Outi Lyytikäinen, THL: Surveillance of healthcare-associated infections

1. SURVEILLANCE OF
HEALTHCARE-
ASSOCIATED INFECTIONS
Outi Lyytikäinen, research professor
Finnish Hospital Infection Program (SIRO)
Department of Health Security
National Institute for Health and Welfare (THL)
7.6.2019 Nurses' role in HAI surveillance/O Lyytikäinen 1

2. Surveillance of healthcare-associated
infections
 Surveillance of healthcare-associated infections (HAI)
– National surveillance activities and surveys in Finland
 Nurses’ roles in acute care hospitals and long-term care
facilities/services
– Infection control (IC) nurses
– Link nurses
– Registered nurses and nursing assistants
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3. Surveillance of healthcare-associated
infections (HAI)
 HAIs are one of the most common adverse events in healthcare
– 1 in 15 hospital patients (ECDC-PPS 2016-2017)
– 1 in 24 long-term care facility (LTCF) residents (HALT 2016-2017)
– Annually 8.8 million HAIs in European hospitals and LTCFs
 In acute care hospitals HAIs are usually more severe
(pneumonia, surgical site infections and bloodstream
infections) than in LTCFs (respiratory infections other than
pneumonia, urinary tract infections and skin/wound infections)
 Majority of the burden of bacteria resistant to antibiotics in Europe
is due to HAIs
 >50% of certain HAIs are preventable
 Surveillance of HAIs is crucial part of effective hospital infection
control program
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4. Background - Finland
 5.5 million population
 20 healthcare districts and
 5 university,15 central and ~30 other acute care hospitals
 1000-2000 long-term care facilities (LTCF)
 Communicable Disease Act passed in 2016
– All healthcare facilities (HCF) incl. LTCFs should have infection
control activities, including control of antimicrobial resistance (AMR)
and HAI surveillance
– Infection control teams (infectious disease doctor, microbiologist and
infection control nurses) in healthcare districts have a consulting role
in these activities, usually working in acute care hospitals
– Some requirements for HCFs to participate in national and regional
activities: incidence surveillance and prevalence surveys as well as
notify certain severe HAI cases and suspected outbreaks
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6. Finland - infection control
 Finnish Society for Infection Control 1975
– >1000 members: majority are nurses (IC nurses and
link nurses), ~10% physicians
– Bulletin 4 times per year and annual meetings
 Three national surveys on infection control (IC)
resources and activities in 2000, 2008 and 2015
 IC committees, IC nurses and IC doctors in all
university and central hospitals
 Link nurse system common
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7. National activities related to HAI prevention
 Finnish Hospital Infection Program (SIRO) collaborates with regional
authorities and experts and acute care hospitals and long-term care
facilities to increase awareness in HAIs and HAI prevention
– SIRO provides surveillance methods to identify HAI problems
– SIRO evaluates infection prevention and control activities in
acute care hospitals
– SIRO draws up guidelines to prevent most common HAIs
– SIRO support communication between different actors in
outbreaks in order to implement control measures timely
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8. National surveillance activities in acute care
hospitals
1. Surgical site infections (SSI) in 10 procedure groups 1999-
 Hip and knee prosthesis, femur fractures, and coronary surgery
 2002 abdominal hysterectomies, appendectomies, breast surgery
and cesarean sections
 2008 laminectomy, spinal fusion
2. Nosocomial bloodstream infections (BSI) 1999-
3. Clostridium difficile infections (CDI) 2008-
4. Prevalence surveys on all types of HAIs
 The first national survey in 2005
 In 2011 and 2016 the EU surveys (ECDC-PPS) coordinated by
ECDC
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9. 1. Surveillance of surgical site infections (SSI)
 Common protocol and training webinars at THL website
 Data collection in hospitals by IC nurses
– Case finding using CDC/EU definitions for SSI
– Data sources
 Microbiology laboratories: positive wound cultures
 Ward notifications by link nurses
 Post-discharge SSIs: readmissions, control visits and questionnaires
 Electronic reporting to the national database by IC nurses
– Data on SSIs and all operated patients (denominator data) from
hospital’s information system (operation theater and administration)
– Checking the data
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10. 2. Surveillance of nosocomial bloodstream
infections (BSI)
 Common protocol and training webinars at THL website
 Data collection by IC nurses
– CDC definition for nosocomial BSI (1988)
– Data source
 Microbiology laboratories: positive blood cultures
 Community vs. nosocomial origin based on symptom onset or specimen
dates and administrative data on admission/discharge dates
 Electronic reporting to the national database by IC nurses
 Data on BSIs and patient-days from hospital’s information system
 Checking the data
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11. 3. Surveillance of Clostridium difficile infections
(CDI)
 Common surveillance protocol with EU definitions for severe and recurrent
CDI cases and origin (community vs. healthcare-associated) and training
webinars at THL website
 Data collection by IC nurses
– Data source
 Microbiology laboratories: positive Clostridium difficile findings
 Community vs. healthcare-associated origin based on symptom onset
or specimen dates and administrative data on admission/discharge
dates
 Electronic reporting to the national database by IC nurses
 Data on CDIs and patient-days from hospital’s information system
 Checking the data
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12. Feedback of surveillance data
 National surveillance data
– Closed website for participating hospitals (IC nurses/doctors and
microbiologists)
 Hospital-specific data and anonymous ranking of infection rates
– Public website
 Aggregated data and annual reports
 Hospital-specific SSI data
– IC nurses and doctors > surgical team incl. surgeons and department head
– Checking the implementation of infection prevention guidelines
 Hospital-specific BSI and CDI data
– IC nurses > ward staff (nurses and doctors) and department head
– Checking the implementation of infection prevention and control guidelines
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13. 4. Prevalence Surveys 2011 and 2016
 ECDC-PPS surveillance protocol with EU definitions translated to Finnish
 Training of infection control teams in hospitals (IC nurses, infectious disease
doctor, microbiologist)
– Webinar on protocol and cases studies
– Extranet during the data collection (questions and answers)
– Feedback webinar on results
 IC nurses in hospitals trained the link nurses and ward staff
 Data collection on paper forms by IC nurses in collaboration with ward staff
– Background data of patients by link nurses
– HAI data by IC nurses and if needed by IC doctors
 Data entry on national level at THL
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HALT survey in 2017
coordinated by ECDC
• National training and
webinars for regional IC
teams/nurses
• IC nurses identified and
trained link nurses in
LTCFs who did locally
the data collection
• Regional link nurse
system for LTCFs

