Epidemiological Surveillance of Healthacare

7/29/2019 Epidemiological Surveillance of Healthacare

1/37

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P

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OVI MU

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EpidEmiologicalSurvEillancE

of HEaltHcarE-aSSociatEdinfEctionS

Module I


2/37

akweees

ths je ws ssbehks b he c ie

deee aey, wh wsee he sbsy026140 - immEdiatE

rESponSE to H1n1

influEnZa.

Also p ublish ed in Spanis h as:

Vigilancia epidemiol gica de las infe cciones a sociadas a la at encin en salu d

PAHO HQ Library Cataloguing-in-Publication

Pan American Health Organization,

Epidemiological Surveillance of Healthcare Associated Infections.

Washington, D. C.: PAHO, 2011.

ISBN 978-92-75-13147-3

I. Title

1. EPIDEMIOLOGIC SURVEILLANCE statistics & numeral data

2. HEALTH SURVEILLANCE OF HEALTH SERVICES

3. CROSS INFECTION prevention & control

4. EPIDEMIOLOGIC STUDIES

5. INFECTION CONTROL - standards

6. PROGRAM EVALUATION - standards

7. QUALITY OF HEALTH CARE

8. LATIN AMERICA

NLM WC 195.DA15

The Pan Americ an Health Organi zation welcom es reques ts for permis sion to reprodu ce or trans late its

publications, in part or in full. Applications and inquiries should be addressed to Editorial Services, Area of

Knowledge Management and Communications (KMC), Pan American Health Organization, Washington, D.C.,

U.S.A., which will be glad to provide the latest information on any changes made to the text, plans for new

editions, and reprints and translations already available.

Pan American Health Organization, 2011

Publications of the Pan American Health Organization enjoy copyright protection in accordance with the

provisions of Protocol 2 of the Universal Copy right Convention. All rights are reserved.

The des ignati ons emp loyed a nd the p resent ation of t he mat erial i n this pu blica tion do n ot impl y the ex pressio n

of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning

the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers

or boundaries.

The menti on of speci fic compa nies or of cert ain manu facture rs produ cts does not i mply tha t they are en dorsed

or recommended by the Pan American Health Organization in preference to others of a similar nature that

are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by

initial capital letters.


3/37

5M ODUL E I

I . I n t r o d u c t I o n a n d r a t I o n a l e page 7

1 ei pms pi

-ssi iis i li

amipage 7

2 c mps pms pi

-ssi iis page 8

3 B iss ppspage 10

I I . S u r v e I l l a n c e M e t h o d o l o g y page 13

1 Miimm pi piipi

spispage 14

2 di-ssi spi ii16

I I I . I n e c t I o n S S u B j e c t

t o S u r v e I l l a n c e page 19

1 Pmi (Pneu)page 192 ui t Ii (utI)page 29

3 Bsm Ii (BSI) page 33

I v . I n d I c a t o r S page 39

tbe ces

Abbreviato

ns

BAC laboratory-conrmedbloodstreaminfection

BAL bronchoalveolarlavage

BSI bloodstreaminfection

CPAP continuouspositiveairwaypressure

PSB protected-specimenbrushing

IUC indwell ingurinarycatheter

CVC centralvenouscatheterorcentralline

FIO2 fractionofinspiredoxygen

ET-CPAP endotrachealcontinuouspositiveairwaypressure

IPPB intermittentpositivepressurebreathing

MINI BAL synonymforNB-BAL

NB-BAL nonbronchoscopicbronchoalveolarlavage

ml milliliter

PAHO PanAmericanHealthOrganization

PaO2 partialpressureofoxygeninarterialblood

P-BAL protectedbronchoalveolarlavage

PMN polymorphonuclearleukocyte

ICU intensivecareunit

CFU/ml colonyformingunitspermilliliter

MV mechanicalvent ilation

* PEEP positiveend-expiratorypressure

RSV respiratorysyncytialvirus


4/37

i re

1/Evaluation of programs for the prevention

and control of healthcare-associated infections

in Latin America

I imp pi spi qik iis iss, P ami

h oizi (Paho) s wk i ri

amis s pimii si ssms

b -iiis bis.

Bw 2006 2007, Paho, i psip wi i

xps, ssssm ss pms

pi -ssi iis i

67 spis i s is i ri (1). as s

i, is p mss imp i

pms. Paho is ssi iss ri .

epimii si isis -

ssi i is (haIs) w m s

qi ii i. Isss wi isis w iii mss, wi w impm bs w

. a sis si ii bi

is s ii mss

impm i piipi isiis.

epimii si i spis s

piip pbms iis i ps ii,

isi ps pimi ssi wi s

Iv. d ata a n a ly S I S a n d I n o r M at I o n

S y S t e M Spage 41

v I . r e e r e n c e S page 44

a P P e n d I c e S

appix 1. m di-assi Ii

Miipage 46

appix 2. dmis page 48

appix 3. h-assi Iis d ci

tb - hspipage 50

appix 4. h-assi Iis d ci

tb - Miis page 52

appix 5. m Si d P ami

h oizipage 54

appix 6. eii as h-assiIis aibii Sspibii P

Miismspage 56

appix 7. Spim ci page 58

r s page 69

B i b i p page 71

7M ODUL E I6 Ep IDEM IOL OgIca L SUr v E IL L a n cE


5/37

mi, iss -ssi ii si

i ii isibii.

