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Transcript of Epidemiological Surveillance of Healthacare
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7/29/2019 Epidemiological Surveillance of Healthacare
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ND
IN
ALUT
SO
R
O
P
S
AHO
ND
IN
P
E
OVI MU
P
EpidEmiologicalSurvEillancE
of HEaltHcarE-aSSociatEdinfEctionS
Module I
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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.
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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
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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
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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
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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.
10 Ep IDEM IOL OgIca L SUr v E IL L a n cE
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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
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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
14 Ep IDEM IOL OgIca L SUr v E IL L a n cE
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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
16 Ep IDEM IOL OgIca L SUr v E IL L a n cE
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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
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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.
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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.
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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.)
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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.
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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).
32 Ep IDEM IOL OgIca L SUr v E IL L a n cE
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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,
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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.)
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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
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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
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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.
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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
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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:
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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
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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
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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
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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:
54 Ep IDEM IOL OgIca L SUr v E IL L a n cE
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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
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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(