Outbreak management ppt comprises the definition , history , investigations and the steps of management of outbreak. This was my seminar and UG class tpoic
Outbreak management ppt comprises the definition , history , investigations and the steps of management of outbreak. This was my seminar and UG class tpoic
Content
What is disease and disease control ?
What is disease Elimination and Eradication ?
Concept of control
Disease control measures
Breaking the chain of infection
National Health Programs for Disease Control
Learning Objectives
Describe about disease and disease control
Differentiate between disease elimination and eradication
Describe the chain of infection and measures to break it
Describe action to be taken for controlling of disease
Enlist the types of surveillance
Enlist the health program runs in India for controlling of disease
Disease
A pathogenic condition in which the normal functioning of an organism or body is impaired or disrupted resulting in extreme pain, dysfunction, distress, or death.
Source of disease
Human Tb, chickenpox, Covid-19
Water cholera, diarrhea, typhoid
Animal Rabies
Disease control
It refers to reducing the transmission of a disease to a level when it no longer remains a “public health problem”.
Example :- In London John Snow controlling the cholera by removing the handle of incriminated water pump.
Disease Elimination:
Reduction of incidence of a disease in a defined geographic area to a predetermined very low level or to zero with continued intervention is known as elimination.
Example - Elimination of Measles, Polio and Diphtheria from large geographic regions or areas.
Disease Eradication:
Eradication is permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts.
Eradication literally means to "tear out by roots".
Example - Small pox is only a disease which is Eradicated
It is eradicated in 1980
Concept of control
The term disease control describes ongoing operations aimed at reducing :-
The incidence of disease
The duration of disease, and consequently the risk of transmission
The effects of infection, including both the physical and psychosocial complication
The financial burden to the community.
DISEASE CONTROL MEASURES
Every disease has certain weak link in the ‘Chain of transmission’.
The basic principle or approach in disease control is to identify that weakest link and break it.
This requires sound epidemiological knowledge about the disease study such as - Epidemiological determinants, Magnitude of disease, distribution of disease etc.
IV. Disease control measures are undertaken to –
- Prevent occurrence of disease
- Reduce morbidity and mortality due to disease
V. It requires :-
Teamwork,
Community participation,
Inter sectoral coordination
Political support and
Adequate information about disease epidemiology
• For disease control action taken at the following levels–
Controlling the Source of Infection
Interruption Transmission of Disease
Protection of Susceptible Host
Reservoir & Controlling the Source of Infection
The chain of transmission of a disease starts from the source or reservoir.
Guidelines for Management of Outbreak in Healthcare Organizationdrnahla
Guidelines for Management of Outbreak in Healthcare Organization
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Past and future of eradication and elimination of different diseases. How to plan for elimination and eradication. What are the diseases can be eliminated? OPV to IPV shift!
Rabies is a deadly virus spread to people from the saliva of infected animals. The rabies virus is usually transmitted through a bite.
Animals most likely to transmit rabies in the United States include bats, coyotes, foxes, raccoons and skunks. In developing countries of Africa and Southeast Asia, stray dogs are the most likely to spread rabies to people.
Once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. For this reason, anyone who may have a risk of contracting rabies should receive rabies vaccines for protection.
To understand:
The principles of detecting and controlling an
outbreak.
What is needed for outbreak investigation
Steps in disease outbreak investigations.
The value of real-world evidence for clinicians and clinical researchers in t...Arete-Zoe, LLC
In the midst of a rapidly spreading global pandemic, real-world evidence can offer invaluable insight into the most promising treatments, risk factors, and not only predict but suggest how to improve outcomes. Despite overwhelming news coverage, significant knowledge gaps regarding COVID-19 persist. The current uncertainties regarding incidence and the case fatality rate can only be addressed by widespread testing. But the paucity of testing, and diversity of approaches implemented in different countries, particularly among the general asymptomatic public, perpetuates a lack of understanding about spread and infectivity. The essential indicators that would describe the pandemic more accurately can be obtained using real-world data (RWD). To that purpose, we designed a data collection tool to collect data from hospitals that treat COVID-19 patients. The captured data will enhance our understanding of the COVID-19 pandemic, identify risk factors relevant for triage, relate to other similar seasonal infections and gain insight into the safety and efficacy of experimental and off-label therapies. Knowledge derived from a focused data collection effort will enable clinicians to adjust rapidly clinical protocols and discontinue interventions that turn out to be ineffective or harmful. By deploying our elegantly designed survey to capture routine clinical indicators, we avoid placing an additional burden on practitioners. Systematically generating real-world evidence can decrease the time to insight compared to randomized clinical trials, improving the odds for patients in rapidly changing conditions.
