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The Keen Surveillance of John Snow

John Snow’s investigation of the 1854 cholera outbreak in London is an early example of Surveillance. With the “germ theory” of the disease still to be postulated, he used rudimentary epidemiological and statistical methods to identify water as the outbreak’s source. 

Dr. Snow spent countless hours on the trail of Surveillance over hospital and government documents to determine the outbreak’s onset. He recommended removing the Broad Street pump handle, preventing further consumption of contaminated water and stopping the attack. This investigation led him to be the father of epidemiology. One sees from it the importance of Surveillance for public health care.

So, his keen observation and study showed everyone the real big picture of disease outbreaks!

 Clinical Surveillance: The Core Element of Epidemiology 

In public health, Surveillance is the “continuous, systematic collecting, analysis, interpretation, and dissemination of data regarding a health-related event to reduce morbidity and death and improve health.”

Clinical Surveillance is an essential component of infection prevention and control. High-quality information on infectious diseases, healthcare-associated infections, and antimicrobial-resistant organisms are necessary to monitor progress, investigate underlying causes, and apply prevention and control measures.

Clinicians can monitor their patients in emergency rooms, operating rooms, intensive care units, and other places. The system connects to some medical devices, such as ventilators, infusion pumps, and patient care monitors. Clinical Surveillance uses data from all connected devices and other sources to detect patient changes and generate clinical alerts. Surveillance improves hospital workflow and patient care. 

Epidemiologists and other public health professionals can monitor the “normal” levels of disease in a population through surveillance activities. The ultimate objective of Surveillance is to detect possible hazards to public health before a public health crisis occurs. 

Need For Surveillance Post-Pandemic

The COVID-19 pandemic pushed healthcare facilities to their breaking points, resulting in increased antimicrobial use and difficulty following infection prevention and control guidance. These challenges predictably lead to an increase in healthcare-associated, antimicrobial-resistant infections in hospitals, with an increase in resistant hospital-onset infections and deaths during the first year of the pandemic. The pandemic highlighted the need for better surveillance systems and updated IPC programs. It is time for the health systems to consider shifting the paradigm toward modern technologies like the recent introduction of electronic surveillance systems.

Role of Electronic Surveillance System

Electronic surveillance systems enhance Surveillance to improve infection prevention and control program decisions. Healthcare facilities worldwide are storing patient medical data in them. Electronic surveillance systems in high-income countries include patient demographics, physician notes, nursing evaluations, patient issue lists, medication lists, discharge summaries, radiology reports, diagnostic test findings, and records for medication. 

Hospital-Acquired Infections

In healthcare settings, one of the essential parts of infection prevention control is keeping an eye out for HAIs.Patients contract healthcare-associated infections during medical or surgical procedures. The widespread misuse of antibiotics has led to the emergence of endemic multidrug-resistant organisms, among the leading causes of HAIs.These infections are potentially fatal and can cause sepsis and other complications. 

HAIs increase hospital stays morbidity and expenses. Endemic HAI surveillance measures their burden, identifies high-risk people and processes, and guides HAI prevention efforts. So, designing a system for collecting data for HAI cases is necessary. 

Surgical Site infections

Our skin serves as a natural defense against infection. Even with several measures and processes to prevent disease, every surgery that generates a skin break can result in a condition. These infections occur in the body at the surgery site, hence known as surgical site infections (SSIs). Microorganisms cause infections following surgery. These include the bacteria Staphylococcus, Streptococcus, and Pseudomonas as the most prevalent. Germs can infect a surgical wound in various ways, through the touch of a contaminated carer, surgical equipment, bacteria in the air, or germs that are already on or in your body and spread to the wound.

Surgical Site Infection Surveillance Service (SSISS) enables hospitals to record incidences of infection following surgery, track patient outcomes, and review or modify practices to prevent infections. This service supports the mandatory Surveillance of SSI in 4 categories of orthopedics and voluntary Surveillance in 13 types of surgical procedures.

 Surveillance Service Goals

The surveillance service provides hospitals with a protocol and tools to collect and analyze data on SSI using the minimum data required to consider key risk factors. It also provides national data for benchmarking SSI rates and ensures high data quality standards. It analyses data to improve our understanding of SSI epidemiology and maintain, as far as possible, comparability with data previously collected so staff can evaluate trends over time.

Conclusion

The world of medical healthcare is changing rapidly, and with ever-increasing advancements, humans need to go hand in hand with technology for a better healthcare system. Newer technologies like electronic case management based on machine learning and Al can assist healthcare organizations in seeing trends in vast amounts of data while making that data more secure and accessible. It has the potential to help turn unsustainable healthcare systems into sustainable ones and level the playing field between medical professionals and patients, improving patient experience and the entire healthcare system.

References

  1. Surgical site infection surveillance service (SSISS). (2022, September 22). GOV.UK. https://www.gov.uk/guidance/surgical-site-infection-surveillance-service-ssiss
  2. O., & Chodosh, S. (2021, April 26). You know nothing. Meet the real John Snow. Popular Science. https://www.popsci.com/real-john-snow/
  3. SURVEILLANCE POLICY FOR INFECTION PREVENTION AND CONTROL, NHS,2019.
  4. Surgical Site Infections. (2019, November 22). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections