CPMS COLLEGE OF

NURSING

ASSIGNMENT
ON
INFECTION SURVEILLANCE

DATED: 22nd June, 2021

SUBJECT: CHILD HEALTH NURSING

SUBMITTED TO SUBMITTED BY:

MAAM ARCHANA DAS AMY LALRINGHLUANI
ASSOCIATE PROFESSOR M.Sc. (N) 1ST YEAR
M.Sc. (N) CHILD HEALTH NURSING CPMS CON
CPMS CON
INTRODUCTION
The rates of bloodstream infections among neonates in developing countries are 3–20 times
higher than those reported in developed countries. In developing countries, approximately
one- half of patients in neonatal ICUs (NICUs) acquire infections, and more than 52% of
affected patients die.

DEFINITION OF SURVEILLANCE
Surveillance is 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

POLICIES FOR INFECTION CONTROL IN NEONATOLOGY

 All Neonatal Care Units staff shall be familiar with the infection control practices that
minimized the infection risk in the staff and patients.
 Strict Hand Hygiene compliance according to WHO 5 moments of hand hygiene.
 Invasive procedure shall be used cautiously and with appropriate aseptic technique.
 Handling of neonates shall be minimized.
 Equipment and supplies should not be shared between infants.
 Visitor management.

PURPOSE OF SURVEILLANCE
 Infection prevention begins with ongoing surveillance to identify infections that are
causing, or have the potential to cause, an outbreak. The facility closely monitors all
residents who exhibit signs/symptoms of infection through ongoing surveillance and
has a systematic method for collecting, consolidating, and analyzing data concerning
the frequency and cause of a given disease or event, followed by dissemination of that
information to those who can improve the outcomes.
 The intent of surveillance is to identify possible communicable diseases or infections
before they can spread to other persons in the facility.
 In addition, surveillance is crucial in the identification of possible clusters, changes in
prevalent organisms, or increases in the rate of infection promptly.
 The results should be used to plan infection control activities, direct in-service
education, and identify individual resident problems in need of intervention.

ELEMENTS OF SURVEILLANCE
Essential elements of a surveillance system include:
 Standardized definitions and listings of the symptoms of infections based upon
national standards of practice
 Surveillance will be based upon the information from the facility assessment,
including the resident population and the services and care provided
  Use of monitoring tools such as surveys and data collection templates, walking rounds
throughout the healthcare facility
 Identification of resident populations at risk for infection
 Identification of the processes or outcomes selected for surveillance
 Statistical analysis of data that can uncover an outbreak
 Feedback of results to the primary caregivers and/or practitioners so that they can
continually assess the residents’ physical condition for signs of infection.

TWO TYPES OF SURVEILLANCE IMPLEMENTED IN

HEALTHCARE FACILITIES
1. Process surveillance
2. Outcome surveillance

1. Process surveillance
Process surveillance reviews practices directly related to resident care in order to identify
whether the practices comply with facility infection prevention and control procedures and
policies based on recognized guidelines. Examples of this type of surveillance include but are
not limited to:
 Monitoring of compliance with transmission based precautions
 Proper hand hygiene
 The use and disposal of personal protective equipment
 Injection safety
 Point‐of‐care testing
 Urinary catheter care
 Dialysis care
 Management of blood borne pathogen exposure
 Cleaning and disinfection of products, equipment or environmental surfaces
 Handling, storing, processing and transporting linens according to procedure

2. Outcome surveillance
The outcome surveillance process consists of collecting/documenting data on individual cases
and comparing the collected data to standard written definitions (criteria) of infections. The
Infection Preventionist or other designated staff reviews data (including residents with fever
or purulent drainage, and cultures or other diagnostic test results consistent with potential
infections) to detect clusters and trends and to be able to identify and report evidence of a
suspected or confirmed HAI or communicable disease.
Sources of relevant data that can be used for outcome surveillance for infections, antibiotic
use and susceptibility may include
 Monitoring a resident with a fever or other signs that may indicate an infection
  Laboratory cultures or other diagnostic test results consistent with potential infections
to detect clusters, trends, or susceptibility patterns
 Antibiotic orders
 Laboratory antibiograms (antibiotic susceptibility profiles)
 Medication regimen review reports
 Medical record documentation such as physician progress notes and transfer
summaries accompanying newly admitted residents
 Transfer/discharge summaries for new or readmitted residents for infections
The facility’s program should choose to either track the prevalence of infections
(existing/current cases both old and new) at a specific point or focus on regularly identifying
new cases during defined time periods. When conducting outcome surveillance, the facility
may choose to use one or more of the automated systems and authoritative resources that are
available, and include definitions.

