Learning Module 5: Surveillance and Infection Control

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Government Structure

The Centers for Disease Control and Prevention (CDC)

– Part of the Dept. of Health and Human Services (HHS)

– Federal agency that protects the health and safety of people

– Overall goal = to improve health through disease control and prevention, environmental health, and health promotion and education activities

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CDC’s Partners

State and Local Health Departments• DHS • HHS

- FDA

- ATSDR

- OER

- HRSA

- SAMHSA

• EPA

• DOD • FBI

• DOE • FEMA

• DOT • NRC

• USDA

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CDC’s Roles

• Assess the health of people affected

• Advise state and local health depts. on rapid identification and characterization of potential biologic and chemical agents

• Train public health laboratories in identifying bioterrorist threat agents and efficiently communicating lab findings

• Assess the success of federal, state and local terrorism programs

• Provide training for healthcare professionals in BT and emergency preparedness

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CDC’s Roles

• Establish and maintain a registry of people exposed to or contaminated by radioactive materials

• Maintain the Strategic National Stockpile for pharmaceuticals, antidotes and other medical supplies and equipment

• Implement smallpox vaccination program and conducts evaluation and research on the anthrax vaccine

• Maintain a public response hotline

• Maintain CDC Emergency Preparedness and Response web site

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Ten Essential Services of Public Health

1. Monitor health status

2. Diagnose and investigate

3. Inform, educate and empower

4. Mobilize state and local partnerships

5. Develop policies and plans

6. Enforce laws and regulations

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Ten Essential Services of Public Health

7. Link people to personal health services

8. Assure a competent public and personal healthcare workforce

9. Evaluate personal and population-based health service programs

10. Participate in research

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Key Program Components

An infection-control program should include:• Surveillance• Disease reporting• Monitoring• Standard and contact precautions• Isolation procedures• Outbreak control• Immunizations• Resident and employee health programs• Recognize, track, and monitor infections

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The Cycle of Contagion Process

See following slide for corresponding model:

• Disease-causing agent enters facility (between pathogen and susceptible person)

• Finds a host (resident, staff, object) (between susceptible person and colonization)

• Infects host and pathogen multiplies (between colonization and transmission mode)

• Infected host transmits to others (between pathogen and transmission)

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The Cycle of Contagion Model

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Infection Control Practices

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Infection Control Practices

The infection control actions include:• Barring the entry of a pathogen• Quickly identifying contagious

illness• Protecting individuals against

specific pathogens• Treating individuals to eradicate

colonization or infection• Interrupting transmission through

hygienic measures

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Establish a Surveillance System

• Determine infections you want to track• Identify sources of data • Follow-up on all transfers of residents to acute

care facilities• Adopt written definitions for diagnosing

nosocomial infections• Collect data on an on-going basis

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Analyze Surveillance Data

• Complete a surveillance worksheet• Examine data for trends• Keep accurate records of all

infections• Compute the rates of new infections• Monitor facility's Quality Indicator UTI• Evaluate data weekly to identify

emerging trends • Compile and share data and statistics• Identify and address infection control

issues

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Making Decisions Based on Surveillance Data

The surveillance report should include: • Summary of infections since last report • Summary rates for all nosocomial infections that have

occurred since the last report • Simple graphs that show infection trends • Counts and rates of infection as needed • Your recommendations for actions to

be taken

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Influenza Trends

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Healthcare Provider’s Role

Report suspicions of intentional release to your local or state health department.

Indications of intentional release of a biologic agent include:– Unusual temporal or geographic

clustering of illness – Unusual age distribution for common

diseases – A large number of cases of acute flaccid

paralysis with prominent bulbar palsies, suggestive of a release of botulinum toxin

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Infection-Control Personnel

The infection-control committee should ensure that the LTC community has access to current telephone numbers for notification of:– Appropriate area hospitals– State and local health departments– FBI field office– CDC Emergency Response office

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Bioterrorism Surveillance These steps should be in the Emergency Disaster Plan:

• Recognition and diagnosis by the medical director • Communication of surveillance information to

public health authorities• Epidemiological analysis of the raw surveillance

data• Delivery of the appropriate medical treatment and

public health measures

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Quarantine

Quarantine can be defined as: The compulsory physical separation, including

restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease, or to efforts to segregate these persons within specified geographic areas

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Quarantine as a Last Resort

Legal precedent for the use of quarantine• Problems with its implementation• Should only be used as a last resort• Need to use least restrictive means

available should be used• Residents of long-term care more at-

risk for disease transmission• Quarantine does not equal treatment

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BT Events and Post-Mortem Care

Use universal precautions

Disaster Plan should:• Identify safe location for holding remains. • Include procedures for the safe handling, storage,

and tacking of bodies. • Include arrangements with the county and

emergency management agency or other healthcare delivery systems.

• Include instructions for funeral directors into Disaster Plan.

End of Module 5 Slides