Dr. Conway discussed two tools that can be utilized to complete these risk assessments.
The first is an ICRA tool that can be accessed through the Centers for Disease Control and Prevention (CDC) website or through the APIC website. The ICRA is “an excel file already set up for you” that “lists all risks for each row, and then the column headers are your assessment of whether you have zero risk, low, medium, or high risk, and what the risk is, what level of risk you’re at, what you already have in place to deal with it, and what resources would be required.” Finally, the tool generates a percentage to highlight the likelihood of a risk. Within this larger risk assessment, they also have smaller risk assessment tools available online, such as the Tuberculosis Risk Assessment Tool, which “asks questions that would be useful for you to ask every year, such as: ‘Are patients with suspected or confirmed TB disease encountered in your setting? How often? How many present to your emergency department?’” Dr. Conway said that this tool will help you assess if there is a low, medium, or high risk of TB.
The second is the Infection Control and Response (ICAR), which was designed in part by the CDC for state inspections; it can also be used so that “you can inspect yourself.” Dr. Conway continued, “It is long, but it is actually more intuitive than the excel spreadsheet to assess your program.”
“So, you’ve got your mandated surveillance, and then you’ve got your surveillance based on your risks, and it’s always going to be too much. So, now you have to decide, ‘we’re going to conduct surveillance, but some of it’s going to have to be modified,’” Dr. Conway said. She continued to share with attendees four effective and efficient ways to conduct targeted surveillance in their own facilities.
1. Narrow your surveillance to your highest risk targets.
Using a point prevalence survey, you can better identify where your biggest problem is, and then just collect data pertaining to your problem area. “So, instead of collecting data on all CLABSIs in your center, just collect data on CLABSIs in oncology; if that’s where your problem is, then only collect data there,” she explained. The only drawback that comes with “very targeted surveillance” is “very small numerators.” Dr. Conway’s solution? “Take your time and surveil them for two years. You can always intervene along the way, especially in a staged way.”
2. Use simple surveillance definitions consistently.
She reminded conference attendees that they do not have to use the CDC’s National Healthcare Safety Network’s (NHSN) definitions “if you don’t want to and it doesn’t work for you.” She continued, “Yes, if you need a really good baseline and a good comparator, then definitely use NHSN definitions, but if it’s not simple for you to use those, then use really simple definitions for yourself.” Another route that can be taken, according to Dr. Conway, is utilizing simplified definitions provided by the World Health Organization for healthcare-associated infections for developing countries.