Content
What is disease and disease control ?
What is disease Elimination and Eradication ?
Concept of control
Disease control measures
Breaking the chain of infection
National Health Programs for Disease Control
Learning Objectives
Describe about disease and disease control
Differentiate between disease elimination and eradication
Describe the chain of infection and measures to break it
Describe action to be taken for controlling of disease
Enlist the types of surveillance
Enlist the health program runs in India for controlling of disease
Disease
A pathogenic condition in which the normal functioning of an organism or body is impaired or disrupted resulting in extreme pain, dysfunction, distress, or death.
Source of disease
Human Tb, chickenpox, Covid-19
Water cholera, diarrhea, typhoid
Animal Rabies
Disease control
It refers to reducing the transmission of a disease to a level when it no longer remains a “public health problem”.
Example :- In London John Snow controlling the cholera by removing the handle of incriminated water pump.
Disease Elimination:
Reduction of incidence of a disease in a defined geographic area to a predetermined very low level or to zero with continued intervention is known as elimination.
Example - Elimination of Measles, Polio and Diphtheria from large geographic regions or areas.
Disease Eradication:
Eradication is permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts.
Eradication literally means to "tear out by roots".
Example - Small pox is only a disease which is Eradicated
It is eradicated in 1980
Concept of control
The term disease control describes ongoing operations aimed at reducing :-
The incidence of disease
The duration of disease, and consequently the risk of transmission
The effects of infection, including both the physical and psychosocial complication
The financial burden to the community.
DISEASE CONTROL MEASURES
Every disease has certain weak link in the ‘Chain of transmission’.
The basic principle or approach in disease control is to identify that weakest link and break it.
This requires sound epidemiological knowledge about the disease study such as - Epidemiological determinants, Magnitude of disease, distribution of disease etc.
IV. Disease control measures are undertaken to –
- Prevent occurrence of disease
- Reduce morbidity and mortality due to disease
V. It requires :-
Teamwork,
Community participation,
Inter sectoral coordination
Political support and
Adequate information about disease epidemiology
• For disease control action taken at the following levels–
Controlling the Source of Infection
Interruption Transmission of Disease
Protection of Susceptible Host
Reservoir & Controlling the Source of Infection
The chain of transmission of a disease starts from the source or reservoir.
Guidelines for Management of Outbreak in Healthcare Organizationdrnahla
Guidelines for Management of Outbreak in Healthcare Organization
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Past and future of eradication and elimination of different diseases. How to plan for elimination and eradication. What are the diseases can be eliminated? OPV to IPV shift!
Rabies is a deadly virus spread to people from the saliva of infected animals. The rabies virus is usually transmitted through a bite.
Animals most likely to transmit rabies in the United States include bats, coyotes, foxes, raccoons and skunks. In developing countries of Africa and Southeast Asia, stray dogs are the most likely to spread rabies to people.
Once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. For this reason, anyone who may have a risk of contracting rabies should receive rabies vaccines for protection.
To understand:
The principles of detecting and controlling an
outbreak.
What is needed for outbreak investigation
Steps in disease outbreak investigations.
The value of real-world evidence for clinicians and clinical researchers in t...Arete-Zoe, LLC
In the midst of a rapidly spreading global pandemic, real-world evidence can offer invaluable insight into the most promising treatments, risk factors, and not only predict but suggest how to improve outcomes. Despite overwhelming news coverage, significant knowledge gaps regarding COVID-19 persist. The current uncertainties regarding incidence and the case fatality rate can only be addressed by widespread testing. But the paucity of testing, and diversity of approaches implemented in different countries, particularly among the general asymptomatic public, perpetuates a lack of understanding about spread and infectivity. The essential indicators that would describe the pandemic more accurately can be obtained using real-world data (RWD). To that purpose, we designed a data collection tool to collect data from hospitals that treat COVID-19 patients. The captured data will enhance our understanding of the COVID-19 pandemic, identify risk factors relevant for triage, relate to other similar seasonal infections and gain insight into the safety and efficacy of experimental and off-label therapies. Knowledge derived from a focused data collection effort will enable clinicians to adjust rapidly clinical protocols and discontinue interventions that turn out to be ineffective or harmful. By deploying our elegantly designed survey to capture routine clinical indicators, we avoid placing an additional burden on practitioners. Systematically generating real-world evidence can decrease the time to insight compared to randomized clinical trials, improving the odds for patients in rapidly changing conditions.
