1

INFECTION CONTROL AND SURVEILLANCE“An ounce of prevention is worth a pound of

cure.”

Learning Objectives

1. Define infection and nosocomial infection.

2. States the meaning of infection control.

3. Explain the organization of infection control program.

4. Discuss the major components of an infection control program.

5. Describe a surveillance of HAIs.

INTRODUCTION – INFECTION AND NOSOCOMIAL INFECTION

Infection is an invasion of pathogens or microorganisms into the body those are capable

of producing disease.

Nosocomial infection - also called “Hospital acquired infections” or “Healthcare

Associated Infection (HAI)”

An infection acquired in hospital by a patient or staff member while in a hospital or health

care facility

It includes infections -

not present nor incubating at admission,

infections that appear more than 48 hours after admission,

those acquired in the hospital but appear after discharge

also occupational infections among staff.

INFECTION CONTROL

“The process by which health care facilities develop and implement specific policies and

procedures to prevent the spread of infections among health care staff and patients.”

Infection Control includes all of the practices used to prevent the spread of

microorganisms that could cause disease in a person.

Prevention of nosocomial infection is the responsibility of all individuals and services

provided by healthcare setting.

2

Why Infection Control?

Hospital acquired infections are a common problem—prevalence about 5-10% in

developed countries and about 25% in developing countries.

Hospital acquired infections contribute to AMR (antimicrobial resistance)

Overuse of antimicrobials (development)

Poor infection control practices (spread)

Hospital-acquired infections increase the cost of health care

World Bank studies have shown that two-thirds of developing countries spend

more than 50% of their health care budgets on hospitals

Effective Infection Control programs are beneficial

They decrease spread of nosocomial infections, morbidity, mortality, and health

care costs.

INFECTION CONTROL PROGRAM

It is a comprehensive, effective and supported program is essential for reducing infection

risk and increasing hospital safety.

At national level – the programme is developed by Ministry of Health, to support

hospital programs. It sets national objectives, develops and updates guidelines

recommended for health care.

In hospital infection control programme – The major preventive effort should be

focused in hospitals and other health care facilities.

Risk prevention for patients and staff is a concern of everyone in the facility.

It must be supported by senior management and provided with sufficient

resources.

It is develop and manage by the infection control committee, infection control

team and infection control manual as per the national guidelines, recommendation.

It must develop a yearly work plan to assess and promote all good health care

activities.

It includes the preventive activities, staff training and surveillance.

ORGANIZATION OF AN INFECTION CONTROL PROGRAMME

As with all other functions of a health care facility, the ultimate responsibility for

prevention and control of infection rests with the health administrator.

The hospital administrator/head of hospital should:

3

Establish an infection control committee which will in turn appoint an infection

control team; and

provide adequate resources for effective functioning of the infection control

programme.

INFECTION CONTROL COMMITTEE

An infection control committee provides a forum for multidisciplinary input and

cooperation, and information sharing and responsible for the development of policies for

the prevention and control of infection and to oversee the implementation of the infection

control programme.

This committee should -

be composed of representatives of various units within the hospital that have roles

to play: e.g. management, physicians, other health care workers, clinical

microbiology, pharmacy, sterilizing service, maintenance, housekeeping and

training services.

elect one member of the committee as the chairperson (who should have direct

access to the head of the hospital administration);

appoint an infection control practitioner (health care worker trained in the

principles and practices of infection control, e.g. a physician, microbiologist or

registered nurse) as secretary.

meet regularly (ideally monthly but not less than three times a year).

develop its own infection control manual/s; and

monitor and evaluate the performance of the infection control programme.

It has the following tasks:

To review and approve a yearly programme of activity for surveillance and

prevention;

to review epidemiological surveillance data and identify areas for intervention;

to assess and promote improved practice at all levels of the health facility;

to ensure appropriate staff training in infection control and safety management,

provision of safety materials such as personal protective equipment and products;

and

Training of health workers.

