HAI Surveillance and Reporting : Past , Present and Future Imperatives
By Kelly M . Pyrek
Infection surveillance accomplishes numerous goals , including using the data to measure the success of an institution ’ s infection prevention and control programs , to identify clinical areas for improvement , and to meet public reporting mandates and pay-for-performance objectives . It is a continual process , encompassing the collection , analysis , interpretation , and dissemination of data that can inform healthcare stakeholders about healthcare-acquired infections ( HAI ) as well as advise around interventions that can improve care and boost outcomes . Most importantly , infection surveillance allows facilities to measure progress – or lack thereof – and course-correct in near real-time .
To review , the Centers for Disease Control and Prevention ( CDC ) reminds us that surveillance is a dynamic process of assess the patient population and identifying those at greatest risk for the outcome or process of interest to the healthcare institution . These can be the HAIs themselves ( outcomes ), as well as patient-care practices aimed at preventing HAIs ( processes ). For example , a facility may select as an outcome to monitor an infection or colonization with a specific organism , a vascular access-related infection in hemodialysis patients , or sharps injuries or occupational exposures . Examples of a process to be monitored is central line insertion practices , surgical care processes ( e . g ., preoperative antimicrobial prophylaxis ), medication errors , influenza vaccination rates , hepatitis B immunity rates , or healthcare personnel compliance with protocols . Clinicians – likely infection preventionists — in charge of surveillance then determine the observation time period , select a surveillance methodology , and then monitor for the outcome or process using standardized definitions for all data collected . They collect appropriate denominator data , if rates are to be calculated , as well as analyze the surveillance data and then report and use this surveillance information in a timely manner .
Surveillance data require interpretation to identify areas where improvements to infection prevention and control practices can be implemented to lower the risk of HAIs . IPs understand that any increase in a healthcare facility ’ s HAI rate should prompt an investigation to identify changes in the
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Surveillance data require interpretation to identify areas where improvements to infection prevention and control practices can be implemented to lower the risk of HAIs . hospital ’ s activities that may explain the new rate of infection . Significant deviations from the institution ’ s baseline HAI rate may indicate the presence of an outbreak , warranting appropriate interventions . HAI rates may be compared to both the facility ’ s own previous HAI rates and benchmarks , or to external standards or benchmarks set by other healthcare settings . When comparing HAI rates to those of other clinical settings , it is essential that the same case finding methods are used , the same case definitions are applied and the same methods for risk stratification are employed . Recommended practice is that a set of peer facilities that serve a similar case mix , use the same case definitions and similar case finding methods be identified to serve as a comparison group .
Surveillance demonstrated its merits for the first time decades ago . Conducted and released more than 47 years ago , the landmark SENIC study is inarguably the beginning of modern attention focused on nosocomial infections , now referred to as HAIs . The SENIC study was a rigorous assessment of infection control effectiveness that compared outcomes in hospitals with