Comprehensive Surveillance Program at a Large Teaching Hospital

Introduction: The Infection Control Unit at our 950-bed (two-site) teaching facility is a member of the National Nosocomial Infection Surveillance (NNIS) system. Targeted surveillance, using NNIS criteria by five infection control practitioners has been performed in surgery and in the medical, surgical, pediatric, and neonatal intensive care units (ICUs). OBJECTIVES: Our comprehensive surveillance program is to monitor high-risk, high-volume surgical procedures; to monitor compliance with surgical prophylactic antibiotic guidelines; to monitor high-risk, compromised patients in the ICU setting; to reduce the incidence of hospital-associated infections by feedback of data to healthcare providers; to compare results from year to year; and to initiate quality improvement (QI) strategies. RESULTS: Surgical site infection (SSI) rates during the past 4 years of vascular, neurosurgery, and orthopedic surgery has ranged from 0% to 3%. A cluster of SSIs during 4 months of cardiothoracic (CT) surveillance contributed to a 9.4% SSI rate in 2000. Following QI strategies, subsequent annual CT SSI rates ranged from 0.16% to 4%. Excellent compliance with selection and timing of prophylactic antibiotic agents was identified during surgical surveillance. Post-op antibiotic dosing has been targeted for QI initiatives. Inappropriate use of vancomycin as a prophylactic agent by CT surgery decreased from 25% in 1995 to 5% in 1996, with subsequent rates not exceeding 2%. Ventilator-associated pneumonia rates (VAPR) during the last four surveillance periods in the surgical ICU ranged from 21 to 29 per 1000 ventilator days. Initiatives were implemented to reduce these rates. NICU surveillance has documented that neonates in the birthweight category (BWC) 1–1000 gm are at higher risk of infection. From January through June 2003, 17 of 19 NICU infections occurred in the BWC 1–1000 gm. CONCLUSION: The effectiveness of our surveillance and prevention program is demonstrated by an overall decrease in hospital-associated infections and the ability to identify areas for improvement. This surveillance program with ongoing data feedback and quality improvement initiatives has contributed to our patient safety initiatives.