INFECTION CONTROL TEAM

4

Health care establishments must have access to specialists in infection control,

epidemiology, and infectious disease, including physicians and infection control

practitioners.

These professionals are specialized teams working for a hospital or a group of health care

establishments; they may be administratively part of another unit (e.g. a microbiology

laboratory, medical or nursing administration, public health services).

The infection control team or individual is responsible for the day-to-day functions of

infection control, as well as preparing the yearly work plan for review by the infection

control committee and administration.

The infection control team should:

Consist of at least an infection control practitioner who should be trained for the

purpose;

carry out the surveillance programme;

develop and disseminate infection control policies;

monitor and manage critical incidents;

Coordinate and conduct training activities.

INFECTION CONTROL MANUAL

A hospital-associated infection prevention manual containing instructions and practices

for patient care is an important tool.

The manual should be developed and updated by the infection control team and reviewed

and approved by the committee.

It must be made readily available for health care workers, and updated in a timely

fashion.

COMPONENTS OF INFECTION CONTROL PROGRAMME

Infection Control Programme

Preventive activities Staff training Surveillance

5

PREVENTIVE ACTIVITY

Basic measures for Infection Control Practices

Standard precautions

Hand hygiene

Using personal protective equipment

Safe handling and disposal of sharps

Safe handling and disposal of chemical waste

Managing blood and bodily fluids

Spillages

Collecting, handling and labelling of specimens

Decontaminating equipment

Cleaning

Disinfection

Sterilisation

Achieving and maintaining a clean clinical environment

Additional (Transmission-Based) Precautions

Airborne precautions;

Droplet precautions; and

Contact precautions.

Appropriate use of indwelling devices

Managing accidental exposure to blood-bornes (PEP-Post exposure prophylaxis)

Staff health and immunization

EDUCATION AND TRAINING OF HEALTH CARE STAFF

Health administrators should be oriented towards the importance of the infection control

programme.

Health care workers should be equipped with requisite knowledge, skills and attitudes for

good infection control practices.

The infection control team should:

Assess training needs of the staff and provide required training through awareness

programmes, in-service education and on-the-job training;

organize regular training programmes for the staff for essential infection control

practices that are appropriate to their job description;

6

provide periodic re-training or orientation of staff; and review the impact of

training.

SURVEILLANCE

Surveillance is an essential component of an effective infection prevention and control

program.

“Ongoing collection, collation, and analysis of data and the ongoing dissemination of

information to those who need to know so that action can be taken.”

“Ongoing, systematic collection, analysis and interpretation of health data essential to

planning, implementation and evaluation of public health services; closely integrated with

timely dissemination of the data to those who need to know about it”.

NEED FOR SURVEILLANCE

It require for improvements in health care with increased quality and safety but changes

in care with new techniques, New pathogens or changes in resistance, increased patient

acuity, ageing population, etc. so, need for active surveillance to monitor changing

infectious risks and identify needs for changes in control measures.

GOAL

Surveillance, as part of infection prevention and control programs in health care facilities,

contributes to meeting the program’s overall goals: protect the patient; protect the health

care worker, visitors, and others in the health care environment; and accomplish these two

goals in a timely, efficient, and cost-effective manner.

PURPOSE OF SURVEILLANCE

Reducing infection rate within hospital

Establishing endemic baseline rates

Identifying outbreaks

Convincing medical staff

Evaluating control measures

Convincing Planners, Media & People

Defending Hospital procedures- legal aspects

Comparing rates between hospitals

OBJECTIVES

The ultimate aim is the reduction of nosocomial infections, and their costs.

The specific objectives of a surveillance programme include:

7

to improve awareness of clinical staff and other hospital workers (including

administrators) about nosocomial infections and antimicrobial resistance, so they

appreciate the need for preventive action

to monitor trends: incidence and distribution of nosocomial infections, prevalence

and, where possible, risk-adjusted incidence for intra- and inter-hospital

comparisons

to identify the need for new or intensified prevention programmes, and evaluate

the impact of prevention measures

to identify possible areas for improvement in patient care, and for further

epidemiological studies (i.e. risk factor analysis).