Wi si, p xps mm

i iis s m

ib -ssi iis; i

bis si s; sbis piiis si-

-ssi iis ps; -

mi w s b pi i

i w m; mp wi pi qims

sks i i s -ssi

ii i spi iss s. ni -

iis w s b spsib sizi s i-

is si ms, pmi ssssm

ii pi pis psss.

I ii, piip is ii

m s -ssi iis

psss i pi ;

isii bis si i wi i

bis; sbis piiis si i

sp pi b ii; mi w ms

b ; pp xisi i iis ms;

bks i pppi sps; p-

m pis pi -

ssi iis sps izi

wi ii; p issmi imi

-ssi iis s

sks iis.

ss ii. Si s ps bks

pimis, b s ms imp pi

mss.

m ss is, i b mi

w imiis i spis

ps i iiis, si m w s s

psi smp spi is i .

o , spis s i b

s Miis h si si ssm b

s i i pi pi pi i.

2/Core components of programs for the

prevention and control of healthcare-associated

infections*

I 2008, W h oizi mi

xps -ssi iis i

ii mps i

ii-bs pms pi

-ssi iis (2). T p

mps s pm : izi,

i iis, i m ss, si

-ssi iis, ssssm mpi wi

ii mmis, spp m mibibis, im, pm i,

bi wi pbi sis. wi

9M ODUL E I

* Any further mention of infection

in this document refers to

healthcare-associated infection (HAI).

8 Ep IDEM IOL OgIca L SUr v E IL L a n cE


6/37

I is mm , wi miis pppi

ri, iis ii ui Ss cs

diss c Pi (cdc)* b s, i

wi kw is s.

S xps i pi -

ssi iis i ri amis b

wi Paho i pm is pps i

is ppibii sss.

* Available at http://www.cdc.gov/ncidod/dhqp/pdf/ nnis/

NosInfDefinitions.pdf

Horan TC, Andrus M and Dudeck MA. CDC/NHSN surveillance

definition of health careassociated infection and criteria for

specific types of infections in the acute care setting. Am J Infect

Control 2008;36:309-32. Available at http://www.cdc.gov/

ncidod/dhqp/pdf/nnis/NosInfDefinitions.pdf

11M ODUL E I

Si s b ssmiz m i is

w wi pi iiis iis wi ms

bk i sps, s w s wi

m ss -ssi iis

iii impmi pi mss.

3/Burden of disease and proposal

I amis, b iss m -

ssi iis is kw. T ib m

sis spi siis i iiis , bs, i sm is. T ibii

i ri is mi. Sm is

si -ssi iis i

iiis, b i ; s m

iiis i ; s i

s si i iiis

i . as s is wi siis,

imp is i ri b q .

Bs is, wi im si pi

iiis i ms

ii bks s b iss

s b -ssi iis, si ssm

s iis ms is impmi pps. T ssm wi b xib

mi is piiis wi iis

ps mi, wi pi s iiis

isms i si iis.

Isms wi b ssmi i s

p -ssi iis, wi

im i pmp spi bks.



7/37

See mehy

Place:a imi p is si ssm

wi m m isi is.

Country capacity: I piip, is ms

pi z . t is , i is ssi

pssis w i

zi pi b spis, w mk i-

sis b pbms . cis

i w si ssm wi iis imi ss-

ms qs pi s i iis Paho.

Healthcare-associated infections: a -ssi i-

i is ii is ps ibi im

missi si, b wi is bs i

pis spi s pis im is.

Healthcare-associated infections in the intensive care unit

(ICU): a -ssi ii ws ps

ibi im missi Icu mi b s-

si wi pis s i Icu, mi b is m Icu.

Healthcare-associated infection in the ICU and associated

with an invasive procedure: a -ssi ii

ws ps ibi im missi

Icu mi b ssi wi pis s i

i wi isi ps i

pis s.

I I

13M ODUL E I


8/37

mii -ssi

iis:

1. riw s pis wi xps s i

iis.

2. I ii is ssp, s s i-

i ii ssi i s s, i pppi.

3. r ii imi m ss (m-

s): pmi, i ii, bsm

ii (s ii s).

4. pis wi m haI pimii

imi i sbis ms: pi i-

ii, m, spi iii, b, pim -

i iss (Icd-9 Icd-10) (pi), sx, ,

Icu missi, Icu is, s

is, xps mi -

ii, iwi i , s

. Kp imi sii.

t pssi i si s

im ss pm sks i ii.

t im si iiis qi ps

mb pis qi s kp

b ii spi, s w s q

si s i isi is. t is

is, pis i mis p pi. tis isi

is m . hw, xpi s sw

15 20 mis p ipi p wk, wi s

w wk s, m b qi. I ws, 10-

b Icu qi bw 150 200 i

mis p wk.

15M ODUL E I

Mibii s b z b i w

ii ws ii.

1/Minimum capacity of participating hospitals

Intensive care unit: I b i i pi

ssms, spi ms s isi

i. is pps, isi i is i s

spi i i wi bs s

ii i pis w qi spiiz mi

si 24 s , i ii spiiz i-

spp qipm (3). tis xs imi pis

(wi mi spi ssis).

