Tutorial

Cohort Health Care Acquired Infections (HAIs) Surveillance in intensive Care Units (ICU)

Follow these two (2) steps to access the system and navigate 1- Go to your Internet browser. Type this: http://admin.inicc.org/admin

There you will see two empty cells: in the one above, the username, enter your "email address". In the cell below, the password, type "inicc" in lowercase; and click on "log in."

2- Now you are already in the "Online System INICC". Here you will see several PDFs documents that represent the latest information available, such as HAIs criteria of CDC NHSN, last HAI rates, and bacterial resistance of CDC NHSN and INICC, and also, you will see the latest HAI prevention guidelines, published by WHO, CDC, SHEA and JCI.

• The basic concept of this type of surveillance is that it is “Cohort HAI Surveillance of in ICU” • This means that you will complete a form for each patient; that is, no matter whether or not such

patient has a HAI, you will complete the data for each patient who is admitted to the ICU. • The data is completed from admission to discharge. • If in a month you have 20 patients hospitalized in the ICU, you will complete 20 forms. • In this system, some patient data is called "denominator" and some data is called "numerator". • Data called "denominator" are the "bed days", the "central line days," the "ventilator-days" and

"urinary catheter days” • The “numerators” are the "HAIs”, such as “CLAB”, “VAP”, and “CAUTI”. • In this way, you will have a summarized medical record for each patient admitted to the ICU; for

those patients with and without HAIs. • In this way, you can validate the information by patient and check if there were errors in the

collection of device days and diagnosis of HAIs. • You can conduct a case-control study; calculate extra days, extra mortality, extra cost, risk factor

analysis and more, with very high accuracy. • This is a step forward in the traditional surveillance systems for HAIs, without neglecting the

methodology and definitions of CDC NSHN. • The "INICC Online System" uses the methodology and definitions of the CDC NHSN, but adds

elements that give a significant improvement to the classic system that does not allow data validation, and also don't allow to calculate extra length of stay, extra mortality and extra costs of patients with HAI, nor to conduct risk factor analyses.

 Follow the next (5) steps to upload your data in the system: Step # 1- On the day of patient admission- Required for all patients. 1- Touch the first tab, which is called: “Cohort HAI Surveillance of in ICU”

2- There, select “Adult and Pediatric Units,” if you upload data of “Adult and Pediatric Units”. Or select “Neonatal Units” if you upload data of a “Neonatal ICU.”

3- Here, click on “Add a new Patient on Detailed ICU Outcome Surveillance.”

4- There, you will see five (5) tabs in BOLD. Click on the first one, called “Mandatory= Patient Data”. There, select the name of your “hospital”, “ICU”, “type of hospitalization”, “bed number” (here, always place two digits, for example, 01.) The remaining eight (8) fields are NOT required.

5- Select the “Date of birth” in the calendar that unfolds by clicking on this cell. For this, first select the

“year”, then the “month”, and then the “day”.

 6- Select “Gender”.

7- Select “Date of admission to ICU” in the calendar that unfolds by clicking on this cell. For this, first select the “year”, then the “month”, and then the “day”.

8- Click below on the right, where it says “Save and continue editing.”

Do NOT touch OPTIONAL tabs #2, #3, #4, #5, #6 and #7; because they are “optional”, and are used only in cases of research studies; and are not indispensable for this type of prospective cohort surveillance.

  Step # 2- Device days from date of admission to discharge- Required for all patients • It is important to know that all each and all the devices that the patient has had in place need be

uploaded. • This means that if the patient started to use a “subclavian central line” on the day 14th August 2014

and has been using it from 14th August 2014 to 21st August 2014; you have to upload this device in the system for each of the days from 14th August 2014 to 21st August 2014. This means, you must upload devices with the dates of 14th August, 15th August, 16th August, 17th August, 18th August, 19th August, 20th August, and 21st August.

• If the patient has a device in place on a determined day and you do not upload this device for such own HAI rate shall be uploaded, because when the denominator is reduced, the HAI rate increases, and when the numerator is reduced, the HAI rate is reduced. This is one of the many basic principles of epidemiology. And HAI Surveillance must be conducted according to the criteria based on epidemiology.

1- Click on the eighth tab, called “Mandatory= Invasive Devices Usage.”

