Outbreak column 18: The undervalued work of outbreak: prevention, preparedness, detection and management

Abstract

There are oft-quoted studies which advise that between 1% and 10% of healthcare-associated infections (HAIs) present as healthcare-associated outbreaks (HAOs). Examination of these studies showed they lacked validity due to a low sensitivity to detect HAO, and because they pre-date both advanced healthcare systems and the emergence of recent nosocomial pathogen challenges. The accepted inference: that as there are so few HAOs the focus of surveillance programmes should be on endemic and not epidemic infections (outbreaks), is therefore called into question.Current estimates of HAI burden are derived from Point Prevalence Surveys (PPS) which are neither designed to nor are capable of detecting HAOs. We considered the extensive Infection Prevention and Control Team (IPCT) work to prevent and prepare for perennial and novel HAOs and suggest that at present this endeavour is largely unseen, underestimated and undervalued.Any HAI burden estimate needs to comprise a more complete HAI summary than PPS data. This can only be done with a more inclusive surveillance system that has a wider focus than just prevalent infections. There is a real risk of redirection of the IPCT resource from outbreak prevention and preparedness work towards HAI that are counted: such a change could only further increase HAO risks.

IPS spotlight

“…And to be the first to use statistical process control charts for MRSA and C. difficile (I believe in the world) was something special (Curran et al, 2002). I am delighted with the Outbreak Columns in general and in particular the latest one, Outbreak Column number 18, on the undervalued work of outbreak: prevention, preparedness, detection and management (Curran and Dalziel, 2015). I was honoured to have been invited to deliver the Cottrell Lecture at last year’s Infection Prevention Society (IPS) Conference.…”