Program for the prevention of healthcare-associated infec-

tions: hspis s s pm pi

-ssi iis is spsib

si pi, bis, sis, sii

bss pi spi iis. T

pm wi s b spsib si s i-

is. T spi pm s qi, i

s wi spsibiiis is, b

sfi m sks pmm i i wk ps (2).

Trained local staff: T spsibiiis s s mmbs

ss (ms) ii xpsppi (mis), kp s, si

z . I , s i s i

b si ps i ii ,

iiis mii wi pi m

piip pi izi ii

spi si ssm. t wi is

m i is spsibiiis s i



9/37

devIce-aSSocIated InectIon MonItorInghealthcare-

aSSo cIated Inec tIon SurveIl lance .

Denominator: t ii pi

pssi wi i- i mb

pi wi mi ii, iwi i

, s Icu , on the orM In

aPPen dIX 1 an d tItl ed, d enoMInatorS

Devices inserted outside the unit under surveillance:

Iis p wii 48 s pis i

is is si isi

i wi not b i m.

rspi iws s b s w pis

b is b ss imi

b bi. us m (appix 1)

.

Frequency of sur veillance: I is mm s-

i b i i isi i s s wi

wk. d s b si m spi-

s s, w Miis h wi

is sis. t Miis h s s

spis pii s i siz w -

i imb.

17M ODUL E I

2/Device-associated hospital infection

Methodology: Si i-ssi iis

i isi is s b i, si, pspi,

pi-bs.

Case-finding: a pp i i i pi

pssi wi ii pis ssp

i i-ssi ii

spi mi .

Numerator: t ii pi ps-

si wi i iis i i pis s

si i ss, ii: mp s, i-

bii s, s pm, psii isis,

sspii i iiis.

Mii haI is qi

pi is is m Icu.

Case confirmation: I pis ssp i

i-ssi ii, ii pi

pssi wi im ii bs

s iii ii si: s m b,

pm, pi missi, is, s,

i (imi); pi m bss

pi s, ii iiws, psi xm s,

s k b psiis ss (4). lbsi s b s i isi, ss

pssib ii isi ii mi

b b i .

t i ii s b mp

im ss (ms) pmi, i

ii, bsm ii (s ii

s) m i appix 1 i, orM or



10/37

ies Sbje See

1/Pneumona (PNEU)

Pmi is is mbii ii,

ii, b ii. t wi pps

sib is ssssm ii m b s

mi si ii smi pmi.

ss i-ssi pmi, pi s

b ib i im s smpms,

b i p 48 s pi s ii.

NOTE: Thereisnominimumlengthoftimethemechanicalventilator

hastobeinplaceforthepneumoniatobeassociatedwithmechanical

ventilation.Casesofinfectionshouldbeanalyzedonacasebycase

basis.Mechanicalventilationcanbeassociatedwithinfectionevenifit

wasinplaceover48 hours beforetheonsetofinfection.

Setting: Pmi si wi b i Icu.

Mii ii-ssi pmi is

qi pi is is m Icu.

Requirements: Si i-ssi pmi

s b i s Icu i ii.

I, mii s b -. hw,

i si is s i spi pis,

mii s k p i s m.

I I I

19M ODUL E I


11/37

Criteria for dening nosocomial pneumonia

Generalcomments

1. Physiciansdiagnosisofpneumoniaaloneis notanacceptable

criterionfornosocomialpneumonia.

2. Althoughtherearespeciccriteriaforinfantsandchildren,pe-

diatricpatientsareincludedandmaymeetanyoftheotherpneu -

monia-speciccriteria.

3. Ventilator-associatedpneumoniashouldbesodesignatedwhen

reportingdata.

4. Whenassessingapatientforthepresenceofpneumonia,itis

importanttodistinguishbetweenchangesinclinicalstatusdue

tootherconditions,suchasmyocardialinfarction,pulmonary

embolism,respiratorydistresssyndrome,atelectasis,malignan-

cy,chronicobstructivepulmonarydisease,hyalinemembrane

disease,bronchopulmonarydysplasia,etc.Also,caremustbe

takenwhenassessingintubatedpatientstodistinguishbetween

trachealcolonization,upperrespiratorytractinfections(e.g.tra-

cheobronchitis),andearly-onsetpneumonia.Finally,itshouldbe

recognizedthatitmaybedifculttodeterminenosocomialpneu -

monia inthe elderly,infants,and immunosuppressedpatients

since suchconditionsmaymasktypicalsignsandsymptoms

associatedwithpneumonia.

5. Nosocomialpneumoniacanbecharacterizedbyitsonset:early

orlate.Earlyonsetpneumoniaoccursduringtherstfourdaysof

hospitalization,andisoftencausedbystrainsofMoraxella cata-

rrhalis, Haemophilus infuenzae,and Streptococcus pneumoniae.

Causativeagentsoflate-onsetpneumoniaarefrequentlygram-

negativebacilliorStaphylococcusaureus,includingmethicillin-

resistantS.aureus.Viruses(e.g.InuenzaAandBorRespiratory

21M ODUL E I

Deniciones

Mechanical ventilator: a i s ssis spi-

i is, isi wi pi,

sm b s ibi.

