Syndromic Surveillance for Hospital-Associated Infections in a Small Animal Referral Hospital
Hospital-associated (HA) infections are an inherent risk of hospitalization. While the field has been studied extensively in human medicine, comparatively little veterinary information is available. One limitation with monitoring of HA infections is rapid and easy identification of potential problems. Syndromic surveillance, which evaluates general clinical syndromes as opposed to specific diseases, is easy, cost-effective, and possible to incorporate into electronic medical record systems. This study evaluated the use of syndromic surveillance to determine the frequency of selected syndromes at a small animal referral hospital and to evaluate factors associated with those syndromes.
All animals that were hospitalized for greater than 1 calendar day between Oct 1, 2006 and Mar 31, 2007 at a private referral and emergency hospital were included. A standardized checklist was posted with each animal's medical record and animals that developed signs consistent with following syndromes were identified prospectively: intravenous (IV) catheter site inflammation, urinary tract infection (UTI), surgical site infection (SSI), acute respiratory or gastrointestinal infection, fever of unknown origin (FUO), and septicemia. Associations between factors and syndromes were evaluated using various statistical tests.
Ninety-two dogs and 33 cats were eligible for inclusion. Mean age of all animals was 8.1 years (SD 4.5, range 0.6-20). Mean duration of hospitalization for the 112 animals for which data were recorded was 6.0 days (SD 5.0, range 1-34). One or more syndrome was identified in 24% of animals. Of these animals, IV catheter inflammation/infection was recorded for 9.8%, UTI for 7.1%, acute gastrointestinal illness for 8.1%, FUO for 5.4%, SSI for 3.6%, acute respiratory infection for 1.8%, and sepsis for 0.9%. Cats were 37.1 times as likely to develop FUO as dogs were (P<0.001). No other differences between species were detected. Animals that developed a FUO were 8.2 times as likely to have received a surgical implant as other animals were(P=0.016). Those that developed a UTI were 104 times as likely to have received a urinary catheter as the others were (P<0.001). Animals that developed SSIs were 9.5 times as likely to have received perioperative antimicrobials as other animals (P = 0.043). Duration of hospitalization was significantly (P=0.026) longer for animals that developed any syndrome; however, it is unclear whether that association represents cause or effect. Similarly, animals with IV catheter inflammation or UTIs were hospitalized longer than others were (P=0.01 and 0.001, respectively).
Syndromic surveillance was easily performed and provided useful baseline information. While syndromic surveillance cannot confirm the origin of infection or even that infection had occurred, it can be used to monitor syndromic rates over time to more rapidly identify potential infectious disease outbreaks and facilitate comparisons between different hospitals or services.