The Gibraltar COVID-19 Cohort: Determining the True Incidence and Severity Ra...asclepiuspdfs
COVID-19 is a new infectious disease with an unclear incidence and an unknown rate of progression to severe disease. The Gibraltar COVID-19 Cohort utilises two distinct cohorts - a clinical cohort and a random population based cohort -, to provide an accurate assessment of case severity rate. Design: Retrospective analysis of a SARS-CoV2 RT-PCR point prevalence study and a RT-PCR confirmed positive clinical case cohort to calculate case severity rates. Settings and Participants: Over a three day period nasopharyngeal swabs were sampled from a randomly selected 1.2% of the population of Gibraltar and then analysed via RT-PCR to determine the background incidence of COVID-19 infection. The results were then analysed and compared to the clinical case cohort. The rate of progression to severe COVID-19 disease in those with COVID-19 infection was then calculated.
SYSTEMS-LEVEL QUALITY IMPROVEMENTFrom Cues to Nudge A Knolisandrai1k
SYSTEMS-LEVEL QUALITY IMPROVEMENT
From Cues to Nudge: A Knowledge-Based Framework
for Surveillance of Healthcare-Associated Infections
Arash Shaban-Nejad1,2 & Hiroshi Mamiya2 & Alexandre Riazanov3 & Alan J. Forster4 &
Christopher J. O. Baker2,5 & Robyn Tamblyn2 & David L. Buckeridge2
Received: 3 June 2015 /Accepted: 30 September 2015 /Published online: 4 November 2015
# Springer Science+Business Media New York 2015
Abstract We propose an integrated semantic web framework
consisting of formal ontologies, web services, a reasoner and a
rule engine that together recommend appropriate level of
patient-care based on the defined semantic rules and guide-
lines. The classification of healthcare-associated infections
within the HAIKU (Hospital Acquired Infections – Knowl-
edge in Use) framework enables hospitals to consistently fol-
low the standards along with their routine clinical practice and
diagnosis coding to improve quality of care and patient safety.
The HAI ontology (HAIO) groups over thousands of codes
into a consistent hierarchy of concepts, along with relation-
ships and axioms to capture knowledge on hospital-associated
infections and complications with focus on the big four types,
surgical site infections (SSIs), catheter-associated urinary tract
infection (CAUTI); hospital-acquired pneumonia, and blood
stream infection. By employing statistical inferencing in our
study we use a set of heuristics to define the rule axioms to
improve the SSI case detection. We also demonstrate how the
occurrence of an SSI is identified using semantic e-triggers.
The e-triggers will be used to improve our risk assessment of
post-operative surgical site infections (SSIs) for patients un-
dergoing certain type of surgeries (e.g., coronary artery bypass
graft surgery (CABG)).
Keywords Ontologies . Knowledge modeling .
Healthcare-associated infections . Surveillance . Semantic
framework . Surgical site infections
Introduction
Healthcare-associated Infections (HAIs) affect millions of
patients around the world, killing hundreds of thousands
and imposing, directly or indirectly, a significant socio-
economic burden on healthcare systems [1]. According
to the Centers for Disease Control (CDC) [2], hospital-
acquired infections in the U.S., where the point preva-
lence of HAIs among hospitalized patients is 4 %, result
in an estimated 1.7 million infections, which lead to as
many as 99,000 deaths and cost up to $45 billion annually
[3, 4]. Similar or higher rates of HAI occur in other coun-
tries as well with an estimated 10.5 % of patients in Ca-
nadian hospitals having an HAI [5]. Clinical assessment
and laboratory testing are generally used to detect and
confirm an infection, identify its origin, and determine
appropriate infection control methods to stop the infection
from spreading within a healthcare institution. Failure to
monitor, and detect HAI in timely manner can delay di-
agnosis, leading to complications (e.g., sepsis), and
allowing an epid ...