NOTE: Lungexpansiondevicessuchasintermittentpositive-pressure

breathing(IPPB);nasalpositiveend-expiratorypressure(PEEP);and

continuousnasalpositiveairwaypressure(CPAP)arenot considered

mechanical venti lators unless delivered via tracheostomy or

endotrachealintubation(e.g.ET-CPAP).

css s pis w isi i

ssis spii is sm

isi ibi ( s b)

w -isi i (wi s, s

m, - msk). Pmi i pis w s

-isi ii is si i-ssi

is si p m mi.



12/37

Pneumoniacasedenitionforsurv

eillance

Criterion1:

a)Radiologicaldata:Twoormoreserialchestx-rayswithatleastoneofthefollowing(1

,2):

-

Neworprogressiveandpersistentinltrate

-

Consolidation

-

Cavitation,and

(NOTE:

Inpa

tien

tswithoutun

derly

ingp

ulmonaryorcard

iac

disease

(e.g.

resp

ira

tory

distres

ssyn

drome

,bronc

hopu

lmonary

dysp

la-

sia

,pu

lmonarye

dema

,orc

hron

ico

bs

truc

tivepu

lmonary

disease

),one

de

fin

itivec

hestx

-ray

isaccep

table[1].)

b)Atleastoneofthefollowingsignsorsymptoms:

-

Fever(>38C)withnootherreco

gnizedknowncause

-

eukopenia(12

,000WBC/mm3)

-

Foradults>70yearsold

,altered

mentalstatuswithnootherrecognizedcause,and

c)Atleasttwoofthefollowing:

-

Newonsetofpurulentsputum(3),orchangeincharacterofsputum(4),orincreasedrespiratorysecretions,

orincreasedsuc-

tioningrequirements

-

Newonsetorworseningcough,ordyspnea,

ortachypnea(5)

-

Rales(6)orbronchialbreathsounds

-

Worseninggasexchange[e

.g.O

2

desaturations(e

.g.

PaO

2/FiO

2

38C)withnootherknow

ncause

-

Leukopenia(12

,000WBC/mm3)

-

Foradults>70yearsold

,alteredmentalstatuswithnootherrecognizedcause,and

c)

Atleastoneofthefollowing:

-

new

onsetofpurulentsputum(3)

,orchangeincharacterofsputum(4),orincreasedrespiratorysecretions,

orincreasedsuc-

tioningrequirements

-

Newonsetorworseningcough,o

rdyspnea,

ortachypnea(5)

-

Rales(6)orbronchialbreathsoun

ds

-

Worseninggasexchange[e

.g.O2

desaturations(e

.g.

PaO

2/FiO

2

25breathsperminute.Tachypneaisdenedas>75breathsperminuteinprema -tureinfantsbornat60breaths/minuteinpatients50breaths/minuteinpatients2-12monthsold;and>30breaths/minuteinchildren>1yearold.

6. Ralesmaybedescribedascrackles.



15/37

Data analysis: T i-ssi pmi

p 1,000 mi i-s is b iii

mb ss i ssi pmi b

mb mi i-s mipi -

s b 1,000. Ts is pm sp

Icu.

2/Urinary Tract Infection (UTI)

ui iis is mbii

ii b ii. utIs wi b

pis wi iwi i

ii is s; i ws, pi

i is im , wii s s

b, s ii.

NOTE:Thereisnoaminimumlengthoftimethatthecatheterhasto

beinplaceforaUTItobeconsideredcatheter-associated.

ppss spi ii si ssms,

s iis i iis ii i

smpmi smpmi iis. I is pps,

smpmi i iis wi b

mpi.

Setting: Si wi k p i isi is.

Mii pis wi i is m Icu is qi.

Requirements: Si i ii is

pm i s Icu i ii

s m. I, mii s b

-. hw, i si is s

i spi pis, mii s k

p i s m.

29M ODUL E I

Collection of culture specimens* used in the diagnosis

of pneumonia, and threshold values

Specimen type Value

Lungparenchyma(openlungbiopsyspecimens

andimmediatepost-mortemspecimensobtained

bytransthoracicortransbronchialbiopsy)

104 CFU/g

tissue

Endotrachealaspirate 105o106CFU

Bronchoscopically(B)obtainedspecimens

- Bronchoa lve olar lav age (B-BAL) 104UFC/ml

-Protectedbronchoalveolarlavage(BP-BAL) 104UFC/ml

-Protectedspecimenbrushing(B-PSB) 103UFC/ml

Non-bronchoscopically(NB)obtained(blind)specimens

-NB-BALorMINIBAL 104UFC/ml

-NB-PSB 103UFC/ml

*Forspecimencollectiontechniques,seeAppendix7.

Numerator data: T m i i appix 1 is s

p s i-ssi p-

mi is ii i m s si-

. T m is pi mpi imi

imi i s mi ii. ai-

i i w pi i, w mi-

isms w is m s i imibisspibiiis. (S Si II si m.)

Denominator data: t mb pis m wi

ii i is appix 2. T p-

i is bi i. T sm s i s is

p m. t mpi sp

isi i ii. (S Si II si

m.)



