3.6 Surveillance Across the Care Continuum

CBIC Associate Infection Prevention and Control a-IPC

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1 Chapter 1: Introduction & Exam Overview

1.1 About the CBIC a-IPC Certification 1.2 Exam Format, Scoring, & Logistics 1.3 Effective Study Strategies & Preparation Plan

2 Chapter 2: Processes to Identify Infectious Diseases

2.1 Chain of Infection & Pathogen Characteristics 2.2 Diagnostic & Laboratory Testing in IPC 2.3 Identifying Healthcare-Associated Infection Syndromes 2.4 Specimen Collection, Handling, Storage, & Transport 2.5 Colonization, Infection, Contamination, & Pseudo-Infection 2.6 Prophylactic, Empiric, & Therapeutic Antimicrobial Use 2.7 Host Risk Factors & Emerging Infectious Disease Threats

3 Chapter 3: Surveillance and Epidemiologic Investigation

3.1 Surveillance Methods & Program Design 3.2 Epidemiological Calculations & Rate Metrics 3.3 Outbreak Investigation Protocols & Epidemic Curves 3.4 NHSN Definitions & Standardized Infection Ratios (SIR) 3.5 Descriptive Statistics & Presenting Surveillance Data 3.6 Surveillance Across the Care Continuum 3.7 Notifiable Disease Reporting, Data Sources, & Registries 3.8 Data Validation & Surveillance Program Evaluation 3.9 Outbreak Control Measures, Environmental Sampling, & Reporting

4 Chapter 4: Preventing and Controlling Transmission

4.1 Standard Precautions & Hand Hygiene Guidelines 4.2 Transmission-Based Precautions & Isolation Protocols 4.3 PPE Selection, Donning, Doffing, & Safety 4.4 Safe Injection Practices & Medication Preparation 4.5 Patient-Care Equipment & Point-of-Care Device Handling 4.6 Emergency Preparedness & the Infection Preventionist's Disaster Role 4.7 Bioterrorism, Special Pathogens, & Community Response Planning

5 Chapter 5: Environment of Care

5.1 Environmental Cleaning & Surface Disinfection 5.2 Water Utilities, Air Handling, & Building Systems 5.3 Construction, Renovation, & Infection Control Risk Assessment (ICRA) 5.4 Laundry, Linen, Waste Management, & Food Safety 5.5 Product Recalls, Supply Chain Monitoring, & Device Incident Reporting

6 Chapter 6: Cleaning, Disinfection, and Sterilization of Medical Devices

6.1 Spaulding Classification System 6.2 Reprocessing Steps & High-Level Disinfection (HLD) 6.3 Sterilization Methods, Monitoring, & Quality Assurance 6.4 Single-Use Devices, Outsourced Reprocessing, & IFU Review 6.5 Reprocessing Failure Investigation & Patient Notification

7 Chapter 7: Employee and Occupational Health

7.1 Occupational Exposures & Post-Exposure Prophylaxis 7.2 Healthcare Personnel Immunizations & Screening 7.3 Work Restrictions & Fit-for-Duty Evaluations 7.4 Sharps Injury Prevention, Product Sensitivities, & Alternatives

8 Chapter 8: Management, Communication, and Antimicrobial Stewardship

8.1 IPC Program Governance, Policies, & Accreditation 8.2 Interdisciplinary Collaboration & Crisis Communication 8.3 Antimicrobial Stewardship Principles & Interventions 8.4 Chain of Command, Resource Advocacy, & the Business Case

9 Chapter 9: Education, Research, and Performance Improvement

9.1 Adult Learning Principles & Staff Education 9.2 Quality Improvement Models & Implementation Science 9.3 Critical Appraisal of Infection Prevention Literature

3.6 Surveillance Across the Care Continuum

Key Takeaways Explain This Topic AI

Long-term care facilities use the revised McGeer criteria rather than NHSN acute-care definitions, and the LTC fever threshold is a single oral temperature above 37.8°C or an increase of 1.1°C over baseline.

Denominators change with the setting: acute care uses patient days and device days, long-term care uses resident days, dialysis uses patient-months, and home health uses visits or catheter days.

Dialysis facilities report to the NHSN Dialysis Event module, where the three reportable events are a positive blood culture, intravenous antimicrobial start, and pus, redness, or swelling at the vascular access site.

Ambulatory surgery centers and clinics concentrate risk in injection safety and device reprocessing rather than in device-associated infection rates.

Congregate behavioral health settings drive outbreaks through shared living space, group activities, and limited hand hygiene infrastructure rather than through invasive devices.

Last updated: August 2026

3.6 Surveillance Across the Care Continuum

Quick Answer: Surveillance definitions and denominators are setting-specific . Acute care uses NHSN definitions with patient days and device days. Long-term care uses the revised McGeer criteria with resident days . Dialysis uses the NHSN Dialysis Event module with patient-months . Applying an acute-care definition to a nursing home resident is a classic surveillance error.

Infection prevention has moved outward from the hospital. Most surgery is now ambulatory, most chronic care is delivered in long-term and home settings, and patients move between all of them carrying their organisms with them.

Setting-by-Setting Comparison

Setting Definitions Denominator Dominant risks

Acute care NHSN Patient Safety Component Patient days, device days, procedures CLABSI, CAUTI, VAE, SSI, MRSA/CDI LabID events

Long-term care Revised McGeer criteria ; NHSN LTCF Component Resident days UTI, respiratory infection, gastroenteritis, skin/soft tissue, scabies

Ambulatory surgery center NHSN ASC module; procedure-based Procedures SSI, injection safety, reprocessing failures

Ambulatory clinic / physician office Largely local; no national mandate Visits or procedures Injection safety, point-of-care device reprocessing, vaccine handling

Outpatient hemodialysis NHSN Dialysis Event module Patient-months Access-related bloodstream infection, hepatitis B transmission

Home health / home infusion Adapted definitions; no national standard Visits, catheter days, infusion days Central line infection, wound infection, caregiver technique

Behavioral health Syndromic and outbreak-based Resident or patient days Gastroenteritis, respiratory outbreaks, scabies, tuberculosis

Long-Term Care: The McGeer Criteria

Nursing home residents differ from hospital inpatients in ways that break acute-care definitions. They are older, frequently afebrile when infected, often cognitively impaired and unable to report symptoms, and rarely have same-day imaging or laboratory access. The revised McGeer criteria were developed for exactly this population.

Constitutional criteria in long-term care

Fever in a resident is defined as any of:

A single oral temperature >37.8°C (100°F) , or
Repeated oral temperatures >37.2°C (99°F) or rectal temperatures >37.5°C (99.5°F) , or
An increase of >1.1°C (2°F) over the resident's baseline temperature

That last clause matters enormously: an older adult whose baseline is 36.1°C and who registers 37.4°C is febrile even though no threshold was crossed.

Other constitutional criteria include acute change in mental status from baseline (using confirmed criteria of acute onset, fluctuating course, inattention, and disorganized thinking) and acute functional decline in activities of daily living.

Two structural rules
All symptoms must be new or acutely worse , and

Non-infectious causes must be excluded — a resident with new incontinence on a new diuretic does not have a urinary tract infection.

Exam Tip: McGeer UTI criteria for a catheterized resident do not require urinary symptoms, because the catheter bypasses the sensation. For a non-catheterized resident, localizing urinary signs are required. And in every case, a positive urine culture alone is never sufficient — asymptomatic bacteriuria is near-universal in this population.

Outpatient Hemodialysis

The NHSN Dialysis Event module counts three events in outpatient hemodialysis patients:

Positive blood culture
Intravenous antimicrobial start
Pus, redness, or increased swelling at the vascular access site

The denominator is patient-months , collected as a census on the first two working days of the month. Access type drives risk: arteriovenous fistulas carry the lowest infection risk, grafts intermediate, and central venous catheters by far the highest , which is why "fistula first" is both a clinical and an infection prevention priority. Dialysis settings also carry a distinct hepatitis B transmission risk, requiring monthly HBsAg screening of susceptible patients, dedicated machines and isolation rooms for HBsAg-positive patients, and vaccination of susceptible patients and staff.

Ambulatory Surgery and Clinics

The defining ambulatory risk is not device-associated infection; it is breaches in basic technique that cause large exposure events:

Reusing syringes or needles between patients, or reentering a single-dose vial
Using a single-dose vial for multiple patients

Failing to reprocess semi-critical devices such as endoscopes, laryngoscope blades, or vaginal probes between patients

Point-of-care device sharing without disinfection — glucometers are the classic hepatitis B vehicle

Because patients are discharged within hours, post-discharge surveillance is the central methodological challenge for ambulatory SSI. Practical approaches include structured post-operative phone calls, review of readmission and emergency department returns, surgeon reporting, and linkage with the referring hospital's data.

Home Health and Home Infusion

No national surveillance system mandates home-care HAI reporting, so programs adapt definitions and choose a denominator such as catheter days or infusion days. The risks are distinctive:

The caregiver, often a family member , performs line care with limited training
The home has no engineering controls, no dedicated clean space, and variable refrigeration
Supply storage, pets, and household activity create contamination opportunities
Education and return demonstration are the primary interventions, not environmental engineering
Behavioral Health and Congregate Settings

Psychiatric units and residential behavioral health facilities have few invasive devices but high congregate risk : shared bedrooms and bathrooms, group therapy and dining, prolonged length of stay, and residents who may not perform hand hygiene or respiratory etiquette reliably. Ligature-risk restrictions also limit the alcohol-based hand rub dispensers and other fixtures that a medical unit takes for granted, so hand hygiene must be engineered around safety requirements. Surveillance is therefore syndromic and outbreak-oriented — clusters of diarrhea, respiratory illness, scabies, or conjunctivitis — rather than device-rate based.

Transitions of Care

Whatever the setting, organisms travel with patients. A structured inter-facility transfer communication form should convey MDRO colonization status, active precautions, pending cultures, current antimicrobials, and any device in place. Failure to communicate at transfer is one of the most common contributors to regional MDRO spread, and it is an explicit blueprint task under communication as well as surveillance.