Surveillance and Reporting of Hospital Acquired Infections (HAIs)

Surveillance and reporting of hospital-acquired infections (HAIs) is an important component of hospital infection control programs that aim to improve patient safety and quality of care. Surveillance is the systematic collection, analysis, and interpretation of data relating to infections acquired in the hospital setting but not present or incubating at the time of patient admission. Regular monitoring aids in the early detection of infection patterns, the identification of outbreaks, and the assessment of infection prevention practices.

Equally important is the early reporting of HAIs to the hospital's Infection Control Committee and the appropriate authorities. All healthcare personnel should report suspected or confirmed HAI cases as soon as possible, including surgical site infections, catheter-associated infections, ventilator-associated pneumonia, and bloodstream infections. Implementation of corrective measures.

Hospitals can reduce the occurrence of HAIs, increase patient trust, and meet NABH and international infection control requirements by maintaining accurate surveillance and transparent reporting.

Would you like me to create a hospital-friendly step-by-step flow (surveillance → reporting → corrective action → feedback) for manuals?

Hospital Acquired Infection (HAI) Surveillance is an organized approach for tracking illnesses that arise in hospital settings. The surveillance cycle consists of four main steps: data collection, data analysis, data interpretation, and data distribution, which ensures an ongoing process of infection monitoring and control.

Objectives of HAI Surveillance:

To determine the baseline (endemic) rate of HAIs and collect data on the different kinds of HAIs that patients are impacted by.
To find differences and areas that require attention by comparing infection rates across various wards or departments within the same hospital as well as with other hospitals.
To pinpoint trouble spots, carry out root cause analysis to find infection control practice weaknesses, and then put corrective measures in place.
To reduce patient risk by identifying and stopping epidemics early.
To track and assess how well infection prevention and control measures are working.
To give physicians and other healthcare professionals immediate feedback that promotes adherence to best practices and ongoing development.

Healthcare Associated Infections Targeted for Surveillance

• Our institute prioritizes HAI surveillance to address key infections that harm patient outcomes and hospital safety:

Catheter-associated urinary tract infections (CAUTI).
Central line-associated blood stream infections (CLABSI)
Ventilator-associated Pneumonia (VAP)
Surgical site infections (SSIs).

Areas of Surveillance

• Surveillance is now limited to critical and high-risk hospital units, but will be expanded if necessary. The current areas include:

High Dependency Units (HDU)/Medical ICU.
Surgical Intensive Care Unit (SICU).
The Neonatal Intensive Care Unit (NICU)
Surgery departments' post-operative wards
All surgical OPDs (to monitor post-discharge surgical site infections).

Procedure for HAI Surveillance

· The hospital adopts an Active Surveillance / Laboratory-based Ward Liaison Surveillance method, which is considered the most reliable for monitoring HAIs. In this system, Infection Control Nurses (ICNs) prospectively monitor patients admitted to the identified areas on a daily basis.

· Monitoring of Patients: ICNs track all new admissions, existing patients with invasive devices (urinary catheter, central line, ventilator), and surgical patients.

· Laboratory Correlation: ICNs review laboratory reports daily to confirm diagnoses of infections.

· Guideline Reference: The surveillance definitions, data collection tools, and analysis protocols are adopted from the National Healthcare Safety Network (NHSN) – CDC Guidelines (Annexure 1 provides case definitions of major HAIs).

Data Collection: Monthly data is compiled from each surveillance area under two main categories:

· a. Identification of HAIs – capturing confirmed cases.

· b. Calculation of Denominator Values – including device days, patient days, and procedure counts, to standardize infection rates.

Identification of HAI

Patients admitted to the designated surveillance areas are monitored daily for the development of targeted HAIs. Infection Control Nurses (ICNs) collect demographic and clinical information using standardized data collection proformas pre-approved by the Hospital Infection Control Committee (HICC) (Annexures 2, 3, and 4 cover adult, pediatric, and immunocompromised patients, respectively).

ICNs also review laboratory reports and correlate the findings with clinical signs to identify infections. Surveillance continues for 15 days of admission or until discharge or death. For patients undergoing major surgeries, ICNs monitor for post-operative infections daily until discharge or death. Surgical Site Infection (SSI) monitoring extends for 30 or 90 days, depending on the type of surgery (Annexure 5). Discharged patients are followed up in surgical OPD during their routine visits using a separate proforma.

At the end of each month, all completed proformas are submitted to the Infection Control Officer, who analyzes the data and diagnoses HAIs according to the CDC case definitions.

This systematic process ensures accurate identification, timely reporting, and effective monitoring of hospital-acquired infections.

Calculation of HAI Rates

The hospital follows the standard CDC/NHSN definitions for Hospital Acquired Infections (HAIs) to ensure uniformity and comparability of data. The incidence rates for device-associated infections—CAUTI, CLABSI, and VAP—are calculated per 1000 device days, while the prevalence of Surgical Site Infections (SSI) is calculated per 100 surgeries performed.

The formulas used for calculation are as follows:

VAP Rate = (Number of VAP cases ÷ Total ventilator days) × 1000
CLABSI Rate = (Number of CLABSI cases ÷ Total central line days) × 1000
CAUTI Rate = (Number of CAUTI cases ÷ Total catheter days) × 1000
SSI Rate = (Number of SSI ÷ Number of surgeries done) × 100
Device Utilization Ratio (DUR) = Number of device days (Foley catheter / central line / ventilator) ÷ Total patient days

Surveillance and Reporting of Hospital Acquired Infections (HAIs)