16/37

UrinaryTractInfectionCaseDenition

Asymptomaticurinarytractinfectionmustmeetatleastoneofthefollowingcriteria:

Criterion1:

a)Clinicaldata:atleastoneofthefollowingsignsorsymptomswithnootherrecognizedcau

se:

-

fever(>38C)

-

urgency(urinary)

-

increasedurinaryfrequency

-

dysuriaorsuprapubictenderness

,and

b)Thefollowinglaboratorycriterion:

-

positiveurineculture(i

.e.

>105

microorganisms/cm3

ofurinewithnomorethantwosp

eciesofmicroorganisms).

31M ODUL E I

Denitions

Indwelling urinary catheter (IUC): a i b

is is i i b , is

i p, is s i ssm;

s . ds i si i-

- s.

Closed urine collection system: a s ssm

s w p isi (b-b)

m w bi. Ssms mi i

i m spim i.



17/37

Numerator data: T m i i appix 1 is s

imi p i ii

is ii i m s si.

t utI m is pi mpi imi

imi w i ws

ps. aii i w pi i,

w mii sms w is m s i

imibi sspibiiis. (S Si II si

m.)

Denominator data: T mb pis m wi

iwi i is appix 2. T

pi is bi i. T sm s i s

is p m. T mpi sp

isi i ii. (S Si II si

m.)

Data analysis: t i ii p 1,000

-s is b iii mb iis

b mb -s mipi s

b 1,000. tis i is pm sp

isi i.

3/Bloodstream Infection (BSI)

Bsm iis ssii i ii- b ii, i s b-im

bmi (Bac) ii spsis (cSeP). a bsm

ii is si i pim s p-

i w i is s b ii si.

si, b-im, pim, i-

s -ssi bmi wi b .

33M ODUL E I

Criterion2:

a)Atleasttwoofthefollowingsignsorsymptomswithnootherrecognized

cause:

-

ever(>38C),

-

urgency(urinary)

-

increasedurinary

frequency

-

dysuriaorsuprap

ubictenderness,and

b)Atleastoneofthefollowing:

-

positivedipstickforleukocyteesteraseornitrate

-

pyuria(urinespec

imenwith>10leukocytes/mm3

or>3leukocytes/hig

h-powereldofunspunurine)

-

organismsseeno

nGramstainofunspunurine

-

105

colonies/mlo

fasingleuropathogen(Gram-negativebacteriaorS.

saprophyticus)

inapatientbeingtreated

withaneffectivea

ntimicrobialagentforaurinarytractinfection

-

physiciandiagnos

isofaurinarytractinfection

-

physicianinstitute

streatmentforaurinarytractinfection

NOTE:

Apos

itivecu

ltureo

faurin

aryca

the

ter

tip

isno

tanaccep

tablelabora

tory

testto

diagnoseaurinary

trac

tinfec

tion

.Urine

cu

lturesmus

tbeo

btained

us

ingappropria

tetec

hn

ique

,suc

hasc

lean-c

atchcolle

ctionorca

the

teriza

tion

.(See

Appen

dix7).



18/37

mm m is.

Temporary central line : a - .

Permanent central line: Is s,

ii isis s, imp s,

ii p--.

NOTES:

1. Anintroducerisnotconsideredanintravascularcatheter.

2. Neitherthelocationoftheinsertionsitenorthetypeofdevicemay

beusedtodetermineifalinequaliesasacentralline.Thedevice

mustterminateinoneofthegreatvesselsorinorneartheheartto

qualifyasacentralline.

3. Pacemakerwiresandothernonlumeneddevicesinsertedintocen-

tral bloodvesselsor theheart are notconsideredcentrallines,

becauseuidsarenotinfused,pushed,orwithdrawnthroughsuch

devices.

Infusion:T ii si b ss

i m. tis m i i p pbsis , s

i s ii is miis,

imi isis s s ss is

imibi miisi, b, i s

ssi misis.

35M ODUL E I

Setting: Si wi i isi is.

Mii bsm iis pi is

is m Icu is qi.

Requirements: Si bsm ii i

s Icu i isii s

m. I, mii s b

-. hw, i si is s

i spii pis, mii s k

p i s m. o bsm

iis ssi p.

Denitions

Primary BSI: BSI ii

si.

Central line-associated BSI: Pim BSI i pi wi

i i p im i

m 48 s b s ii.

NOTE:Thereisnorequiredminimumlengthoftimethecentrallinemust

beinplacefortheinfectiontobeconsideredcentralline-associated.

Central line (CVC): a is mi-

s s i sss

is s isi, wiw b, m-

mi mii. t wi si

ss s pps pi - i ii s

i -i s: , pm , s-

pi , ii , bipi is,

i is, sbi is, x i is,



19/37

Numerator data: T m i i appix 1 is

pi mpi imi imi

i. T m is s s w pi

i, w miisms w is m b s

i imibi sspibiiis. (S Si II

si m.)

Denominator data: dmi si

m i i appix 2. Si pi m

m bi, wi b

b is i pis i s i Icu. (S

Si II si m.)

I pi s m mp i

i , is is s -i .

I pi s b mp pm

i sm , is is s mp-

-i .

I pi s pm i, i i i

i pm -i , bii

s ss ii i s.

Data analysis: t bsm ii p

1,000 -i s is b iii mb

BSIs b mb - s mipi b

1,000. Ts is pm sp

isi i.