This study was conducted to understand the status of scabies infection and its
epidemic characteristics in the Korean hospitals. 43 hospitals (86.0%) received the
reports of scabies infection with suspicious or definite diagnosis to infection control
department, implicating continuous increases 14.6% (7/48), 20.8% (10/48), 35.7%
(17/48), 44.1% (21/48), and 56.7% (27/48) in 2010 to 2013 and 35.7% (17/48) in 2014
up to April.
92.0% of the hospitals had the rules and guideline of scabies infection control,
which seemed to be prepared by the recent certifications of medical institutions and
establishment of rules in infection control departments. However, less than half of the
hospitals 44.0% (22/50) prepared the screening system related to scabies during the
admission processes of the patients, 56.7% of the patients had the typical symptoms
related to scabies when they admitted with 47.0% of pruritus, requiring the system to
prevent from the scabies epidemic beforehand
SYSTEMS-LEVEL QUALITY IMPROVEMENTFrom Cues to Nudge A Kno.docxdeanmtaylor1545
SYSTEMS-LEVEL QUALITY IMPROVEMENT
From Cues to Nudge: A Knowledge-Based Framework
for Surveillance of Healthcare-Associated Infections
Arash Shaban-Nejad1,2 & Hiroshi Mamiya2 & Alexandre Riazanov3 & Alan J. Forster4 &
Christopher J. O. Baker2,5 & Robyn Tamblyn2 & David L. Buckeridge2
Received: 3 June 2015 /Accepted: 30 September 2015 /Published online: 4 November 2015
# Springer Science+Business Media New York 2015
Abstract We propose an integrated semantic web framework
consisting of formal ontologies, web services, a reasoner and a
rule engine that together recommend appropriate level of
patient-care based on the defined semantic rules and guide-
lines. The classification of healthcare-associated infections
within the HAIKU (Hospital Acquired Infections – Knowl-
edge in Use) framework enables hospitals to consistently fol-
low the standards along with their routine clinical practice and
diagnosis coding to improve quality of care and patient safety.
The HAI ontology (HAIO) groups over thousands of codes
into a consistent hierarchy of concepts, along with relation-
ships and axioms to capture knowledge on hospital-associated
infections and complications with focus on the big four types,
surgical site infections (SSIs), catheter-associated urinary tract
infection (CAUTI); hospital-acquired pneumonia, and blood
stream infection. By employing statistical inferencing in our
study we use a set of heuristics to define the rule axioms to
improve the SSI case detection. We also demonstrate how the
occurrence of an SSI is identified using semantic e-triggers.
The e-triggers will be used to improve our risk assessment of
post-operative surgical site infections (SSIs) for patients un-
dergoing certain type of surgeries (e.g., coronary artery bypass
graft surgery (CABG)).
Keywords Ontologies . Knowledge modeling .
Healthcare-associated infections . Surveillance . Semantic
framework . Surgical site infections
Introduction
Healthcare-associated Infections (HAIs) affect millions of
patients around the world, killing hundreds of thousands
and imposing, directly or indirectly, a significant socio-
economic burden on healthcare systems [1]. According
to the Centers for Disease Control (CDC) [2], hospital-
acquired infections in the U.S., where the point preva-
lence of HAIs among hospitalized patients is 4 %, result
in an estimated 1.7 million infections, which lead to as
many as 99,000 deaths and cost up to $45 billion annually
[3, 4]. Similar or higher rates of HAI occur in other coun-
tries as well with an estimated 10.5 % of patients in Ca-
nadian hospitals having an HAI [5]. Clinical assessment
and laboratory testing are generally used to detect and
confirm an infection, identify its origin, and determine
appropriate infection control methods to stop the infection
from spreading within a healthcare institution. Failure to
monitor, and detect HAI in timely manner can delay di-
agnosis, leading to complications (e.g., sepsis), and
allowing an epid.