CHARACTERISTICS OF SURVEILLANCE SYSTEM

A surveillance system must meet the following criteria

Characteristics of the system:

timeliness, simplicity, flexibility

acceptability, reasonable cost

representativeness (or exhaustiveness)

Quality of the data provided:

sensitivity, specificity

predictive value (positive and negative)

usefulness, in relation to the goals of the surveillance (quality indicators)

COMPONENTS OF A STRONG SURVEILLANCE PROGRAM

Should be based on sound epidemiological and statistical principles

Designed in accordance with current recommended practices

Needs to be able to identify risk factors for infection

Adverse events

Implement risk-reduction measures

Monitor the effectiveness of intervention

Should be able to Identify the-

Outbreaks

Emerging infectious diseases

Antibiotic-resistant organisms

8

Surveillance data will be used to reduce the occurrence of infections by using risk factors

and implementation of risk-reduction measures and monitoring effectiveness of

interventions.

FACTORS AFFECTING SURVEILLANCE PROGRAMS

Shorter hospital stays

Aging of the population

Increased use of invasive procedures and devices

More acutely ill patients and residents

Healthcare worker shortage

Emerging and re-emerging infectious diseases

Mandatory and public reporting

New diseases emerging

Antimicrobial resistance

Mandatory reporting requirements increase

New surveillance methods are needed to meet the changing environment

ESSENTIAL ELEMENTS OF SURVEILLANCE

1) Assess the population and identify those individuals at greatest risk for the outcome (e.g.,

bloodstream infection) or process (e.g., central line insertion practices) of interest

a) Healthcare-associated infections (HAIs) (outcomes)

b) Patient care practices aimed to prevent HAIs (processes)

2) Select the appropriate outcome or process to be monitored by surveillance

a) Examples of outcomes: HAI, infection or colonization by a specific organism,

pyrogenic reaction or vascular access infection in hemodialysis patients, and sharps

injuries

b) Examples of processes: Central line insertion practices (CLIPs), surgical care

processes (e.g., preoperative antimicrobial prophylaxis), medication errors, influenza

vaccination rates, hepatitis B immunity rates, and personnel compliance with

protocols

c) Examples of other events: Occurrence of reportable diseases and conditions,

communicable diseases in personnel, and organisms or syndromes indicative of

bioterrorist events

9

3) Determine the observation time period: This time period should be appropriate for

collecting sufficient data and may be affected by factors like hospital resources, hospital

size, target population, and healthcare priorities.

4) Choose the surveillance methodology

5) Monitor for the outcome or process using standardized definitions for all data collected

6) Collect appropriate denominator data if rates are to be calculated

7) Analyse surveillance data

8) Report and use surveillance information in a timely manner

LOCATION OF SURVEILLANCE

The patient care area to which a patient is assigned while receiving care in the healthcare

facility. The location of surveillance may be inpatient, outpatient, or both.

Inpatient locations: Locations serving patients whose date of admission to the healthcare

facility and the date of discharge are different calendar days.

1. Intensive care units - that provides intense observation, diagnosis, and therapeutic

procedures, includes Adult ICU, PICU, NICU etc.

2. Specialty care area (SCA): bone marrow transplant, solid organ transplant, inpatient

acute dialysis, hematology/oncology, or long term acute care.

3. Other inpatient: This section includes any inpatient locations that do not have an ICU

or SCA, e.g., inpatient medical, surgical, or other wards, step-down units, or operating

rooms (ORs). The OR may include an operating room, C-section room, interventional

radiology room, a cardiac catheterization lab, or a post-anesthesia care unit.

Outpatient locations: These locations serve patients whose date of admission to the

healthcare facility and the date of discharge are the same calendar day. These may include

any outpatient clinic, the Outpatient Emergency Department, or same day surgery and its

24-hour observation area.

Other locations include:

NON-PATIENT CARE LOCATIONS: e.g., laboratory or laundry

TYPES OF SURVEILLANCE

Total or Whole House Surveillance

Monitors all HAI in the entire facility

Overall facility infection rate should not be calculated

Rates should be calculated for specific AHIs in a defined population

Overall facility rates are not sensitive enough to identify potential problems

10

Are not adjusted for specific infection or injury risks so they are not appropriate for:

measuring trends over time

Comparisons between groups

Benchmarking

Although ideal most facilities do not have the technical and personnel resources to do

house-wide surveillance

Advantages:

Provide Complete picture

Disadvantages:

Unrealistic

Require Manpower

Not related to specific goals

Collection of data for sake of collection

Target surveillance

Target surveillance is generally conducted

1990 CDC shifted from total house surveillance to target surveillance

Based on facility-specific risk assessment

Focuses on:

particular care units (e.g., ICU, nurseries etc)

Infections related to devices (e.g., intravascular and urinary catheters)

Invasive procedures (e.g., surgery)

Organisms (e.g., resistant organisms such as MRSA, VRE, ESBL, etc)

Focuses on high-risk, high-volume procedures and adverse outcomes that are

potentially preventable

Advantages:

Surveillance based on identified risks

Best use of limited resources

Risk adjusted & comparative national rates available

Disadvantages:

Limited knowledge of facility norms

Recent trends in “targeted surveillance” include:

Site-oriented surveillance:

11

Priorities will be to monitor frequent infections with significant impact in

mortality, morbidity, costs (e.g. extra hospital days, treatment costs), and which

may be avoidable.

Common priority areas are:

ventilator-associated pneumonia (a high mortality rate)

surgical site infections (first for extra-hospital days and cost)

primary (intravascular line) bloodstream infections (high mortality)

multiple-drug resistant bacteria (e.g. methicillin-resistant Staphylococcus

aureus, Klebsiella spp. with extended-spectrum beta-lactamase).

This surveillance is primarily laboratory-based. The laboratory also provides units

with regular reports on distribution of microorganisms isolated, and antibiotic

susceptibility profiles for the most frequent pathogens.

Unit-oriented surveillance:

efforts can focus on high-risk units such as intensive care units, surgical units,

oncology/haematology, burn units, neonatalogy, etc.

Priority-oriented surveillance:

Surveillance undertaken for a specific issue of concern to the facility (i.e. urinary

tract infections in patients with urinary catheters in long-term care facilities).

While surveillance is focused in high-risk sectors, some surveillance activity

should occur for the rest of the hospital. This may be most efficiently performed

on a rotating basis (laboratory-based or repeated prevalence studies).

Active and passive surveillance

Active surveillance

Trained personnel, mainly ICPs, are vigorously look for HAIs

Information is accumulated using a variety of data sources within and beyond the

nursing ward

Passive surveillance

Persons who do not have a primary surveillance role, such as ward nurses or

respiratory therapists, identify and report HAIs

Patient-based and laboratory-based surveillance

Patient-based surveillance

Count HAIs, assess risk factors, and monitor patient care procedures and practices

for adherence to infection control principles

Requires ward rounds and discussion with caregivers

12

Laboratory-based surveillance

Detection is based solely on the findings of laboratory studies of clinical

specimens.

Prospective and retrospective surveillance

Prospective surveillance

Monitor patients during their hospitalization

For SSIs, also monitor during the post-discharge period

Retrospective surveillance

Identify infections via chart reviews after patient discharge

Priority-directed and comprehensive surveillance

Priority-directed surveillance (also called targeted or focused surveillance)

Objectives for surveillance are defined

The focus is on specific events, processes, organisms, and/or patient populations

Comprehensive surveillance

Continuous monitoring of all patients for all events and/or processes

Highly personnel resource intensive if done manually

SURVEILLANCE DATA COLLECTION

The data collected may be numerator or denominator data.

Numerator: the upper portion of a fraction used to calculate a rate or ratio. In surveillance,

it is usually the number of cases of a disease or event being studied.

Denominator: the lower portion of a fraction used to calculate a rate or ratio.

Example: 5 UTIs/135 Catheter Days = rate

5 is the Numerator 135 is the Denominator

Numerator Data Collection

Personnel other than infection control professionals (ICP) may be trained to screen data

sources for HAI, or automated screening of electronic databases may be used, as long as the

ICP makes the final determination of presence of HAI according to the criteria for defining

HAI.

Numerator data to collect

Demographics – name, date of birth, gender, hospital identification number,

admission date

Infection – onset date, site of infection, patient care location of HAI onset

Risk factors – devices, procedures, and other factors associated with HAI

13

Laboratory – pathogens, antibiogram, serology, and pathology

Radiology/imaging – X-ray, CT scan, MRI, etc.

Sources of numerator data

Admission/discharge/transfer records and microbiology laboratory records

Visits to patient wards for observation and discussion with caregivers

Patient charts (paper or computerized) for case confirmation

Laboratory and radiology/imaging results

Nursing and physician’s notes and consults

Admission diagnosis

History and physical examination findings

Records of diagnostic and surgical interventions

Temperature chart

Information on administration of antibiotics

For post-discharge-detected SSI, sources include records from surgery clinics,

physicians’ offices, and emergency departments.

How an ICP collects numerator data

Screens admission/discharge/transfer records for patients who were admitted with

infection and those whose diagnoses put them at risk of acquiring an HAI

Reviews laboratory reports to look for patients with possible infections (e.g.,

positive microbiology cultures, positive pathology findings) and discusses with

laboratory personnel to identify both patients who may be infected and clusters of

infections, especially in areas not targeted for routine HAI surveillance

During ward rounds, quickly screens nursing care reports, temperature charts,

antibiotic administration sheets, and converses with nurses and physicians to

identify patients who may be infected

Performs chart review of patients who are suspected of having HAI: reviews

physicians’ progress notes and nurses’ notes, laboratory data, radiology/ imaging

reports, surgery reports, etc.; if electronic charts are available, these charts can be

reviewed from the ICP’s desk, but ward rounds are still essential for surveillance,

prevention, and control activities

Completes HAI data collection forms/screens as data sources are reviewed

Denominator Data Collection

Denominator data may be collected by someone other than the ICP as long as that person is

trained. When denominator data are available from electronic databases (e.g., patient tracking

14

systems, respiratory therapy database), these sources may be used as long as the counts are

not substantially different from those collected manually.

Denominator data to collect

Counts of the cohorts of patients at risk for acquiring an HAI

Device-associated Bloodstream Infection (BSI), Ventilator-Associated Pneumonia

(VAP), and Urinary Tract Infection (UTI) incidence density rates: record on a

daily basis the total number of patients and total number of ventilator-days, central

line-days, and urinary catheter-days in the patient care area(s) under surveillance;

sum these daily counts at the end of the surveillance period for use as

denominators

Dialysis Event (DE): record the number of chronic hemodialysis patients with

each access type who received hemodialysis at the center during the first two

working days of the month

Antimicrobial Use and Resistance (AUR)-microbiology: record the number of

tested isolates

AUR-pharmacy: record the patient-days for in device-associated HAIs

Surgical Site Infection (SSI) or Post-Procedure Pneumonia (PPP): record

information on operative procedures selected for surveillance (e.g., type of

procedure, date, risk factors)

Sources of denominator data

Device-associated BSI, VAP, and UTI incidence density rates: visits to patient

care areas to obtain daily counts of the number of patients admitted and the

number of patients with each commonly used devices associated with HAI (i.e.,

one or more central line, ventilator, or indwelling urinary catheter)

DE: visits to patient hemodialysis outpatient clinics to obtain monthly counts of

chronic hemodialysis patients served

AUR-microbiology: process laboratory reports

AUR-pharmacy: total patient-days as shown in device-associated HAIs

For SSI or PPP rates: detailed logs from the operating room for each operative

procedure

How an ICP collects denominator data

For device-associated incidence density rates: records daily counts of the number

of patients admitted and the number of patients with each of the commonly used

15

devices associated with HAI (i.e., one or more central line, ventilator, or

indwelling urinary catheter)

For SSI rates: obtains data on operations from operating room logs and patient

charts as needed

SURVEILLANCE DATA ENTRY

Collect only necessary data

Record data in a systematic formatting

Organize data in a meaningful way:

Flow sheet or line-list.

