IPAC – PANA April 28, 2015

Sandra Callery RN MHSc CIC

World Youth Day - Toronto 2002

World Youth Day – Downsview Park 2002

#1 issue =Heat-related illness. ◦ A rehydration ward was established on-site (300

beds) and most cases were managed on-site.

Detected early onset of cases and initiated a rapid and successful response.

Lines of communication and collaboration between emergency medical services and volunteer medical staff on-site had been established beforehand.

Surge capacity was planned for and volunteers on standby were brought in when required.

Toronto SARS Concert 2003

Detect clusters of syndromes: ◦ Influenza like illness (ILI) and other respiratory illnesses

◦ Gastrointestinal (GI) illnesses

These illnesses would be beyond what would normally be expected in the population for a similar period of time.

Traditional surveillance which includes clinical diagnosis is neither complete nor timely enough to allow for the most effective public health intervention efforts.

For example, most individuals with symptoms of influenza-like illness (ILI) often do not present for medical care, and thus are not eligible for laboratory testing or clinician diagnosis.

Syndromic surveillance uses existing health-related data that are independent of a confirmed diagnosis and signals for further public health response.

These data also capture individual behaviours that occur following the onset of disease symptoms such as absences from school or work.

PIDAC - 2012

Sensitivity

Specificity

Many public health jurisdictions have begun monitoring a variety of syndromic surveillance data sources in the past decade

Absenteeism (employee; school) Pharmacy sales (over the counter and

prescriptions) Emergency department chief complaint 911 calls and EMS data Medical record ICD codes by community health

care providers On-line sources Sentinel community health care providers Tele health

“Surveillance is the systematic, ongoing collection, collation and analysis of data with timely dissemination of information to those who require this information in order to take action. The actions usually relate to improvements in prevention or control of the condition”.

◦ PIDAC - Best Practices for Surveillance of Health Care-associated Infections in Patient and Resident Populations , July 2014

7 to 60% Reductions in the rates of nosocomial infections following the implementation of surveillance programs.

~70% of nosocomial infections are preventable

Surveillance Planning

Data Collection

Analysis

Evaluation

Communication

Interpretation

StepsI. Assess the population II. Select the outcome or process

for surveillanceIII. Use Surveillance definitions

StepsIV. Collecting surveillance data

StepsV. Calculate and analyze

surveillance ratesVI. Apply risk stratification

methodology

StepsVII. Interpret surveillance rates

StepsVIII. Communicate and use

surveillance information

StepsIX. Evaluate surveillance

system

◦ What is the “most risky” procedure or intervention that we perform on site?

◦ What intervention has historically caused adverse outcomes such as infection? Requires readmission or a longer length of stay?

◦ Who are our partners for interventional and surgical procedures?

◦ What rates are we mandated to report ?

? Urinary tract infections in LTC residents with indwelling catheters

? Pneumonia (in LTC) and Ventilator associated pneumonia (in acute care)

? Antibiotic resistant organisms

? Surgical site infections – targeted procedures

? Line related blood stream infections

Screening tool completed daily and picked up by IP&C/ or emailed or faxed to IP&C

New onset of nausea, vomiting and diarrhea

Compliance calculated monthly by unit and reported quarterly:

Number of days tool completed

Number of days in the month X 100

0%

20%

40%

60%

80%

100%

Unit

1

Unit

2

Unit

3

Unit

4

Unit

5

Unit

6

Unit

7

Unit

8

Unit

9

Unit

10

Unit

11

Unit

12

Unit

13

Unit

14

Unit

15

Unit

16

Unit

17January February March

Monitoring communicable and reportable diseases

Monitoring and reporting clusters of staff illness such as Norovirus – like symptoms or influenza like illness.

Measure vaccine compliance.

“Outbreak”

Quarterly summary line listing of respiratory and gastrointestinal outbreaks – shared with

facility

Outbreak Units Start date End date

Duration (days) Type

Causative agent

# Resident

Cases# Staff Cases

Unit 2 March 26 April 6 11 Gastro Norovirus 7 4

Unit 1 March 30 April 11 13 Respiratory Influenza B 8 0

Keeping a “low threshold” for Declaring Outbreaks

Measles Outbreak Epi CurveDecember 2014 – January 2015

• 39 cases primary Disney• 1 case who reports visiting Disney outside of initial time period California Department of Public Health – Immunization Branch

Quarterly report by facility of hand hygiene compliance (%)

Includes◦ Trends by quarter

51% 54%

74%

54%65%

73%

85% 87% 86% 87%94% 89% 88% 89% 88% 86% 88%

82%89% 92% 90%

0%10%20%30%40%50%60%70%80%90%

100%

Nov 0

7-Feb 0

8

Aug -

Oct

09

Nov 0

8-M

ar

09

July

-A

ug 0

9

Q3 2

009-10

Q4 2

009-10

Q3 2

010-11

Q4 2

010-11

Q2 2

011-

12

Q3 2

011-12

Q4 2

011-12

Q1 2

012-13

Q2 2

012-13

Q3 2

012-13

Q4 2

012-13

Q1 2

013-14

Q2 2

013-14

Q3 2

013-14

Q4 2

013-14

Q1 2

014-15

Q2 2

014-15

HH

Com

pliance (%

)

Includes◦ Compliance

Moment

Unit

Type of Healthcare worker (nurse, physician, allied health, support staff)

90%79%

100%90% 90%

0%10%20%30%40%50%60%70%80%90%

100%

Nursing

Staff

Medical

Staff

Allied

Health

Staff

Support

Staff

LTC

Average

HH

Com

pliance (%

)

HH by Profession

83%100%

50%

93% 90%

0%10%20%30%40%50%60%70%80%90%

100%

HH

Com

pliance (%

)

HH by Moment

Regular HH audits◦ anonymous, include all HCWs, immediate feedback

Norovirus ◦ Gastroenteritis◦ Fecal-oral transmission, via contaminated hands◦ Norovirus outbreaks common in LTC◦ Standard approach to environmental cleaning

Norovirus outbreak in SB LTC ◦ Jan 15 – Feb 18, 2009

Regular hand hygiene audits in SB LTC

Objective: analyze relationship between outbreak impact and HH compliance

Unit Attack Rate vs HH Compliance

0

10

20

30

40

50

60

70

80

90

100

A B C D E F G H I

Unit

HH

Com

plia

nce/

Atta

ck R

ate

(%)

Unit Attack Rate (%)Unit HH Compliance (%)

Unit Attack Rate vs Unit HH Compliance

y = -0.5079x + 42.829R2 = 0.5547

0

20

40

60

0 20 40 60 80 100

HH compliance (%)

unit

atta

ck r

ate

(%)

HH and AR inversely related (↑HH ↓AR)

(statistically significant p=0.001)

Syndromic surveillance ◦ Tells you where you are heading..

Prospective surveillance◦ Tells you what is happening now..

Retrospective surveillance◦ Tells you where you have been..