 2006;18:127-133
year
¤ Decrease of infection during the 4th surveillance year (RR = 0.69; CI95 = 0.52–0.89) and further during the 5th year (RR = 0.43; CI95 = 0.24–0.76)
No significant risk reduction was
observed for patients operated on during the
second and third surveillance years
% SSI
Geubels et al Intern J Qual Health Care 2006;18:127-133
¤ Surveillance reduces SSIs … … but infec2on control teams need to be perseverant and surveillance programs should be given 2me before evalua2on
Geubels et al Intern J Qual Health Care 2006;18:127-133 Create a Surveillance Plan Organizing Surveillance Define
¤ Define priorities ¤ Identify clear, specific goals/objectives ¤ Include surveillance components:
² Definitions ² Data sources ² Population surveyed ² Surveillance or case-finding methods ² Data management ² Data analysis and interpretation ² Reporting and feedback
¤ By unit ¤ By infection type ¤ By organism
² Can be prevented ² Occur frequently ² Cause serious morbidity ² Increase mortality ² Increase length of stay ² Are difficult to treat ² Are costly to treat ² Are reportable/required
¤ Definitions (examples): ² CDC/ECDC ² Individual country ² Hospital system
¤ How to use: ² Use exactly as written ² Use some of the definitions ² Adapt or modify the definitions
¤ Related to the scope of the program and to the surveillance methods
¤ Examples include: ² All patients ² High risk patients (e.g., in ICUs, surgical) ² Patients with resistant organisms ² Mandated patient populations
¤ Patient’s paper or electronic record
¤ Medication or pharmacy records ¤ Temperature records ¤ Laboratory records ¤ Patient examination ¤ Clinical rounds ¤ Informal conversations with staff
indirectly contribute to a health outcome ¤ Using data to improve process and
possibly the outcome ¤ Adjunct to surveillance for HAIs ¤ Use as a surrogate for outcome
assessment or combine with outcome data`
¤ Process should be associated with the designated outcome ² Urinary catheter care bundle ² Central-line bundle ² Hand hygiene ² Door openings in operating room
¤ Concurrent or retrospective ¤ Collect only necessary data ¤ Record data in a systematic format ¤ Organize data in a meaningful way
² Cards: 1 card per infection or patient ² Flow sheet or linelist ² Computer database
¤ When ² Regular intervals ² When special circumstances arise
¤ To whom ² Clinical Departments ² Nursing units ² Infection Control Committee ² Other Committees ² Upper level administrators
Evaldson, et al. Acta Obstet Gynecol Scand 1992;71:54-58.
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Pre Post
All nosocomial infectionsWound infectionEndometritis post C-section
Infection rates before and after regular feedback of infection rates. *p<0.05
¤ How and What ² Graph rates over time ² Tables with the number of
infections, the denominators, & the rates over time
² Linelist of affected patients ² Assessments and conclusions
¤ Did system detect clusters or outbreaks?
¤ Were data used to: ² Change patient care practices?
² Decrease endemic rate? ² Assess interventions?
² Ensure that rates did not increase when P/P changed?
¤ Comparisons are valid only if all parties ² Used the same definitions ² Used the same surveillance intensity ² Used the same data collection methods ² Risk-adjusted for differences in population
¤ Garbage in = garbage out
I will not even start with talking about public repor2ng …
TESTED THE BEST Good choice! Hospital with
lowest infection rate after
surgery
“Yah, but there is a slight drawback. Most patients here do NOT
¤ Systematic differences in the way surveillance is done ² Differences over TIME ² Differences among PLACES
¤ Different case definitions ¤ Different interpretations of the same case
definition ¤ Different effort used to find patient with
HAIs Break-thro ugh project
" The na2onal surveillance indicated major differences with regard to SSI between hospitals à this indicates that further reduc2on of SSI must be possible in many hospitals
8-15 multidisciplinair samengestelde teams afkomstig uit verschillende zorginstellingen en/of regio’s in Nederland vormen een tijdelijk samenwerkingsverband. Al deze teams werken aan het optimaliseren van de zorg op hetzelfde onderwerp of zorgproces. Binnen het centrale onderwerp of zorgproces formuleren de teams hun eigen doelstelling. Tijdens het Doorbraakproject worden de teams begeleid door inhoudelijk en methodische deskundigen. Veel aandacht wordt hierbij besteed aan het meten van resultaten (indicatoren).
Breakthrough projects
" Exchange experience and control of local projects during na2onal group mee2ngs " Na2onal advisory team " Measure outcome solely to evaluate project " Change process parameters to achieve be\er outcome
PLAN
DO STUDY
ACT
Outcome indicator e.g. # SSIs
Hair removal
Discipline during OP Antibiotic-prophylaxis Process indicators
Breakthrough project: Method
" Number of door movements and number of people in the OR " AB-‐prophylaxis
¤ Surveillance will reduce nosocomial infec2ons ¤ Any improvement of surveillance projects will take 2me to show an effect
¤ Surveillance (QI) should be a con2nuous process ¤ Surveillance of outcome indicators alone is no more sufficient and/or possible ² Use process indicators to influence behaviour and monitor effect of interven2ons
² Changes in care (day-‐surgery, reduced 2me of admission) make surveillance of outcome indicators difficult
• One flue patient can cause an epidemic • One yawn can causes lots of other yawns • One surveillance project can reduce infections