Computer data-base (excel, Epi-info, SPSS or STATA).

SURVEILLANCE DATA ANALYSIS

Put the results of data collected into rates and ratios: A / B x 100 or 1000

For the numerator A use the number of nosocomial infection in particular group at risk.

For the denominator B you may use one of the following:

Number of admission or discharge in an interval

Number of person undergoing a procedure

Patient-days in the hospital or on a particular unit

Number of device-days

Approach for analysis of data :

Defining and calculating rates

Prevalence which include point prevalence and period prevalence

Both types count active cases of a disease in a defined population

Incidence which is the total number of a new cases of disease that occurs

among given population during a specified period of time

Comparing rates among patient groups

The denominator must reflect the population at risk

Intrinsic risk factors

Extrinsic risk factors

Comparing rates overtime

The importance is risk related as major risks varies overtime

16

e.g. SSI are getting less than before as of hospital stay is getting

less

Identifying outbreaks

Looking at your trends

Assessing appropriateness of medical care

Comparing different devices

DISSEMINATION OF DATA

Data should not be used for punitive purposes but rather to augment quality improvement

efforts.

Narrative summaries and tabular graphic reports of surveillance data will be provided to

the hospital infection control committee, executive director, general manager and head of

departments.

BENCHMARKING

Benchmarking is the process of comparing oneself to others who are performing similar

activities, so as to continuously improve. The National Healthcare Safety Network (NHSN)

in the US is the oldest and most widely used network for benchmarking. Although it is very

appealing to compare one’s rates externally with others’ rates, the comparisons should be

made only after ensuring that the following conditions are met:

Criteria for defining a case are standardized and up to date.

Criteria are consistently used by all participants and all data collectors.

The population and time period for the study are well defined.

The surveillance methodology is standardized and consistently used by all of the

participants over time.

Rates and ratios are calculated using the same numerators (number of cases) and

denominators (population at risk).

The size of the population studied (denominator) is large enough to provide an accurate

estimate of the true rate.

A standardized risk adjustment method is used by all of the participants.

All data collectors receive training on how to collect data and use a standardized form.

The facility and population that is compared is similar to the types of facilities and

populations in an aggregate database used for external comparison (for example, data

from a neonatal ICU is compared with data aggregated from other neonatal ICUs).

17

There is a mechanism for ensuring the accuracy, sensitivity, and specificity of the

collected data.

The analysis and interpretation of the data provided by the benchmarking system is

accurate and in a form that is understandable to the users.

Feedback will be disseminated to those who can affect change.

The data provided by the GCC Center for Infection Control to external similar bodies

(e.g., NHSN) are coded for confidentiality, and the reports provided to these bodies or to

the public do not contain facility identifiers

SURVEILLANCE REPORTING

A written report should be developed to provide a mechanism to interpret and disseminate

surveillance data to stimulate performance improvement activities. Tables, graphs, and charts

are effective tools for organizing, summarizing, and visually displaying data and should be

used as applicable. The format and level of detail in each report will depend on the intended

audience.