Diagnostic accuracy of MALDI-TOF mass spectrometry for the direct identification of clinical pathogens from urine
Journal Club (Systematic Review & Meta Analysis)
Clinical Microbiology Fellowship
Approach to Aquatic Skin & Soft Tissue Infections. Clinical Microbiology Residency Program
King Fahd Hospital of The University, Al Khobar
Saudi Arabia
To Present an up-to-date summary of the best microbiology practice related to malaria diagnostics
PGY-3, IAU Clinical Microbiology Residency
Dammam, KSA
Best Practice for Colistin Susceptibility Testing: Methods and Evidence (Mini...Abdullatif Al-Rashed
Mini-Review presentation
Best Practice for Colistin Susceptibility Testing: Methods and Evidence
Clinical Microbiology Residency Program, King Fahd Hospital of the University
Al Khobar, Saudi Arabia
Antiretroviral Resistance in HIV-1 Patients at a Tertiary Medical Institute in Saudi Arabia: a Retrospective Study and Analysis.
Journal Club,
Virology Rotation , 1/5/2019
Clinical Approach To Aseptic Meningitis and Encephalitis
Virology Rotation (R2) , Clinical Microbiology Residency
King Fahd Hospital of The University
23/4/2019
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
3. Introduction
Investigations of acute infectious disease outbreaks are very common in hospital
settings.
The most important reason to investigate a recognized outbreak of disease is
that exposure to the source of infection may be continuing; so by identifying
and eliminating the source of infection, we can prevent additional cases.
Other reasons for investigating outbreaks are the opportunity to 1) describe new
diseases and learn more about known diseases; 2) evaluate existing prevention
strategies, e.g., vaccines; 3) teach (and learn) epidemiology; and 4) address
public concern about the outbreak.
Association for Professionals in Infection Control (APIC) and Epidemiology, Inc. (2014). Chapter 12: Outbreak Investigations. In APIC Text of
infection control and epidemiology (4th ed.).
4. Definitions
Association for Professionals in Infection Control (APIC) and Epidemiology, Inc. (2014). Chapter 12: Outbreak Investigations. In APIC Text of
infection control and epidemiology (4th ed.).
Term Definition
An outbreak An increase in the incidence of a particular infection or colonization over the
expected rate or when an unusual microbe or adverse event is recognized.
Pseudo-
outbreak
Episode of increased disease incidence due to enhanced surveillance or
other factor not related to the disease under study. (There is a rise in test
results without actual clinical disease)
Cluster An aggregation of cases in a given area over a particular period regardless of
whether the number of cases is more than expected.
5. Definitions
Association for Professionals in Infection Control (APIC) and Epidemiology, Inc. (2014). Chapter 12: Outbreak Investigations. In APIC Text of
infection control and epidemiology (4th ed.).
Term Definition
Epidemic
curve
is a graph in which the cases of a disease that occurred during an outbreak
are plotted according to the time of onset of illness in each case.
Case
definition
is a standard set of criteria for deciding whether an individual should be
classified as having the health condition of interest. A case definition
includes clinical criteria and, particularly in the setting of an outbreak
investigation, restrictions by time, place, and person.
Line-listing is a two-column list with variables in one column and the number and
percentage of those who match that variable in the other column.
6. What are the ways to
recognize an outbreak?
• Routine surveillance activities
• Reports from clinicians and
laboratories
• Reports from affected
individuals.
Chapter 12: Outbreak Investigations. In APIC Text of infection control and epidemiology (4th ed.).
7. Role of Microbiology lab In
Outbreak Investigation
The microbiology laboratory plays a crucial role in providing
investigative support in an outbreak investigation and in the creation
of routine surveillance information. The availability of culture
reviews, which may result in the initiation of an outbreak
investigation.
8. Causes of Pseudo-outbreaks?
1- Laboratory factors
◆ Introduction of a new test which was previously
unavailable locally.
◆ Introduction of a new laboratory test with poor
specificity and/ or sensitivity.
◆ Improved laboratory techniques for identification.
◆ Contamination during processing in the laboratory of
media or cross- contamination of the specimen during
processing.
9. Causes of pseudo-outbreaks?
2- Ward level
◆ Mis-labelling of specimens. Remember, if in
doubt, ask for another specimen!