37M ODUL E I

Bacterrmia*DenitionCriteria

Laboratory-conrmedbacteremiamustm

eetatleastoneofthefollowingcriteria:

Criterion1:

a)Apathogenwasidentiedinoneorm

orebloodculturesofthepatient,exceptforcommonskin

contaminantmicroorga-

nisms(seeCriterion2below),and

b)Themicroorganismculturedfromthe

bloodisnotrelatedtoinfectionsatothersites.

Criterion2:

a)Clinicaldata:patienthasatleastone

ofthefollowingsignsorsymptomswithnootherrec

ognized

cause:

-fever(>38C)

-chills

-hypotension,and

b)Positivelaboratoryresultsarenotrelatedtoaninfectionatanothersite,and

c)Thefollowinglaboratorycriterion:c

ommonskincontaminant(e

.g.

diphtheroids[Coryne

bacteriumspp.],

Bacillus

[notB

.

anthracis]spp.,

Propionibacterium

spp.,

coagulase-negativestaphylococci[including

S.

epidermidis],viridansgroup

Streptococci,Aerococcusspp.,M

icrococcusspp.)

culturedfromtwoormoreblood

samplesdrawnonseparateoc-

casions.

(SeeAppendix7forspec

imencollectiontechnique.)



20/37

is

Indicators for Calculating ICU Healthcare

Associated Infection Rates

Infection and

Indicator

Description Calculation

Ventilator-associatedpneumonia

Incidenceofven-tilator-associated

pneumonia

Numberofcasesofpneumoniainpa-

tientswithmechani-

calventilation/

Numberofmecha-

nicalventilator-days

x1000

Indwellingurinary

catheterassociated

urinarytractinfection

Incidenceofindwe-

llingurinarycatheter-

associatedurinary

tractinfections

Numberofurinary

tractinfectionsinpa-

tientswithindwelling

urinarycatheters/

NumberofIUC-days

x1000

Centralvenous

catheter-associated

bloodstreaminfection

Incidenceofcentral

venouscatheter-

associatedbloods-

treaminfection

Numberofbloods-

treaminfectionsin

patientswithcentral

venouscatheter/

Numberofcentralvenouscatheter

-daysx1000

I v

39M ODUL E I


21/37

d ayss i Syses

Infections subject to surveillance:

1. Mi i-ssi pmi

2. Iwi i -ssi smpmi i ii

3. c s -ssi, b-m

bsm ii.

Data: d wi b m isi is i

pis s; iis i p is is

m Icu wi b , i

pis s i isi i. Mibi

mpi sp isi i ii.

Numerator: nms wi b i isi

i s wi p wk i si

spsibii ii pi m.

T wi imi s b m

ss (ms): pmi ( ii ),

i ii ( ii ), bsm

ii ( ii ). Ts wi b

m i appix 1.

Denominator: dmi b s i

s wi b: mi ii s; iwi i

v

41M ODUL E I


22/37

T i wi i spis iii

mpi :

Ii si iwi i -ssi

i iis

Ii si s -ssi

bsm iis

Ii si mi ii-ssi

pmis

Wi is imi, i

10, 25, 50, 75, 90 pis s

ii si appix 4. I is mm

is sis b m i ii p.

Pan American Health Organization: Paho qss

i i s m

i i appix 5 (m Sbmissi d P

ami h oizi). t wi ,

iis s pi spi ii iis

bi s i mpi imi

qs i appix 4.

43M ODUL E I

s; s s; pi

s p m p isi i.

Information system: T imi ssm s

s: s, , ii; s,

i i; i, P ami h

oizi.

Hospital: T spi is spsib mpii

(ms mis), is sis, -

i iis. asis s b b si-

i isi i, pb m. T

spi s s mi ii-ssi pmi, iwi i -ssi

i ii, s -ssi

bsm ii i m

bsis. T spi wi m i appix 1.

t pi s b mi i p m

isi i. d m m wi b i

mp pm p ss ps (appix 3).

t spi wi s m tb Sbmissi

d h aiis (appix 3) i,

pb m.

Health authority:T i wi i

imi m spi, m i appix 3. T

imi wi b sm m

isi is i spi wii i im pi.

t i s mi q wi

wi s b s m spi. W mm,

mximm, q ps.



23/37

Appendices

reeees

1. GrupoPanamericanodeEvaluacindelaInfeccinHospitalaria.Evaluacindelainfeccinhospitalariaensietepaseslatinoame -ricanos.RevPanamInfectol2008;10(4Supl1):S112-122.

2. FernandoOtaza,CarmemPessoa-SilvaEd.CorecomponentsforinfectionpreventionandcontrolprogrammesInfectionPre -ventionandControlinHealthcareInformalNetworkReportoftheSecondMeeting,2627June2008,Geneva,Switzerland.World

HealthOrganization2009.

3. Preparacindelosestablecimientosdesaludantecasoinusita-dooimprevistooconglomeradodeinfeccinrespiratoriaagudagraveIRAG.VersinABRIL/2009.OrganizacinPanamericanadelaSalud.

4. BRASIL.MinistriodaSade.Padronizaoda NomenclaturanoCensoHospitalar.PortariaN312demaiode2002.

5. Horan,Andrus,andDudeck.CDC/NHSNSurveillanceDenitionofHealthcare-AssociatedInfectionandCriteriaforSpecicTy -pesofInfectionsintheAcuteCareSetting.AmJInfectControl2008,36:309-32.

