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1 Surveillance, Outbreaks, and Reportable Diseases, Oh My! Assisted Living Facility, Nursing Home and Surveyor Infection Prevention Training February 2015 A.C. Burke, MA, CIC Health Care-Associated Infection Prevention Program Manager 1/30/ To understand the role and value of surveillance in an infection prevention and control program To define carbapenem-resistant Enterobacteriaceae To review updates to Florida s reportable disease rule 1/30/ /30/

2 1/30/ First things first 1/30/ What is it? The ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know. Ehrenkranz, NJ Am J Med /30/

3 Continuous process Defining events to be surveyed Collection of relevant data Consolidating data Analyzing/interpreting data Using information to bring about change 1/30/ Improve outcomes Detect clustering of disease Answer the questions: who, when and where? Assess impact of interventions Guide treatment (antimicrobials) Satisfy regulatory standards 1/30/ Define the categories of infection Define the population at risk Determine the most efficient way to find and collect the necessary data Tabulate, analyze, and interpret the data Report the data Use the data to drive change 1/30/

4 Establish baseline endemic rates Identify outbreaks/clusters Identify specific infection/colonization risk factors Evaluate and improve control measures Decrease endemic health care-associated infections 1/30/ National Healthcare Safety Network (NHSN) McGeer /30/ Standardized Consistent Reproducible 1/30/

5 Clinical vs. surveillance definitions: Clinical definitions are designed to make diagnoses and guide evaluation and treatment decisions for individual patients. Clinical definitions surveillance definitions Surveillance definitions clinical definitions Surveillance definitions are for the purposes of standardizing data and trending over time in populations. May not capture clinical subtleties May over/under classify infections from a clinical perspective 1/30/ Laboratory reports Progress notes (physician, nursing) Chart reviews Admission information 1/30/ Cases (e.g. residents) meeting pre-determined criteria (i.e. case definition) Signs and symptoms Laboratory results 1/30/

6 Multi-drug resistant organisms (MDRO) and/or C. difficile infection Health care-onset (HO) = Positive lab result for (clinical) specimen collected greater than 3 days after admission (i.e. on or after day 4) Community-onset (CO) = Positive lab result for (clinical) specimen collected within 3 days of admission (i.e. days 1, 2 or 3 of admission) 1/30/ Patient Information Target Organism Resident ID Date Specimen Collected Date Admitted to Facility Positive Lab Result- Organism /10/2013 9/5/2013 MRSA /1/ /1/2013 VRE /4/2013 8/7/2013 CDI /11/ /10/2013 CDI MRSA = Methicillin-resistant S. aureus VRE = Vancomycin-resistant Enterococcus CDI = Clostridium difficile infection 1/30/ Patient Information Target Organism Resident ID Date Specimen Collected Date Admitted to Facility Positive Lab Result- Organism /10/2013 9/5/2013 MRSA HO /1/ /1/2013 VRE CO /4/2013 8/7/2013 CDI HO /11/ /10/2013 CDI CO 1/30/

7 Infection type Device use Organism 1/30/ Number of cases Health Care-Onset (HO) and Community-Onset (CO) C. difficile Infections, January December 2014 HO CO 1/30/ Resident days Rates [Number of HO CDI/resident days in month] x 1000 Admissions Prevalence [Number of CO CDI/number of admissions in month] x 1000 Device days Number of days with indwelling urinary catheter Counted at the same time everyday 1/30/

8 [Number of MRSA infections/number of resident days] x 1000 [Number of urinary tract infections (UTI)/number of resident days] x 1000 [Number of catheter-associated UTIs/number of urinary catheter days] x 1000 [Number of ventilator-associated pneumonias/number of ventilator days] x /30/ Urinary Tract Infections Per 1000 Resident Days, July 2013-March 2014 Urinary tract infection rate Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar Is there an outbreak or cluster? Is there a trend? Are rates increasing or decreasing? Why? What has changed? Has there been a change in policy or procedures recently? Has there recently been a product change? Is action needed? 1/30/

9 14 Urinary Tract Infections (UTI) and Catheter- Associated Urinary Tract Infections (CAUTI), January June 2014 Number of infections UTI CAUTI 0 January February March April May June 1/30/ Look for the problem Observe practices Develop solutions Educate staff Develop and implement new policy and/or procedures 1/30/ /30/

10 All outbreaks and clusters of any disease are reportable to the Department of Health by law. Section , Florida Statute 1/30/ More than expected Above baseline 1/30/ /30/

11 Two or more epidemiologically linked cases or suspected cases: confirmed illness not required Influenza-like illness (ILI) Gastro-intestinal illness Especially of unknown cause Scabies Not sure? Call the local health department. 1/30/ Legionellosis Salmonellosis Hepatitis Hepatitis A-immediately by phone 1/30/ Methicillin-resistant S. aureus (MRSA) Electronic laboratory reporting Vancomycin-resistant S. aureus (VRSA) Vancomycin-intermediate S. aureus (VISA) Reportable to Department of Health VRSA and VISA individual case Nationally Notifiable Disease 1/30/

12 Aerobic gram-negative bacteria (GNB) Normal gut flora Enterobacteriaceae Klebsiella spp. Escherichia coli Citrobacter freundii Enterobacter spp. Serratia spp. Salmonella spp. Photo source: CDC 1/30/ Doripenem Imipenem Meropenem Ertapenem 1/30/ Any bacteria in the Enterobacteriaceae family that is resistant to carbapenems KPC = Klebsiella pneumoniae carbapenemase NDM = New Delhi Metallo-beta-lactamase Example: KPC producing E. coli, Klebsiella spp., or Enterobacter spp. Example: Carbapenem-resistant Klebsiella pneumoniae or CRKP 1/30/

13 Effective June 4, /30/ Removed: Encephalitis, other (non-arboviral), Endemic typhus fever (Rickettsia typhi), Invasive streptococcal disease, group A Staphylococcus aureus, community-associated mortality Toxoplasmosis Added: Neonatal abstinence syndrome Human papillomavirus (HPV)-associated laryngeal papillomas or recurrent respiratory papillomatosis in children <6 years old and anogenital papillomas in children <12 years old Haemophilus influenzae invasive disease in children <5 years old Streptococcus pneumoniae invasive disease in children <6 years old 13

14 Updated: Arboviral infections not otherwise listed: now explicitly listed as reportable Possible exposure to herpes B virus: now explicitly listed as reportable (previously captured under possible exposure to rabies) Vibriosis: now includes other closely related species Photobacterium damselae (formerly Vibrio damselae) and Grimontia hollisae (formerly Vibrio hollisae) Rocky Mountain spotted fever: expanded to include all spotted fever rickettsioses 1/30/ Antimicrobial Resistance Acinetobacter baumannii Citrobacter species Enterococcus species Enterobacter species Escherichia coli species Klebsiella species Pseudomonas aeruginosa Serratia species 1/30/ /30/

15 A.C. Burke, MA, CIC Health Care-Associated Infection Prevention Program Manager Bureau of Epidemiology Florida Department of Health Phone: /30/

Florida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC

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