◆ Contamination during collection of
specimens if the correct procedure is not
followed or specimen sent in a non- sterile
container.
◆ Incorrect diagnosis of clinical entity.
10. Causes of pseudo-outbreaks?
3- Environmental factors
◆ Use of poor quality of water in the endoscopic washer disinfectors.
• This can occur due to the presence of environmental mycobacteria (e.g.
Mycobacterium chelonae) from the rinse water which subsequently contaminated
bronchial washings sent for culture, leading to false positive results.
11. Steps of an outbreak investigation
1.Verify the diagnosis.
2.Confirm the outbreak.
3.Define a case and conduct case
finding.
4.Tabulate and orient data.
5.Take immediate control
measures.
6. Formulate hypothesis.
7. Test your hypothesis.
8. Plan and execute additional
studies.
9. Implement and evaluate control
measures.
10. Communicate findings.
These steps may occur simultaneously or be repeated as
new information is received.
Third (3rd) edition of GCC Infection Prevention & Control Manual.
13. Case 1
• Known case of SCD admitted to 4C with Vaso-
occlusive crisis, Date of Admission (DOA)
10/6/2019.
• Shifted to MICU in 19/6/2019 duo to cardiac
arrest , bed E137-A
• Was having multiple bed sores, Folyes catheter
and Jagular CV line and on mechanical ventilator
Rectal Screening on 4/7/2019 grew:
14. Case2
• Presented with Stroke. DOA 3/5/2019.
• Admitted in MICU Multiple time last one in
17/6/2019, bed E-144 A
• Was bed ridden and have stroke, dementia, on
mechanical ventilation developed VAP
Transtracheal Culture on 7/9/2019
15. Case 3
• K/C Chrons disease admitted with
acute flare attack with intestinal
obstruction. DOA 22/6/2019
• Admitted in MICU in 1/7/2019, duo to
ARDS and was intubated on
mechanical ventilation bed E-143 A
• Bed ridden and have stroke, dementia,
on mechanical ventilation developed
VAP
Transtracheal Culture and sacral bed sore swab on
11/7/19
16. Case 4
• DOA: 23/6/2019,
• Medically free presented with pylonephritis,
kidney stones, S/P stone removal. Developed
sepsis and VAP after the operation.
• intubated on mechanical ventilation shifted to
SICU in 26/6/19 bed A-101 A
Rectal screening on 4/7/2019
17. Case 5
• K/C DM, HTN, CAD, HF, Post bariatric
surgery. DOA: 3/6/2019.
• Admitted to SICU multiple times duo to
intra-abdominal collections last admission
on 6/7/19 bed A-104 G
• Intubated on mechanical ventilation.
Throat swab on 7/7/2019
18. Case 6
• DOA 4/7/2019,
• Presented with
decreased level of
consciousness duo to
subdural hematoma,
admitted to SICU on
4/7/2019 bed A-104 C .
• Intubated on mechanical
ventilation.
Throat swab on 7/7/2019
19. Case 7
• DOA 23/6/2019,
• Presented with
polytrauma duo to
RTA, was intubated
in 23/6/2019 on
mechanical
ventilation in SICU
bed A-104 F
Transtracheal aspirate on 7/7/2019
20. Summary of Cases
In a one-week interval (4-11/7/2019)
Nearly all of the cases are in near by beds
7 cases grew same strain of MDR Acinetobacter buamannii in surgical and medical ICUs
4 SICU 3 MICU
21. Cont
Microbiolgy oncall team
suspected possible outbreak duo
to recurrent isolation of same
strain of A.bummanii
Infection Control department
has been notified to start an
investigation of possible
outbreak
22. Before starting any investigation:
• Get a commitment of support from the hospital staff and an approval
from the administration and microbiology department.
• Designate a leader for the investigation.
• Advise microbiology to save specimens and isolates for antimicrobial
susceptibility testing , molecular and non-molecular typing .
• Alert laboratory to keep any subsequent isolates that may be part of
the outbreak.
23. 1- Verify diagnosis of the reported cases;
identify agent if possible
1. Rule out pseudo-outbreak
2. Characterize the nature of disease and signs and symptoms by
reviewing patient charts.
3. Obtain appropriate laboratory specimens to identify specific agent
responsible.
