Definitions for the strength of recommendation grading (IA-IC, II, and no recommendation) are provided at the end of the "Major Recommendations" field.
Surveillance
III.A. Monitor the incidence of epidemiologically-important organisms and targeted healthcare-associated infections (HAIs) that have substantial impact on outcome and for which effective preventive interventions are available; use information collected through surveillance of high-risk populations, procedures, devices, and highly transmissible infectious agents to detect transmission of infectious agents in the healthcare facility (Haley et al., 1985; Pottinger, Herwaldt, & Perl, 1997; Lee et al., 1998; Lemmen et al., 2001; Ostrowsky et al., 2001; O'Grady et al., 2002; Gaynes & Emori, 2001; Centers for Disease Control and Prevention [CDC], 2000; Haley, 1995; Curran, Benneyan, & Hood; 2002; Lanotte et al., 2003). Category IA
III.B. Apply the following epidemiologic principles of infection surveillance (Pottinger, Herwaldt, & Perl, 1997; Gaynes & Emori, 2001; Haley, 1995; Curran, Benneyan, & Hood, 2002; CDC, 2001). Category IB
- Use standardized definitions of infection.
- Use laboratory-based data (when available).
- Collect epidemiologically-important variables (e.g., patient locations and/or clinical service in hospitals and other large multi-unit facilities, population-specific risk factors [e.g., low birth-weight neonates], underlying conditions that predispose to serious adverse outcomes).
- Analyze data to identify trends that may indicated increased rates of transmission.
- Feedback information on trends in the incidence and prevalence of HAIs, probable risk factors, and prevention strategies and their impact to the appropriate healthcare providers, organization administrators, and as required by local and state health authorities.
III.C. Develop and implement strategies to reduce risks for transmission and evaluate effectiveness (Haley et al., 1985; Haley, 1995; Macartney et al., 2000; Lanotte et al., 2003; Weinstock et al., 2000; Coopersmith et al., 2004). Category IB
III.D. When transmission of epidemiologically-important organisms continues despite implementation and documented adherence to infection prevention and control strategies, obtain consultation from persons knowledgeable in infection control and healthcare epidemiology to review the situation and recommend additional measures for control (Haley et al., 1985; Drosten et al., 2003; Ostrowsky et al., 2001). Category IB
III.E. Review periodically information on community or regional trends in the incidence and prevalence of epidemiologically-important organisms (e.g., influenza, respiratory syncytial virus [RSV], pertussis, invasive group A streptococcal disease, Methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE]) (including in other healthcare facilities) that may impact transmission of organisms within the facility (Stevenson, 1999; Ostrowsky et al., 2001; O'Brien et al., 2002; Nicolle et al., 1999; Seybold et al., 2006). Category II
Definitions:
Strength of the Recommendations
The recommendations are categorized on the basis of existing scientific data, theoretical rational, applicability, and when possible, economic impact, as follows:
Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.
Category IB. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.
Category IC. Required for implementation, as mandated by federal and/or state regulation or standard.
Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.
No recommendation; unresolved issue. Practices for which insufficient evidence or consensus regarding efficacy exists.