MONITORING
 Monitoring the implementation of the program, its effectiveness, the condition of any
resident with an infection, and the resolution of the infection are considered an
integral part of the healthcare facility surveillance.
 The healthcare facility monitors tasks (e.g., dressing changes and transmission‐based
precaution procedures) to ensure consistent utilization of practice standards.
 All residents are monitored for the risk of infection and the presence of actual
infections.
 Healthcare facility infection control reports identify the types and severity of the
infection.
 The reports are used to identify trends and patterns.
 The facility monitors practices (e.g., dressing changes and transmission‐based
precaution procedures) to ensure consistent implementation of established infection
prevention and control policies and procedures based on current standards of practice.
 All residents are monitored for current infections and infectious risk.
 In addition to monitoring processes and outcomes, the healthcare facility collects data
about infections.

SOURCES OF DATA
The Infection Preventionist (IP) reviews data on a regular basis including:
 elevations in temperatures,
 purulent drainage,
 culture results or other diagnostic test results consistent with potential infections
 change in X‐ray results consistent with possible infection
 increased falls
 changes in mental status
 changes in vital signs
Other sources of relevant data include:
 medication records of antibiotic orders,
 laboratory cultures and antibiograms (antibiotic susceptibility profiles),
 medication regiment review reports,
 medical record reviews of all new admissions
 pre‐admission consideration of all potential admissions with infections

DATA COLLECTION
1. The unit charge nurses will identify residents with symptoms or identified infections
and complete the Criteria for Infection Report Forms for the respective type of
infection:
a) Urinary Tract Infection
b) Respiratory Tract Infection
c) Gastrointestinal Tract Infection
d) Skin, Soft Tissue and Mucosal Infection

2. The Infection Preventionist or designee will be alerted to identify any necessary

interventions and add to the Monthly Infection Control Log for follow up and data
collection. The Infection Preventionist will utilize this information to document
infection site, type of infection, pathogen if known, signs and symptoms, resident
location, etc., in order to identify trends or clusters for action.

3. The Infection Preventionist will keep an updated map of infections to identify any
clusters or trends.

4. Data obtained from Process Surveillance Audits will be collected to analyze the
compliance of staff with facility policies and procedures.

DATA ANALYSIS
The Infection Preventionist and the Infection Prevention and Control Committee will utilize
the information collected from both Process and Outcome Surveillance activities in order to
analyze the data to identify opportunities for improved care and process and identify an
action plan for follow up and corrective action and reporting.
Data Analysis will assist the facility in:
1. Determining the origin of infection assists the facility to identify the number of
residents who developed infections within the facility. The healthcare facility can then
evaluate whether it needs to change processes or practices to enhance infection
prevention and minimize the potential for infection transmission.

2. Comparing current and past infection control surveillance data to past performance
enables detection of any unusual or unexpected outcomes. It is important that
surveillance reports be shared with appropriate personnel in the nursing home,
 including, but not limited to, the director of nursing and medical director. The
infection control data summaries support the rationale for infection control measures
that enhance its practices to prevent future infections.

3. Comparing the reported incidence of infections by type and location to previous

facility reports helps staff identify efficient and ineffective practices.

4. Determining need for additional education and staff competency with results of
process surveillance audits

5. This data is recorded at least quarterly and included in the report to the QAA (Quality
Assurance and Assessment) committee.
The surveillance reports are shared with appropriate individuals including the Director of
Nursing, and medical director. Also, it is important that the staff and practitioners receive
reports that are relevant to their practices to help them recognize the impact of their care on
infection rates and outcome.

PLAN
Based on analysis of data, develop and implement an action plan that includes correction
actions, staff education, and measurable goals.

EVALUATE
Assess the effectiveness of the corrective actions based on the outcome measures identified in
the action plan.

DOCUMENTATION
 Facilities may use various approaches to gathering, documenting, and listing
surveillance data. The facility’s infection control reports describe the types of
infections and are used to identify trends and patterns.
 Descriptive documentation provides the facility with summaries of the observations of
staff practices and/or the investigation of the causes of an infection and/or
identification of underlying cause(s) of infection trends.
 It is important that the infection prevention and control program define how often and
by what means surveillance data will be collected, regardless of whether the facility
creates its own forms, purchases pre-printed forms, or uses automated systems.