6. Manualdeorientaesecritriosdiagnsticossistemadevigi-lnciaepidemiolgicadasinfeceshospitalaresdoestadodeSoPaulo.Maro2009.SecretariadeestadodasadedeSoPaulo.CoordenadoriadeControledeDoenasCCD.Centrodevigilnciaepidemiolgicaprof.AlexandreVranjac.Diviso

deInfecoHospitalar.7. Guadeevaluacinrpidadeprogramasdeinfeccionesintrahos-

pitalarias.Washington,D.C.Juliode2005.readeprevencinycontroldeenfermedadesunidaddeenfermedadestransmisi -bles.OrganizacinPanamericanadelaSalud.

8. Zuritaycolaboradores.GuiadeTomadeMuestrasparaMicro-biologia.Zuritaandcols.OPS2010.Inpress.

v I



24/37

Urinarytractinection(UTI)

Indwe

llingurinaryca

the

ter

YES(1)/NO(0)

Indwe

llingurinaryc

athe

ter

YES(1)/NO(0)

Da

teo

fIUCs

tart:

(dd/mm

/aaa

a)

Da

teo

fIUCs

tart:(

dd/mm

/aaaa

)

Da

teo

fIUCen

ds:

(dd/mm

/aaa

a)

Da

teo

fIUCen

ds:(

dd/mm

/aaaa

)

IUCdays:

IUCdays:

Syn

toma

tic

Urinary

trac

tinfection

?

YES(1)/NO(0)

Syn

toma

tic

Urinary

trac

tinfec

tion

?

YES(1)/NO(0)

UTIda

te:

UTIda

te:

Etio

log

ica

lagen

t:

Etio

log

ica

lagen

t:

Bloodstreaminection(BSI)

Cen

tra

lvenousca

the

ter

YES(1

)/NO(0)

Cen

tra

lvenouscat

he

ter

YES(1)/NO(0)

Da

teo

fCVCs

tart:

(dd/mm

/aaaa

)

Da

teo

fCVCs

tart:

(dd/mm

/aaaa

)

Da

teo

fCVCen

ds:

(dd/mm

/aaaa

)

Da

teo

fCVCen

ds:

(dd/mm

/aaaa

)

CVCdays:

CVCdays:

Bloo

ds

tream

infec

tion

?YES(1

)/NO(0)

Bloo

ds

tream

infect

ion

?YES(1)/NO(0)

BSIda

te:

BSIda

te:

Etio

log

ica

lagen

t:

Etio

log

ica

lagen

t:

47M ODUL E I

Appen

dix1

.FormorDevice-AssociatedInection

Monitoring

NumeratorandDenominato

rCollectionForm

Infec

tion

1:

Incom

ing

ICUdate:

Patientidentication:

Disc

harge

ICUdate

:

Name:

Gen

der:

(F)o

(M)

Pa

tien

tiden

tica

tion:

Disc

hargemo

tive:

disc

hargeo

fhosp

ita

l(0),

trans

fer

toano

ther

hosp

ita

l(1)

,disc

hargeo

f

ICU(2),dea

th(3).

Age:

Incom

ing

disease:

Be

dnum

ber:

Pneumonia(PNEU)

Mec

han

ica

lVen

tilation

YES(1)/NO(0)

Mec

han

ica

lVen

tilation

YES(1)/NO(0)

Da

teo

fMVs

tart:

(dd/mm

/aaaa

)

Da

teo

fMVen

ds:

(dd/mm

/aaaa

)

Da

teo

fMVen

ds:

(dd/mm

/aaa

a)

Da

teo

fMVen

ds:

(dd/mm

/aaaa

)

MVdays:

MVdays:

Pneumon

ia?YES(1)/NO(0)

Pneumon

ia?YES(1)/NO(0)

Pneumon

iada

te:

Pneumon

iada

te:

Etio

log

ica

lagen

t:

Etio

log

ica

lagen

t:



