Epidemiology and Surveillance of Hospital Infection
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Epidemiology and Surveillance of Hospital Infection |
Surveillance is an ongoing day-to-day activity of the Infection Control Team [ICT]. It includes laboratory-based monitoring of microbial isolates from hospitalized patients and correlating with signs of clinical infection. This is usually carried out daily by the Infection Control Nurse in liaison with the microbiology staff and ward nurses. Surveillance also includes early detection, notification and monitoring of particularly transmissible, so-called “alert organisms”. These organisms are Methicillin-resistant Staphylococcus aureus [MRSA]. Vancomycin resistant Enlerococcus [VRE], Clostridium difficile, Acinetobacter baumannii, Multiple resistant organisms, Neisseria meningitidis, Legionella pneumophila. Day-to-day surveillance allows early detection of an “alert organism’, cross infection or outbreak. The ICT can then move to investigate and control the infection.
Surveillance of Infection Control practices and monitoring proper implementation of laid policies is a function of the ICT. ICT performs regular Visits to essential hospital departments such as wards and clinics, operating theaters and the laboratory, housekeeping, catering, engineering and pharmacy. Hospital Infection rate is published monthly and distributed to all hospital wards and departments. Surveillance of hospital-acquired infection is a good measuring tool and indicator that should keep everyone aware of the occurring infection and ways to control it.
Recording & Classification of post-operative wound infection
Surgical operations are classified into four categories, each with a permissible infection rate. These categories are:Clean Wound
A clean wound is a surgical wound with no evidence of inflammation and the gastro-intettinal [G1], respiratory or genito-urinary [GU] systems have not been entered. The expected [permissible] rate of infection of a clean wound is 1-2%.Clean Contaminated Wound
A clean contaminated wound is a surgical wound giving access to a procedure in which the G1, respiratory or GU systems are entered under controlled conditions without spillage. Biliary, appendix, vagina and oropharynx may be included. There must be no evidence of inflammation. The expected [permissible] rate of infection of a clean contaminated wound is 3-5%.Contaminated Wound
A contaminated wound is an open fresh accidental wound giving access to a site of acute, non-purulent inflammation or where the G1, respiratory or GU systems are entered and it is known they are infected. Also where there is spillage from one of the systems during the course of procedure. The expected [permissible] rate of infection of s contaminated wound is 5-15%.Dirty Wound
A dirty wound is an old traumatic wound where there is devitalized tissue present of where there has been faecal contamination or a surgical wound giving access to perforated viscous or free pus is encountered. The expected [permissible] rate of infection of a dirty wound is 15-25%.Daily incidence report criteria on nosocomial infection
Type of Nosocomial infection
- Surgical site infection
Simplified criteria
- Any purulent discharge, abscess, or spreading cellulitis at the surgical site during the month after the operation.
- Urinary infection
- Positive urine culture [1 or 2 species with at least 10-bacteria/ml] with or without clinical symptoms.
- Respiratory infection
- Respiratory symptoms with at least to of the following signs appearing daring hospitalization.
- Purulent sputum
- New infiltrate on chest radiograph
- Consistent with infection
- Vascular catheter infection
- Inflammation, lymphangitis or purulent discharge at the insertion site of the catheter
- Septicemia
- Fever or rigors and at least one Positive blood culture
Epidemiology and Surveillance of Hospital Infection
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