INFECTION SURVEILLANCE CONSIDERATIONS

Surveillance of infections should be attributed to a Long‐Term Care Facility (LTCF) onset if:
a) There is no evidence of an incubating infection at the time of admission to the facility
by clinical documentation of appropriate signs and symptoms and not solely on
screening microbiologic data.
b) The onset of clinical manifestation occurs greater than 72 hours after admission.
 c) Although debate exists about the use of this time frame to determine the LTCF onset
for C. difficile infections, the definition is consistent with acute care infection
surveillance reporting and surveillance methodology.
(Stone, N., Ashraf, M., Calder, J., Crnich, C., Crossley, K., Drinka, P., . . . For the Society for
Healthcare Epidemiology Long‐Term Care Special Interest Group. (2012). Surveillance
Definitions of Infections in Long‐Term Care Facilities: Revisiting the McGeer Criteria.
Infection Control and Hospital Epidemiology, 33(10), 965‐977. doi:10.1086/667743)

SURVEILLANCE SYMPTOMS CONSIDERATIONS

1. All symptoms must be new or acutely worse. Many residents have chronic symptoms,
such as a cough or urinary urgency that are not associated with infection; however, a
new symptom or a change from baseline may be an indication that an infection is
developing.
2. Alternative non-infectious causes of signs and symptoms (e.g., dehydration,
medications) should be considered and evaluated before an event is deemed an
infection.
3. Identification of infection should not be based on a single piece of evidence but
should always consider the clinical presentation and any microbiologic or radiologic
information that is available. Microbiologic and radiologic findings should not be the
sole criteria for defining an event as an infection. Similarly, diagnosis by a physician
alone is not sufficient for a surveillance definition of infection and must be
accompanied by documentation of compatible signs and symptoms.
(Stone, N., Ashraf, M., Calder, J., Crnich, C., Crossley, K., Drinka, P., . . . For the Society for
Healthcare Epidemiology Long‐Term Care Special Interest Group. (2012). Surveillance
Definitions of Infections in Long‐Term Care Facilities: Revisiting the McGeer Criteria.
Infection Control and Hospital Epidemiology, 33(10), 965‐977. doi:10.1086/667743)
 Residents who have positive cultures but no signs and symptoms of infection may be
colonized rather than infected so should not be included in these data.
 Infections are counted in the data only once. An infection lasting over more than one
reporting period is reported only once for the period of onset.
 If an infection completely resolves and then recurs, it will be counted as a new infection.
 Unless specifically designated as a criterion for infection, a physician’s written, or verbal
diagnosis of infection without supporting clinical evidence does not justify counting
condition like an infection

COMMON TYPES OF INFECTION

A. Healthcare Associated Infection (HAI):
Healthcare‐associated infections are infections that patients acquire during receiving
treatment for other conditions within a healthcare setting
 Infection develops within 72 hours or more after admission or re‐admission.
 Infection appears at a new or different site in the same resident.
  The infection did NOT develop as the result of a procedure carried out in a
hospital, physicians’ office, or other health care facility.

B. Community –‐Acquired Infections

An infection acquired in the community in contrast to a healthcare facility.
 Infection is present on admission to the facility.
 An infection would be classified as community‐acquired if the patient had not
recently been in a health care facility.
OR
 Infection is present on readmission to the facility but was not present or
incubating when the resident was transferred from the facility.
 The infection developed as a result of a procedure carried out in a hospital,
physician’s office, or another healthcare facility (e.g., surgical site infection).

INFECTION SURVEILLANCE METHODS

1. Concurrent surveillance:
a. Regular rounds of resident care units
b. Verbal reports from nursing staff

2. Retrospective surveillance:
a. Positive culture
b. Pharmacy reports of antibiotic use
c. X‐ray
d. Chart review

INFECTION DATA COLLECTION AND ANALYSIS

1. Data is tabulated by type of infection.
2. Data is calculated into rates periodically (monthly, quarterly, and yearly).
3. The calculation to be used is number of infections per 1000 resident days.
The formula for calculation:

Number of new HAI ’ s infections

×1000
Number of resident days ∈a month

4. Rates are compared over time to discern

a. Changes in patterns
b. Clusters
c. Trends
d. Opportunities for process assessment and improvement.

REPORTING
1. Analysis and conclusions are reported to the Quality Assurance (QA) committee on a
minimum of a quarterly basis.
 2. Surveillance results are communicated to the appropriate departments

QUALITY ASSESSMENT AND ASSURANCE COMMITTEE (QAA)

1. The designated IP or at least one of the individuals if there are more than one IP will
regularly attend and report on the Infection Prevention and Control Program at the
facility’s quality assessment and assurance committee.
2. The responsibilities include active implementation and reporting on current Quality
Assurance and Performance Improvement projects.