25/37

Mon

th/Day

#pa

tien

tew

/CVC

#pa

tien

tew

/IUC

#patie

ntew

/MV

#Pa

tien

t

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

Total

49M ODUL E I

Appen

dix2

.Denominators

Hospital

ICU

Mon

th/Day

#pa

tien

tew

/CVC

#pa

tien

tew

/IUC

#patie

ntew

/MV

#Pa

tien

t

1 2 3 4 5 6 7 8 9 10

11

12

13

14



26/37

Incidence

PNEU/MV

BAC/CVC

UTI/IUC

%U

SEM

V

%U

SECVC

%U

SEIUC

TotalHospital

51M ODUL E I

Appen

dix3

.Healthcare-AssociatedInectionsDataCollectionTable-Hospital

Year

Intensive

careunit

Numberof

mechanical

ventilation

associated

pneumonia

Numberof

indwellinguri-

narycatheter

associated

urinarytract

Numberof

centralvenous

catheter

associated

bloodstream

infection

Ventilation-

days

CV

C-days

IUC-days

Total

patient-days

Total



27/37

Incidence

PNEU/MV

BAC/CVC

UTI/IUC

%U

SEM

V

%U

SECVC

%U

SEIUC

TotalCountry

53M ODUL E I

Appen

dix4

.Healthcare-AssociatedInectionsDataCollection

Table-MinistryoHealth

Year/Month

Hospitalname

Numberof

mechanical

ventilation

associated

pneumonia

Numberof

indwellinguri-

narycatheter

associated

urinarytract

infections

Numberof

centralvenous

catheter

associated

bloodstream

infection

ventilation-

days

CV

C-days

IUC-days

Total

patient-days

TotalCountry



28/37

Healthcare-associatedinec

tionsinICU

Year

IncidenceDensity(per1000

devicedays).Percentil

Inections

under

surveillance

10

25

50

75

90

Mechanical

ventilation-

associated

pneumonia

Indwellinguri-

narycatheter-

associated

urinarytract

infection

Centralve-

nouscatheter-

associated

bloodstream

infection

55M ODUL E I

Appen

dix5

.FormorSendingDatatothePanAmericanHealthOrganization

AnnualCountryReport

Country:

Totalpopulation:

Year:

Totalnum

bero

fhosp

ita

lsrepo

rting:

Num

bero

fICUs:

Adm

inistra

tiveca

tegory:

Num

bero

fpu

blichosp

ita

ls:

Num

bero

fpriva

tehosp

ita

ls:

Num

bero

fun

ivers

ity

hosp

itals

:

Num

bero

fo

ther:

Totalnum

bero

fbe

ds:

La

bora

tory:

Numberofintensivecareunit(ICU)beds:

Numberofisolates/year:

NumberICU/adults:

Numberofantibio

grams/year:

NumberICU/pediatrics:

NumberICU/neonatology:



29/37

40

Klebsie

llapneumon

iaeresistanttothird

generation

cephalosporins

54

Pseu

domo

nasspmipenem-resistant

64

Stap

hyloco

ccusaureusoxacillin-resistant

65/66

S.

ep

iderm

idisandotheroxacillin-resistant

coagulase-negativestaphylococcus

57M ODUL E I

Appen

dix6

.EtiologicAgentsoHealth-AssociatedInectionsandAntibioticS

usceptibilityProfleoMicroorganisms

Microorganism

Code

Microorga

nismand

resistance

profle

Numberoisolates

Pneumonia

Bacteremia

Urinarytract

inection

1

Ac

ine

tobac

ter

bauman

iiimipenem-resistant

10

Can

didaa

lbicans

11

Can

didanonalbicans

12

Can

didasp(llonlywhennospeciesis

identiedb

ythelaboratory)

32

Esc

herichiaco

liresistanttothirdgeneration

cephalosporins

31

En

terococcussprvancomycin-resistant



30/37


31/37


32/37


33/37


34/37


35/37

reeees

1. ChastreJ,FagonJY,Bornet-LescoMetal.Evaluationofbron-choscopictechniquesforthediagnosisofnosocomialpneumo-nia.AmJRespirCritCareMed1995;152:231-240.

2. TorresA,El-EbiaryM.Diagnosticapproachesandhospital-ac-quiredpneumonia.SemRespirCritCareMed1997;18:149-161.

3. WimberlyN.FalingLJ,BartlettJG.Aberopticbronchoscopy

techniquetoobtainuncontaminatedlowerairwaysecretionsforbacterialculture.AmRevRespirDis.1979;119:337-342.

4. BroaddusC,DakeMD,StulburgMS,etal.Bronchoalveolarla-vageandthransbronchialbiopsyforthediagnosisofpulmonaryinfectionsintheacquiredimmunodeciencysyndrome.AmIn -ternMed.1986;102:742-752.

5. RoubyJJ,RossignonM D,NicolsMHetal.Aprospectivestudyofprotectedbroncho-alveolarlavageinthediagnosisofnosocomialpneumonia.Anesthesiology1989;71:679-685.

6. ChastreJ,ViauF,BrunP,etal.Prospectiveevaluationofthepro-tectedspecimenbrushforthediagnosisofpulmonaryinfectionsinventilatedpatients.AmRevRespirDis1984;130:924929.

7. WilmberlyNW,BassJB,BoydBW,etal.Useofbronchoscopicprotectedcatheterbrushforthediagnosisofpulmonaryinfec -tions.Chest.1982;81:556-582

8. ReimerLG,CarrollKC:Roleofthemicrobiologylaboratoryin

thediagnosisoflowerrespiratorytractinfections.ClinInfectDis1998;26:742748.

9. Madeo M, Barlow G. Reducing blood-culture contaminationratesby theuse ofa 2%chlorhexidinesolution applicatorinacuteadmissionunits.JHospInfect2008;69:307309.

10. ClarridgeJE,PezzloMT,VostiKL.Laboratorydiagnosisofurinarytractinfections.InWeissfeldAS,coordinatingeditor.1987Cumi -tech2A.AmericanSocietyforMicrobiology,Washington,D.C.

69M ODUL E I

Appen

dix7

.SpecimenCollection

(Con

tinu

ed)

Thequantityofbloodiscurrentlyregardedasoneofthemostcriticalvariablesinthein

creaseinpositivityofbloodcultures(13

,14

,

15).Becausethemajorityofb

acteremiasareoflowmagnitude(

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