A surveillance report should:

1. Define the event, population, setting, and time period studied (e.g., surgical site

infections in patients undergoing coronary artery bypass graft in hospital A from

January through December 2013)

2. State the criteria used for defining a case (e.g., NNIS criteria for urinary tract

infection)

3. Specify the number of cases or events identified and the number in the population

studied (e.g., 2 surgical site infections occurred during 179 total hip replacement

procedures)

4. Explain the methodology used to identify the cases (e.g., case reports from personnel

and review of medical records and laboratory results)

5. Identify the statistical methods and calculations used, when appropriate (e.g., fall rate

in April = falls in April / # resident days in April x 1,000 or 3/414 x 1,000 =7.2 falls

per 1,000 resident-days)

6. State the purpose for conducting surveillance (e.g., to reduce the rate of occurrence of

an event)

7. Interpret the findings in a manner that is understandable to those who read the report

8. Describe any actions taken and recommendations made for prevention and control

measures

18

9. Identify the author and date of the report

10. Identify the recipients of the report

Mechanism of reporting:

After you prepare the report according to the above criteria (including conclusions and

recommendations that are easy to understand), the following persons/bodies need to receive a

copy of your final report:

1. Immediate supervisor, higher ranking administration, or any other healthcare facility

employee who is required (by your facility’s local policies) to be informed and/or are

authorized to implement the suggested recommendation.

2. Ministry of Health or even higher national or international bodies (according to your

country’s health policies regarding certain outbreaks).

3. Healthcare workers who have immediate concerns about the report contents (e.g., the

surgical team that performed the procedures for which you are reporting SSI rates)

4. ICPs that are directly involved in data collection as a way to keep them informed as

well as promote quality improvements.

SUMMARY

As the health workers are having more risk to get infected while providing care to the

patients, it is necessary for them to have a proper knowledge and attitude regarding

infection control. Poor knowledge can put them in risk so they must compulsorily

follow the universal precautionary measures like hand hygiene, sterilization and

disinfection procedures, use of personal protective equipment, biomedical waste

management and post exposure prophylaxis. In this way we can reduce the incidence

of health care associated infections.

Surveillance practices evolve in response to changes in healthcare delivery. The use

of surveillance data has shifted from measuring clinical outcomes, such as infections,

to guiding performance improvement activities and demonstrating improvements in

clinical outcomes and healthcare practices. With the increase of antimicrobial

resistance and outbreaks caused by emerging and re-emerging infectious diseases and

intentionally released pathogens highlights the need for local, regional, national, and

global surveillance systems.

19

ICPs responsible for managing surveillance programs must ensure that their programs

are based on sound epidemiological and statistical principles and designed and

evaluated in accordance with current recommendation and practices and have the

resources needed to promote quality healthcare.

REFERENCES

1. Burke JP. Infection control-a problem for

patient safety. New England Journal of

Medicine. 2003;348(7):651–6.

2. Centre for Health Protection - ICB Infection

Control Guidelines [Internet]. [cited 2014 Mar

11]. Available from:

http://www.chp.gov.hk/en/guideline1/346/365.

html

3. Dr. Vikas Manchanda. Quality Manager.

Secretary, HICC. HOD Microbiology, CNBC.

Hospital Infection Control - I. Principles and

Practice. [Internet]. Delhi; 2011 [cited 2014

Mar 11]. Available from:

http://www.delhi.gov.in/wps/wcm/connect/15f

dbc0047bc87bc99d0dd3a9bcac0f8/04A+Hospi

tal+Infection+Control+and+Patient+Safety.pdf

?

MOD=AJPERES&lmod=1776443604&CACH

EID=15fdbc0047bc87bc99d0dd3a9bcac0f8

4. Dr. Vikas Manchanda. Quality Manager.

Secretary, HICC. HOD Microbiology, CNBC.

Hospital Infection Control - II. Principles and

Practice. [Internet]. Delhi; 2011 [cited 2014

Mar 11]. Available from:

http://www.delhi.gov.in/wps/wcm/connect/29e

4220047bc896499ebdd3a9bcac0f8/04B+Hospi

tal+Infection+Control+and+Patient+Safety.pdf

?

MOD=AJPERES&lmod=1776570259&CACH

EID=29e4220047bc896499ebdd3a9bcac0f8

5. Gaynes R, Richards C, Edwards J, Emori TG,

Horan T, Alonso-Echanove J, et al. Feeding

back surveillance data to prevent hospital-

acquired infections. Emerging infectious

diseases. 2001;7(2):295.

6. Gloria C. Morrell,. Principles and Practice of

Surveillance of Healthcare-associated

Infections for PA. [Internet]. Atlanta, GA;

2011 [cited 2014 Mar 11]. Available from:

http://www.docstoc.com/docs/98057909/8111

1-CDCs-HAI-Surveillance-Presentationpdf---

Pennsylvania

7. Infection Prevention & Control | Health and

Community Services [Internet]. [cited 2014

Mar 11]. Available from:

http://www.health.gov.nl.ca/health/publichealt

h/cdc/infectionpreventionandcontrol.html

8. Jarvis WR. Benchmarking for prevention: the

Centers for Disease Control and Prevention’s

National Nosocomial Infections Surveillance

(NNIS) system experience. Infection.

2003;31:44–8.

9. Jarvis WR. Infection control and changing

health-care delivery systems. Emerging

infectious diseases. 2001;7(2):170.

10. McKibben L, Horan T, Tokars JI, Fowler G,

Cardo DM, Pearson ML, et al. Guidance on

public reporting of healthcare-associated

infections: recommendations of the Healthcare

Infection Control Practices Advisory

Committee. American journal of infection

control. 2005;33(4):217–26.

20

11. NICE. CG139 Infection control: full guideline

[Internet]. NICE. [cited 2014 Mar 11].

Available from: http://www.nice.org.uk/

12. Plachy RJ. Evaluate job to set compensation.

Mod Healthc (Short Term Care). 1975

Dec;4(6):52.

13. Richards C, Emori TG, Edwards J, Fridkin S,

Tolson J, Gaynes R. Characteristics of

hospitals and infection control professionals

participating in the National Nosocomial

Infections Surveillance System 1999.

American journal of infection control.

2001;29(6):400–3.

14. Sehulster L, Chinn RY, Arduino MJ, Carpenter

J, Donlan R, Ashford D, et al. Guidelines for

environmental infection control in health-care

facilities. Morbidity and Mortality Weekly

Report Recommendations and Reports RR

[Internet]. 2003 [cited 2014 Mar 11];52(10).

Available from:

http://www.cdc.gov/MMWR/PREVIEW/MM

WRHTML/rr5210a1.htm

15. Surveillance Manual 2012 - National Guard

Health Affairs [Internet]. 2011 National Guard

Health Affairs. Gulf Cooperation Council –

Centre for Infection Control. Riyadh 22490,

Kingdom of Saudi Arabia; 2011 [cited 2014

Mar 11]. Available from:

http://www.ngha.med.sa/error.aspx?

aspxerrorpath=/English/MedicalCities/

AlRiyadh/Centers/Documents/

Surveillance_Manual_2012.pdf

16. Tokars JI, Richards C, Andrus M, Klevens M,

Curtis A, Horan T, et al. The Changing Face of

Surveillance for Health Care—Associated

Infections. Clinical infectious diseases.

2004;39(9):1347–52.

17. WHO | Infection prevention and control in

health care [Internet]. WHO. [cited 2014 Mar

11]. Available from:

http://www.who.int/csr/bioriskreduction/infecti

on_control/en/

18. World Health Organization, Regional Office

for the Western Pacific, World Health

Organization, Regional Office for South-East

Asia. Practical guidelines for infection control

in health care facilities. [Internet]. Manila;

New Delhi: World Health Organization,

Regional Office for Western Pacific ; World

Health Organization, Regional Office for

South-East Asia; 2004 [cited 2014 Mar 12].

Available from:

http://www.wpro.who.int/publications/docs/pra

ctical_guidelines_infection_control.pdf

19. Zoutman DE, Ford BD, Bryce E, Gourdeau M,

Hébert G, Henderson E, et al. The state of

infection surveillance and control in Canadian

acute care hospitals. American Journal of

Infection Control. 2003;31(5):266–73.

----------------------------

21