In Our Cases?
24. 2- Confirm the existence of an outbreak
• Compare the current incidence with the usual or baseline
incidence:
• Make initial judgment using numerator data.
• Do this comparing the outbreak period rate with the background
rate of the same disease.
• If no local data is available use outbreak rates from the literature.
25. 5
Comments and Recommendations:
Graph Represents the 1st and 2nd quarter of 2019 monthly data over time for “Hospital
acquired MRAB rate”. The P values are less than (0.05), therefore the process was unstable.
and was present of special cause Version.
Graph Represents the comparison of the actual performance of Hospital acquired MRAB
rate of 2014 to the 2nd quarter of 2019 by quarters with the Benchmark. There is an increase
in the rate during the 2nd quarter 2019 (MRAB outbreak in MICU during the month of April
and MRAB outbreak in CCU during the month of May-June)both outbreak were investigated
and corrected by infection control team ),main reasons for the outbreak are 1- the non
availability of recommended supply for cleaning and disinfection of medical equipment
2- staff are not fully compliant with cleaning and disinfection of medical equipment
Letters was made with recommendations to concerned department and administration
Hospital Acquired MRAB rate per 1000 patients days
Infection ControlResponsibility
ProcessType
High risk, Problem prone.Criteria for selection
number of new cases of hospital acquired MRABNumerator
number of patients daysDenominator
N/D * 1000Equation
≤1.2%Threshold
Patient chart/records, Quadra med CPR System, Lab resultData source
SafetyDimension of Performance:
MonthlyFrequency of measurement
1
2
2
1
KFHU Data
26. 3-Define a case definition and conduct case
finding
• Develop a specific case definition using:
Symptoms or laboratory results (Person)
Time period (Time)
Location (Place)
• Conduct surveillance using case definition
Existing surveillance
Active surveillance (e.g. review medical records)
• Interview case-patients
Must be applied consistently and without
bias to all persons under investigation
The case definition maybe changed as new
information is gathered.
27. Characterize cases of diseases by person,
place and time
• Time: used to create an epidemic curve.
• Epidemic curve - Illustrates time course of the outbreak by drawing a histogram of
number of cases by their date of onset.
• Place:
• by service, ward, operating room. May use tables.
• Person:
• Characteristics of the case patients help in defining the most likely risk factors for
infection. Factors to assess include :
• Patient characteristics (i.e., age, sex, underlying disease)
• Possible exposures (i.e., surgery, nursing and medical staff, infected patients)
• Therapeutic modalities (i.e., invasive procedures, medications, antibiotics)
• Use all of the above to develop an accurate description of the population at risk
29. 3- Define a case and conduct case finding
• Classification:
• Definite (confirmed)
• Laboratory confirmed
• Probable
• Typical clinical features without lab confirmation
• Possible (suspected)
• Fewer of the typical clinical features
30. In our Cases?
• Person?
• Patients with multiple comorbidities have MDR Acinetobacter baumannii
• Place?
• MICU & SICU (specify the beds?)
• Time?
• July 2019
31. Search for additional cases:
• Encourage immediate reporting of new cases
by laboratory, physicians, nursing staff and
others as appropriate (e.g. radiology in new
cases of pneumonia).
• Search for other cases that may have
occurred retrospectively or concurrently
through laboratory reports, medical records,
patient charts, physicians and nursing staff
and public health data.
32. 4-Tabulate and orient data
• Create line
listing with
benchmar
k
5
Comments and Recommendations:
Graph Represents the 1st and 2nd quarter of 2019 monthly data over time for “Hospital
acquired MRAB rate”. The P values are less than (0.05), therefore the process was unstable.
and was present of special cause Version.
Graph Represents the comparison of the actual performance of Hospital acquired MRAB
rate of 2014 to the 2nd quarter of 2019 by quarters with the Benchmark. There is an increase
in the rate during the 2nd quarter 2019 (MRAB outbreak in MICU during the month of April
and MRAB outbreak in CCU during the month of May-June)both outbreak were investigated
and corrected by infection control team ),main reasons for the outbreak are 1- the non
availability of recommended supply for cleaning and disinfection of medical equipment
2- staff are not fully compliant with cleaning and disinfection of medical equipment
Letters was made with recommendations to concerned department and administration
Hospital Acquired MRAB rate per 1000 patients days
Infection ControlResponsibility
ProcessType
High risk, Problem prone.Criteria for selection
number of new cases of hospital acquired MRABNumerator
number of patients daysDenominator
N/D * 1000Equation
≤1.2%Threshold
Patient chart/records, Quadra med CPR System, Lab resultData source
SafetyDimension of Performance:
MonthlyFrequency of measurement
1
2
2
1
33. 5-Take immediate control measures
• If an obvious source of the contamination is identified…institute
control measures immediately!
• e.g.: Hand hygiene
• Additional use of barriers (e.g., gloves and gown),or specified
suspected product (e.g., patient care item)
34. In our cases
• Infection control department encourge for strict compliance to hand
hyagine, PPE use and isolation precautions.
What are the infection control precaution of A.baumannii ?
35. 6-Formulate hypothesis
• Record, tabulate and review data collected from above activities to
summarize common host factors and exposures.
• Also Literature reviews of previous outbreaks.
• Develop a hypothesis (best guess) on the likely reservoir source, and
mode of transmission of the disease.
• Hypothesis should explain the majority of cases
36. Hypotheses should address
• Reservoir
• Source of the agent
• Mode of transmission (Vector or vehicle )
• Exposure that caused disease
Review data to determine common host factors and exposures.
37. 7- Test hypothesis
• Analyze data derived from case investigation and determine sources
of transmission and risk factors associated with disease.
40. 8-Plan and execute additional studies
• Environmental sampling or personnel based
oCollect appropriate samples
oAllow epidemiological data to guide testing
oIf analytic study results are conclusive, don’t wait for positive samples
before implementing prevention.
41. In our cases
Investigation was done by the IC team to determine the
source of this recurrent outbreak through direct observation
and environmental cultres.
Including ECG Machines, Nurse stations tables, Portable CXR,
Stethscopes, portable computers, Infusion pumps, bedside files table,
PPE tables, E.g.
42. IC
• Envornmental cultures showed growth of Acintobacter baumannii
MDR (same strain isolated from the patients) in SICU ECG machine.
• Which after investigations showed that is the shared by SICU, MICU, 1D,
burn unit and other units.
• The source of this oubreak has been identified.
• Furthermore, Pseudomonas aerigonosa, Pantoea spp, and E.coli have
beem identified from other medical equepiments.
43.
44.
45.
46.
47.
48.
49.
50.
51. 9-Implement and evaluate control measures
1. Prevent further exposure and future outbreaks by eliminating or
treating the source
2. Work with regulators, industry, and health educators to institute
measures
3. Create mechanism to evaluate both short-and long-term success.
52. In our Cases
• In order to prevent recurrent outbreaks, these actions have
been applied:
Guiding all units about proper cleaning & disinfiction of
medical equipment after each use by the concerned staff
(user).
Strict compliance to hand hyagine, PPE use and isolation
precautions.
KFHU MRAB IPP
54. References
• Third (3rd) edition of GCC Infection Prevention & Control Manual.
• Association for Professionals in Infection Control (APIC) and Epidemiology, Inc.
(2014).
• Chapter 12: Outbreak Investigations. In APIC Text of infection control and
epidemiology (4th ed.).
• KFHU outbreak management IPP
• CBAHI Outbreak Management Manual
There are many definitions of outbreak but this is from APIC book
Causes of pseudo-outbreak will be discussed in the following slides
Epidemic curve is used in outbreak investigation
We will start with this qs
It is better to devide the causes according to
We will go through these steps while discussing the cases
The story started with this case
They repeated screening multiple times
What do you notice regarding the strain
This is the importance of micro lab in outbreak investigation. Suspect possible outbreak if you notice recurrent isolation of same strain of any micro-organisms
Now we will go through the steps in theory and apply it in our cases.
In our cases as we said, acintobacter baumannii was identify it in patients having multiple co-morbidites, bed ridden and on devices. Pseudo-outbreak has been roled out
This is the KFHU data of hospital acquired MRAB
The thershold or benchmark is 1.2% (rate/1000 patients)
This is in details the case definition
They thought that devices are the main source of infection in our cases so
How we implement and evaluate control measures?
by