2- Here, click on “Today” if you are uploading it in real time. Or select the day on the “calendar” if this device is not being uploaded in real time.

 3- In the second column, called “Devices of your patient to be chosen”, you will see a list containing all

the invasive devices that are used in the entire world. Select only the devices that the patient in this bed is using today. When you find the device, click on it and its background will turn blue. When it turns blue, select the blue arrow on the right of this box, and the device will go to the third column, called “Chosen Devices of your patient.”

4- You may do this every day in real time, or may fill in a paper form for this patient from admission to discharge, and then upload all the data together on the same day in the “INICC Online System.” In both cases, when you want to upload the devices for the next day, you have to click on “add another.”

5- When you have finished uploading all the devices all of the days from the admission day to discharge day, click on “Save and continue editing.”

Do NOT touch the OPTIONAL tabs #9 and #10, because they are “optional,” and are used only in cases of research studies; and are not indispensable for this type of prospective cohort surveillance.

6- The following day, and every day from admission to discharge, please access this patient, go to the

eighth tab, called “Mandatory= Invasive Devices Usage”, and repeat the process day by day.

 Step # 3- The day of patient discharge- Required for all patients

1- On the day of patient discharge, go to tab #13, called “Mandatory= Patient discharge.” Here, click

on “today” if you are uploading data online in real time. Or select the date in the “calendar” if you decide to upload everything in paper forms. In “Final ICU outcome,” select if the patient is “alive” or “dead” on the day of discharge. Click on “Save“

Step # 4- Positive culture of the patient- This data is added only in patients with a positive culture 1- When you know that the patient in this form has a positive culture, click on tab #11, called

“Mandatory= Culture results of the Adult and Pediatric Patient” and there complete the “date” the culture was taken (this is not the day on which results where received), complete “type of culture”, “microorganism”, and “sensitivity to each antibiotic.” Then click on “Save and continue editing.”

 

Step # 5- Patient’s HAI- This data is added only in patients with HAI 1- When you know that this patient has a HAI, click on the blue box on the top right margin called

“Health Care Acquired Infection (HAI) according to CDC-NHSN Criteria.”

2- There, you have to select the signs, symptoms and the studies of your patient with HAI. To know the updated criteria of the CDC-NHSN to consider that the patient has a HAI, please consult the document called “CDC-NHSN HAI Criteria.” Select the criteria.

3- Click on diagnose and you will see the diagnosis that appears when selecting the criteria.

4- Click on “Back to ICU.”

5- Click on “Mandatory= Adult and Pediatric Health Care Acquired Infection (HAI) result.” There check

and correct the date of the HAI if necessary. The date of HAI is the date the culture was taken, or the day on which symptoms started, or the day on which the antibiotic treatment was initiated. Any of these 3 situations are a surrogate for the date of HAI.

 6- If you wish to delete that HAI, click on “delete” at the “upper right corner”, and then click on “save

and continue editing”.

7- Click on “Save.”

You have uploaded and saved everything.

 Follow these ten (10) steps to see your tables and charts:

1- Click on the top left margin, where it says “Cohort HAI Surveillance in ICUs” there select “Adult and Pediatric Units”. Select “Adult and Pediatric Units” or “Neonatal Units”.

2- On the upper right, click on the blue rectangle, where it says “Generate Report.”

3- There select your “country”, and your “city.” Where it says “hospital,” select it and its background will turn blue; when it turns blue, click on the blue arrow on the right of this box.

4- You will see that the name of the hospital has passed to the box called “Your Chosen Hospital.” Then select your “ICU.”

5- To select the start of the period that you want to see, click where it says “date start” and there select first the “year”, then the “month” and then the “day”. To select the end of the period that you want to see, click where it says “date end” and there select first the “year”, then the “month” and then the “day”.

 6- Click below on the left, where it says “Generate Report.”

7- You will see this. Wait two (2) minutes and go to the tab called “Report already done”

8- Click on the tab called “Report already done”.

9- Click on the name of your hospital. Click on “see report” at the upper right corner. Now you can

see your report.

10- You can print your report by clicking on “Printable version” at the lower left corner. You can convert your report to a PDF file by clicking on “Printable version” at the lower left corner.

 At your report you will see 11 tabs with data of this unit for the determined period. In these 11 tabs, there are 62 charts and tables that are generated in only 4-5 seconds. There follow some of those 62 charts and tables: