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Pick Your Battles: Conducting Efficient & Effective Targeted Surveillance in Your Facility

APR 12, 2017 | KRISTI ROSA
At the Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference in St. Louis, MO, Laurie Conway, RN, PhD, CIC, delivered a presentation explaining that, infection preventionists (IPs) need to “pick their battles,” when it comes to surveillance targets. She also shared with a room full of conference attendees some ways to ensure effective surveillance efforts.

“Surveillance takes up about 44% of our time, so we need to choose wisely when we say we are going to monitor and act on something. Only about one third of hospitals use electronic surveillance systems, so when it comes to picking our battles, we’re talking about how we’re going to spend our personal IP time,” Dr. Conway said. She reminded attendees that having rational surveillance targets is a “core component of any Infection Prevention and Control (IPAC) program and mandatory surveillance targets are usually chosen due to “their preventability and ease of comparison, not local risk.”

There are two ways to choose surveillance targets according to Dr. Conway: regulatory mandates and formal risk assessments. For the United States, Dr. Conway shared that there are regulatory mandates in place for central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), Clostridium difficile infections (CDI), methicillin-resistant Staphylococcus aureus (MRSA), healthcare worker (HCW) vaccination, and ventilator-associated events (VAE); however, there are different regulated surveillance targets for different types of facilities.
“This is a huge list and that alone can take up all of your time,” Dr. Conway said.

In addition to federal mandates, there are also state mandates that are updated regularly. According to Dr. Conway, they can be accessed via the APIC website simply by searching for public policy; each state has different reporting requirements.

“So, now we’re dictated to in a big way, but we also know we have local risks,” she said. “To identify these risks, and be able to say ‘yes’ to some, and ‘no’ to others, we have to conduct a formal risk assessment,” or infection control risk assessments (ICRAs). ICRAs are to be done each year to assess hazards based on: “the community that you serve, the services you provide, what services are building, what [ones] are winding down as well as the case mix that provides.” Furthermore, existing healthcare-associated infection rates should also be considered, as well as any notable trends. She also mentioned the importance of an antibiogram: “Is resistance changing? Are there organisms and pathogens that you should start monitoring or stop monitoring?” Lastly, the infrastructure of your facility needs to be taken into consideration.

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