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Resident Assessment Instrument (RAI) in
Finnish long-term care facilities
• >40% of the Finnish LTCFs use RAI instrument to assess
residents´ status at admission and at least twice a year to
develop individualized plans for care
• Current quality indicators related to infections:
antimicrobial use, urinary catheters, urinary tract
infections and influenza vaccination
• Data collection by trained RAI nurses

16. IC nurses per 250 hospital beds
2011 vs. 2016
≥1.3 vs. 1.6
IC doctors per 250 hospital beds
2011 vs. 2016
0.5 to <0.8 vs. 0.6
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 Core competencies (knowledge, skills and abilities) are
defined for medical doctors, nurses or caregivers.
 Core competencies are classified in areas and
domains, and separately for introductory and expert
level.
 Introductory level (junior specialist): newly
appointed infection control and hospital hygiene staff
member with little or no previous experience.
 Expert level (senior specialist): infection control and
hospital hygiene professionals who are confident and
experienced; who use reasoning, critical thinking,
reflection and analysis to inform his/her assessment
and decision-making; and are able to develop and
implement new solutions to problems.
• University of applied sciences offer practice-oriented higher
education at both Bachelor's and Master's levels as well as further
education for registered nurses and infection control nurses:
30 ECTS (junior) and 30 ECTS (senior)
• ECTS - European Credit Transfer and Accumulation System

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