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S31.1 Surveillance: Utilizing statistical process control charts and feedback mechanisms in reducing resistant organisms and healthcare-associated infections
Speakers' Abstracts ~International Journal of Antimicrobial Agents 26S (2005) S1 $63 Production mid Stockpiling of Biological mid Toxin Weapons banned tile use of such agents. However, there are still many official and hidden laboratories worldwide where scientists develop either methods to defend the population against bioterrorism (the peace makers) or new ways to affect human health (war-dreamers). Tile author makes a review of tile current flu'eats of attacks worldwide using bioagents. Tile histmy, present state and future possibilities are discussed, giving examples for the most often etiologic microorganisms applied for bioterrorism. These data were presented at the ARW of NATO on bioterrorism in Varna, Bulgaria in May/June 2003, where the author was appointed as a Director of tile ARW of NATO on tiffs topic.
$49
There has been limited use of control charts in infection control; however guidelines relating to their application and limitations are available. Accepting these limitations and recognizing both our infection control and microbiological resource constraints, we have utilized existing MRSA microbiological data to develop statistical process control charts mid feedback tiffs data to targeted MRSA problem areas within tile hospital in an effort to reduce MRSA. Interpreting control charts, establishment of the program, feedback of data, measuring the effects of interventions and outcome will be discussed.
S31.2
$30.3
Surveillance: The Basics during an Outbreak
Severe Acute Respiratory Syndrome
Patlicia T.Y. CHING. Senior Nursing Ojfice~ Infection Control Uni~
Queen Mary Hospital, Hong Kong SAR, PROC M. PEIRIS. The ly)ziversi~ of Hong Kong Queen Mary Hospital, Hong
Kong SAR, PROC The last 10 years saw the emergence of 4 major infectious disease threats in the Asian region, viz., enterovirus 71, Nipah, avian influenza virus A (H5N1) and SARS. Three of these diseases are of zoonotic origin. These incidents illustrate tile need for preparedness and rapid response to emerging infectious disease ttueats. In tile winter of 2002, an unusual "atypical pneumonia" emel~ged in Guangdong, southern China with a predilection for disease clustering in family members and healtheam workers. The etiological agent was a novel coronavirns (SARS CoV), which emerged from an animal reservoir and adapted to efficient human to human transmission. It spread to affect over 8000 patients in 29 countries across 5 continents. Confronting this outbreak required understanding the etiology, modes of transmission and pathogenesis, developing specific diagnostic tests and effective infection control strategies. In the longer term, identifying therapeutic agents and vaccine development are required.
$31. Surveillance and Healthcare-associated Infections $31.1 Surveillance: Utilizing Statistical Process Control Charts and Feedback Mechanisms in Reducing Resistant Organisms and Healthcare-assoeiated Infections Glenys HARRINGTON, K. WATSON, E. COCKROFF, S. BORRELL, L. HOUSTON, G. LAND. The Alfred, Bayside Health, Melbourne,
Australia Background: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major problem in most Austa'alian hospitals. Successful strategies to control MRSA are often both infection control and micro biological laboratory resoumes intensive. Such resources are limited in Australiml hospitals. A novel and less resource intensive approach to controUing MRSA has been utilized by Culran et al. in tile United Kingdom. This includes tile targeted use and feedback of MRSA microbiological data utilizing statistical process control charts. Main message: Control charts have been used successfully in industry for many years. In industry, control charts are used to analyze data, detect trends or changes mid identify true change from a change that is part of random background variation that is not easy to avoid or control. Average values (mean) mid control limits (upper and lower) are plotted on graphs, usually over time. As discussed by Oaklands et al., control charts can be thought of as a form of traffic signal with lower limits (lamber) indicating that there may be a problem, and upper limits (red) indicating that it is likely there is a problem that must be explored and corrected.
Tile investigation of outbreaks is one of tile most important roles of tile Infection Control Nurse (ICN). To ensure efficiency in tile identification of an outbreak, the Infection Control Unit should have a comprehensive surveillance program that is ongoing. The surveillance should include review of the microbiology laboratory results with focus on organisms causing notifiable disease, e.g., shigellosis mid multi-resistmlt organisms such as MRSA, MR Acinetobacter baumannii. For endemic infectious diseases, each hospital should have a thieshold and investigation should be started whenever tile daily review shows that a disease exceeds tile threshold. The ICN should also rule out variation due to changes in definition, laboratory techniques and surveillance methods. The steps of the investigations are as follows: 1 Initial evaluation: Is tile outbreak worth investigating? 2 Initial case definition and case-finding 3 Initial collection of data and specimens 4 Institute standard control measures 5 Evaluate basic investigations compatible with known epidemiology? 6 Make list listing and draw epidemic curve 7 Start major investigation with further definition refinement and data/specimens collection 8 Hypothesis generation mid refining data 9 Hypothesis proving: case-control & typing studies 10 Finalize and implement control measures After the investigation, the ICN should give feedback to the ward and also to the Infection Control Committee. In times of massive community outbreaks such as SARS, tile Infection Control Unit should also inform tile local authority. Outbreak investigation is an important role of tile Infection Control Unit. This is a responsibility of both the infection control doctor and infection control nurses, who should be familiar with the steps. The involvement of the laboratory is key in the identification of the causative organism and also when typing is indicated. Observation and discussion with tile front-line staff is paramount, especially when there is a bleach in patient care procedures.
$32. Respiratory Infections in Asia (Co-sponsored
by the Hongkong Thoracic Society) $32.1 HSN1 and SARS - What Have We Learned? Chung Ming CHU. U)zited Christian Hospital, Hong Kong SAR, PROC
Background: Two newly emerged respiratory viruses, H5N1 influenza vires and SARS associated coronavirus (SARS CoV), have arisen in Asia at the turn of the millennium. Both are zoonotic in origins and have the potential of causing global pandemics via high-speed international
$49
There has been limited use of control charts in infection control; however guidelines relating to their application and limitations are available. Accepting these limitations and recognizing both our infection control and microbiological resource constraints, we have utilized existing MRSA microbiological data to develop statistical process control charts mid feedback tiffs data to targeted MRSA problem areas within tile hospital in an effort to reduce MRSA. Interpreting control charts, establishment of the program, feedback of data, measuring the effects of interventions and outcome will be discussed.
S31.2
$30.3
Surveillance: The Basics during an Outbreak
Severe Acute Respiratory Syndrome
Patlicia T.Y. CHING. Senior Nursing Ojfice~ Infection Control Uni~
Queen Mary Hospital, Hong Kong SAR, PROC M. PEIRIS. The ly)ziversi~ of Hong Kong Queen Mary Hospital, Hong
Kong SAR, PROC The last 10 years saw the emergence of 4 major infectious disease threats in the Asian region, viz., enterovirus 71, Nipah, avian influenza virus A (H5N1) and SARS. Three of these diseases are of zoonotic origin. These incidents illustrate tile need for preparedness and rapid response to emerging infectious disease ttueats. In tile winter of 2002, an unusual "atypical pneumonia" emel~ged in Guangdong, southern China with a predilection for disease clustering in family members and healtheam workers. The etiological agent was a novel coronavirns (SARS CoV), which emerged from an animal reservoir and adapted to efficient human to human transmission. It spread to affect over 8000 patients in 29 countries across 5 continents. Confronting this outbreak required understanding the etiology, modes of transmission and pathogenesis, developing specific diagnostic tests and effective infection control strategies. In the longer term, identifying therapeutic agents and vaccine development are required.
$31. Surveillance and Healthcare-associated Infections $31.1 Surveillance: Utilizing Statistical Process Control Charts and Feedback Mechanisms in Reducing Resistant Organisms and Healthcare-assoeiated Infections Glenys HARRINGTON, K. WATSON, E. COCKROFF, S. BORRELL, L. HOUSTON, G. LAND. The Alfred, Bayside Health, Melbourne,
Australia Background: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major problem in most Austa'alian hospitals. Successful strategies to control MRSA are often both infection control and micro biological laboratory resoumes intensive. Such resources are limited in Australiml hospitals. A novel and less resource intensive approach to controUing MRSA has been utilized by Culran et al. in tile United Kingdom. This includes tile targeted use and feedback of MRSA microbiological data utilizing statistical process control charts. Main message: Control charts have been used successfully in industry for many years. In industry, control charts are used to analyze data, detect trends or changes mid identify true change from a change that is part of random background variation that is not easy to avoid or control. Average values (mean) mid control limits (upper and lower) are plotted on graphs, usually over time. As discussed by Oaklands et al., control charts can be thought of as a form of traffic signal with lower limits (lamber) indicating that there may be a problem, and upper limits (red) indicating that it is likely there is a problem that must be explored and corrected.
Tile investigation of outbreaks is one of tile most important roles of tile Infection Control Nurse (ICN). To ensure efficiency in tile identification of an outbreak, the Infection Control Unit should have a comprehensive surveillance program that is ongoing. The surveillance should include review of the microbiology laboratory results with focus on organisms causing notifiable disease, e.g., shigellosis mid multi-resistmlt organisms such as MRSA, MR Acinetobacter baumannii. For endemic infectious diseases, each hospital should have a thieshold and investigation should be started whenever tile daily review shows that a disease exceeds tile threshold. The ICN should also rule out variation due to changes in definition, laboratory techniques and surveillance methods. The steps of the investigations are as follows: 1 Initial evaluation: Is tile outbreak worth investigating? 2 Initial case definition and case-finding 3 Initial collection of data and specimens 4 Institute standard control measures 5 Evaluate basic investigations compatible with known epidemiology? 6 Make list listing and draw epidemic curve 7 Start major investigation with further definition refinement and data/specimens collection 8 Hypothesis generation mid refining data 9 Hypothesis proving: case-control & typing studies 10 Finalize and implement control measures After the investigation, the ICN should give feedback to the ward and also to the Infection Control Committee. In times of massive community outbreaks such as SARS, tile Infection Control Unit should also inform tile local authority. Outbreak investigation is an important role of tile Infection Control Unit. This is a responsibility of both the infection control doctor and infection control nurses, who should be familiar with the steps. The involvement of the laboratory is key in the identification of the causative organism and also when typing is indicated. Observation and discussion with tile front-line staff is paramount, especially when there is a bleach in patient care procedures.
$32. Respiratory Infections in Asia (Co-sponsored
by the Hongkong Thoracic Society) $32.1 HSN1 and SARS - What Have We Learned? Chung Ming CHU. U)zited Christian Hospital, Hong Kong SAR, PROC
Background: Two newly emerged respiratory viruses, H5N1 influenza vires and SARS associated coronavirus (SARS CoV), have arisen in Asia at the turn of the millennium. Both are zoonotic in origins and have the potential of causing global pandemics via high-speed international