Korean J healthc assoc Infect Control Prev.  2022 Dec;27(2):104-117. 10.14192/kjicp.2022.27.2.104.

Applicability of New Indicators for Healthcare-associated Infections Surveillance in Korea

• Park SH
• Cho SY
• Choi SH
• Choi JY
• Son HJ
• Kim HB
• Lee MS

• KMID: 2537071
• DOI: http://doi.org/10.14192/kjicp.2022.27.2.104

Abstract

The Korean National Healthcare-associated Infections Surveillance System (KONIS) started surveilling healthcare-associated infections (HAIs) in intensive care units in 2006. Since then, the KONIS modules have expanded, and the participating hospitals have diversified. To allow for these changes, surveillance indicators need to be improved to represent national data and provide useful benchmarks. Herein, we reviewed the national HAI surveillance systems in 11 countries and the European Union, which were searched online during October–December 2019, and compared the target healthcare facilities, indicators, and surveillance methods. Twelve experts independently evaluated the priorities in terms of disease burden, relevance, intervenability, urgency, applicability, acceptability, barriers and facilitators of implementation on a scale of 0-10 in each category, and the highest score had the highest priority. This review identified five areas of improvement. First, new surveillance nfl indicators that require web-based automated systems can be introduced. These would include laboratory-based surveillance, such as Clostridioides difficile infection and multi-drug resistant organisms, and surveillance of antimicrobial resistance and use. Second, surveillance areas can be expanded to general or specialized wards, according to the needs of the participating hospitals. Third, healthcare facilities, such as outpatient dialysis clinics or outpatient surgical centers, can be included in the KONIS. Fourth, standardized infection ratios (SIRs) and standardized utilization ratios (SURs) can be introduced as effective benchmarks. Finally, the point prevalence survey can play a supplementary role in identifying new HAIs and help allocate efforts to their prevention. Among these points, the use of SIR and SUR was considered a top priority indicator for the KONIS. As the KONIS continues to evolve, it is necessary to introduce new indicators and benchmark methods to address these changes. It is of utmost importance that the KONIS be operated stably and steadily, and new enrollees in the KONIS need to understand and adapt to the KONIS before introducing new indicators. In addition, it should be evaluated which indicators and benchmarks can be well-incorporated and appropriately used in the KONIS and the government should make efforts to establish an automated surveillance system using electronic medical information.

Keyword

Public health surveillance; Health facilities; Cross infection; Quality indicator; Health care

Figure

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  Fig. 1 The priority scores in introducing new surveillance indicators and benchmarks in the Korean National Healthcare-associated Infections Surveillance System (KONIS). Abbreviations: SUR, standardized utilization ratio; CL, central line; SIR, standardized infection ratio; CLABSI, central line associated bloodstream infection; ACH, acute care hospital; AU, antimicrobial use; PPS, point prevalence survey; CDI, Clostridium difficile infection; AR, antimicrobial resistance; SSI, surgical site infection; LTCF, long-term care facility; HH, hand hygiene; MDRO, multidrug resistant organisms; VEN, ventilator; UC, urinary catheter; GW, general ward; CLIP, central line insertion practice; VAP, ventilator associated pneumonia; CAUTI, catheter-associated urinary tract infection; PedVAP, pediatric VAP; VAE, ventilator-associated events; MBI-LCBI, mucosal barrier injury-laboratory confirmed bloodstream infection.

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