scholarly journals Supporting Healthcare-Associated Infection (HAI) Surveillance in Resource-Limited Settings: Lessons Learned, 2015–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s395-s396
Author(s):  
Matthew Westercamp ◽  
Paul Malpiedi ◽  
Amber Vasquez ◽  
Danica Gomes ◽  
Carmen Hazim ◽  
...  
Keyword(s):  
Data Collection ◽  
Sierra Leone ◽  
Clinical Care ◽  
Lessons Learned ◽  
External Support ◽  
Healthcare Associated Infection ◽  
Case Definitions ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Healthcare Associated

Background: Since 2015, the CDC has supported the development and implementation of healthcare-associated infection (HAI) surveillance in resource-limited settings through technical support of case definitions and methods that are feasible with existing surveillance capacity and integration with clinical care to maximize sustainability and data use for action. Methods: Surveillance initiatives included facility-level implementation programs in Kenya, Sierra Leone, Thailand, and Georgia; larger national or regional network-level projects in India and Vietnam were also supported. For assessment and planning, surveillance capacities were grouped into 3 domains: staff, informatics, and diagnostic capacities. Based on these capacities, simplified case definitions surveillance methodologies were devised to balance resources and effort with the anticipated value and use of findings. Results: There was broad understanding of the importance of HAI surveillance; however, the required resources and other challenges (eg, training, staffing, quality of available data) were underappreciated. Staff capacities were often influenced by a lack of dedicated surveillance staff and limited experience in systematic data collection and analysis. Informatics capacities were generally limited by the lack of digital data management, nonstandardized clinical data collection and storage, and the inability to assign and maintain unique patient identifiers. We found that capacity for diagnostics, a critical component of traditional HAI surveillance systems, was limited by its availability, frequency of use, and inconsistent rationale in clinical care. We found that successful surveillance strategies were generally simple, matched existing capacities, and targeted specific HAI priorities identified by clinical teams. For example, in Kenya and Sierra Leone, participating facilities established, with minimal external support, simplified SSI surveillance among post–caesarean-delivery patients. These initiatives improved integration of surveillance with clinical care through encouraging participation of the clinical team in surveillance and planning. Furthermore, these models directly linked surveillance activities to improved patient care (eg, combined clinical checklists with surveillance data collection forms). Discussion: In resource-limited settings, the local cost and effort required to establish and sustain the necessary infrastructure for HAI surveillance can be substantial. Establishing actionable and sustainable HAI surveillance can be achieved through simplifying HAI surveillance to match existing capacities and can result in valuable surveillance programs, even in very resource-limited settings.Funding: NoneDisclosures: None

scholarly journals Feasible Surgical Site Infection Surveillance in Resource-Limited Settings: A Pilot in Sierra Leone

2020 ◽  
Vol 41 (S1) ◽  
pp. s38-s38
Author(s):  
Matthew Westercamp ◽  
Aqueelah Barrie ◽  
Christiana Conteh ◽  
Danica Gomes ◽  
Hassan Benya ◽  
...  
Keyword(s):  
Data Collection ◽  
Cesarean Delivery ◽  
Sierra Leone ◽  
Clinical Decision Making ◽  
Case Finding ◽  
Surveillance Strategy ◽  
Case Definitions ◽  
Patient Interviews ◽  
Resource Limited ◽  
Infection Surveillance

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). SSI surveillance can be challenging and resource-intensive to implement in LMICs. To support feasible LMIC SSI surveillance, we piloted a multisite SSI surveillance protocol using simplified case definitions and methodology in Sierra Leone. Methods: A standardized evaluation tool was used to assess SSI surveillance knowledge, capacity, and attitudes at 5 proposed facilities. We used simplified case definitions restricted to objective, observable criteria (eg, wound purulence or intentional reopening) without considering the depth of infection. Surveillance was limited to post-cesarean delivery patients to control variability of patient-level infection risk and to decrease data collection requirements. Phone-based patient interviews at 30-days facilitated postdischarge case finding. Surveillance activities utilized existing clinical staff without monetary incentives. The Ministry of Health provided training and support for data management and analysis. Results: Three facilities were selected for initial implementation. At all facilities, administration and surgical staff described most, or all, infections as “preventable” and all considered SSIs an “important problem” at their facility. However, capacity assessments revealed limited staff availability to support surveillance activities, limited experience in systematic data collection, nonstandardized patient records as the basis for data collection, lack of unique and consistent patient identifiers to link patient encounters, and no quality-assured microbiology services. To limit system demands and to maximize usefulness, our surveillance data collection elements were built into a newly developed clinical surgical safety checklist that was designed to support surgeons’ clinical decision making. Following implementation and 2 months of SSI surveillance activities, 77% (392 of 509) of post-cesarean delivery patients had a checklist completed within the surveillance system. Only 145 of 392 patients (37%) under surveillance were contacted for final 30-day phone interview. Combined SSI rate for the initial 2-months of data collection in Sierra Leone was 8% (32 of 392) with 31% (10 of 32) identified through postdischarge case finding. Discussion: The surveillance strategy piloted in Sierra Leone represents a departure from established HAI strategies in the use of simplified case definitions and implementation methods that prioritize current feasibility in a resource-limited setting. However, our pilot implementation results suggest that even these simplified SSI surveillance methods may lack sustainability without additional resources, especially in postdischarge case finding. However, even limited phone-based patient interviews identified a substantial number of infections in this population. Although it was not addressed in this pilot study, feasible laboratory capacity building to support HAI surveillance efforts and promote appropriate treatment should be explored.Funding: NoneDisclosures: None

Comparison of Data Collection for Healthcare-Associated Infection Surveillance in Nursing Homes

2016 ◽  
Vol 37 (12) ◽  
pp. 1440-1445 ◽  
Author(s):  
Lauren Epstein ◽  
Nimalie D. Stone ◽  
Lisa LaPlace ◽  
Jane Harper ◽  
Ruth Lynfield ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nursing Homes ◽  
Data Collection ◽  
Clinical Risk Factors ◽  
Healthcare Associated Infection ◽  
Screening Criteria ◽  
Clinical Risk ◽  
Level Data ◽  
Healthcare Associated ◽  
The Impact

OBJECTIVETo facilitate surveillance and describe the burden of healthcare-associated infection (HAI) in nursing homes (NHs), we compared the quality of resident-level data collected by NH personnel and external staff.DESIGNA 1-day point-prevalence surveySETTING AND PARTICIPANTSOverall, 9 nursing homes among 4 Centers for Disease Control and Prevention (CDC) Emerging Infection Program (EIP) sites were included in this study.METHODSNH personnel collected data on resident characteristics, clinical risk factors for HAIs, and the presence of 3 HAI screening criteria on the day of the survey. Trained EIP surveillance officers collected the same data elements via retrospective medical chart review for comparison; surveillance officers also collected available data to identify HAIs (using revised McGeer definitions). Overall agreement was calculated among residents identified by both teams with selected risk factors and HAI screening criteria. The impact of using NH personnel to collect screening criteria on HAI prevalence was assessed.RESULTSThe overall prevalence of clinical risk factors among the 1,272 residents was similar between NH personnel and surveillance officers, but the level of positive agreement (residents with factors identified by both teams) varied between 39% and 87%. Surveillance officers identified 253 residents (20%) with ≥1 HAI screening criterion, resulting in 67 residents with an HAI (5.3 per 100 residents). The NH personnel identified 152 (12%) residents with ≥1 HAI screening criterion; 42 residents had an HAI (3.5 per 100 residents).CONCLUSIONWe identified discrepancies in resident-level data collection between surveillance officers and NH personnel, resulting in varied estimates of the HAI prevalence. These findings have important implications for the design and implementation of future HAI prevalence surveys.Infect Control Hosp Epidemiol 2016;1440–1445

scholarly journals Evaluation of Paradoxical TB-Associated IRIS With the Use of Standardized Case Definitions For Resource-Limited Settings

2010 ◽  
Vol 9 (2) ◽  
pp. 104-108 ◽  
Author(s):  
Ingrid Eshun-Wilson ◽  
Fiona Havers ◽  
Jean B. Nachega ◽  
Hans W. Prozesky ◽  
Jantjie J. Taljaard ◽  
...  
Keyword(s):  
Case Definitions ◽  
Resource Limited Settings ◽  
Resource Limited

Responding to Major Burn Disasters in Resource-Limited Settings: Lessons Learned From an Oil Tanker Explosion in Nakuru, Kenya

2011 ◽  
Vol 71 (3) ◽  
pp. 573-576 ◽  
Author(s):  
Eline van Kooij ◽  
Inge Schrever ◽  
Walter Kizito ◽  
Martine Hennaux ◽  
George Mugenya ◽  
...  
Keyword(s):  
Lessons Learned ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Major Burn ◽  
Oil Tanker

scholarly journals The prevalence of suspected ventilator-associated pneumonia in Scottish intensive care units

2019 ◽  
Vol 21 (2) ◽  
pp. 140-147
Author(s):  
Robert Hart ◽  
Scott McNeill ◽  
Sarah Maclean ◽  
Jamie Hornsby ◽  
Sarah Ramsay
Keyword(s):  
Data Collection ◽  
Ventilator Associated Pneumonia ◽  
Healthcare Associated Infection ◽  
Screening Process ◽  
Mechanically Ventilated ◽  
Endotracheal Tubes ◽  
Data Comparison ◽  
Healthcare Associated ◽  
The Impact ◽  
Meaningful Data

Ventilator-associated pneumonia is the most common healthcare-associated infection in mechanically ventilated patients. Despite this, accurate diagnosis of ventilator-associated pneumonia is difficult owing to the variety of criteria that exist. In this prospective national audit, we aim to quantify the existence of patients with suspected ventilator-associated pneumonia that would not be detected by our standard healthcare-associated infection screening process. Furthermore, we aim to assess the impact of tracheostomy insertion, subglottic drainage endotracheal tubes and chlorhexidine gel on ventilator-associated pneumonia rate. Of the 227 patients recruited, suspected ventilator-associated pneumonia occurred in 32 of these patients. Using the HELICS definition, 13/32 (40.6%) patients were diagnosed with ventilator-associated pneumonia (H-posVAP). Suspected ventilator-associated pneumonia rate was increased in our tracheostomy population, decreased in the subglottic drainage endotracheal tube group and unchanged in the chlorhexidine group. The diagnosis of ventilator-associated pneumonia remains a contentious issue. The formalisation of the HELICS criteria by the European CDC should allow standardised data collection throughout Europe, which will enable more consistent data collection and meaningful data comparison in the future. Our data add weight to the argument against routine oral chlorhexidine. The use of subglottic drainage endotracheal tubes in preventing ventilator-associated pneumonia is interesting and requires further investigation.

scholarly journals Risk for Clostridioides difficile infection among hospitalized patients associated with multiple healthcare exposures prior to admission

2020 ◽  
Author(s):  
Aaron C Miller ◽  
Daniel K Sewell ◽  
Alberto M Segre ◽  
Sriram V Pemmaraju ◽  
Philip M Polgreen ◽  
...  
Keyword(s):  
Hospitalized Patients ◽  
Healthcare Associated Infection ◽  
Case Definitions ◽  
Multiple Exposures ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Increase Risk ◽  
Clostridioides Difficile Infection ◽  
Degree Of Association ◽  
Healthcare Associated

Abstract Purpose Clostridioides difficile infections (CDIs) are a common healthcare-associated infection and often used as indicators of hospital safety or quality. However, healthcare exposures occurring prior to hospitalization may increase risk for CDI. We conduct a case-control study comparing hospitalized patients with and without CDI to determine if healthcare exposures prior to hospitalization (i.e., clinic visits, antibiotics, family members with CDI) were associated with increased risk for hospital onset CDI, and how risk varied with time between exposure and hospitalization. Methods Records were collected from a large insurance-claims database from 2001-2017 for hospitalized adult patients. Prior healthcare exposures were identified using inpatient, outpatient, emergency department, and prescription drug claims; results were compared between various CDI case definitions. Results Hospitalized patients with CDI had significantly more frequent healthcare exposures prior to admission. Healthcare visits, antibiotics and family exposures were associated with greater likelihood of CDI during hospitalization. The degree of association diminished with time between exposure and hospitalization. Results were consistent across CDI case definitions. Conclusions Many different prior healthcare exposures appear to increase risk for CDI presenting during hospitalization. Moreover, patients with CDI typically have multiple exposures prior to admission, confounding the ability to attribute cases to a particular stay.

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