Clean Care is Safer Care

WHO GLOBAL SURVEYS – 5 MAY 2014

FREQUENT QUESTIONS AND ANSWERS (FAQs)

General questions on both surveys

Questions on surgical antibiotic prophylaxis survey

Questions on the Laboratory-based Survey on MULTIDRUG-RESISTANT ORGANISMS (MDROs) in Health Care

General questions on both surveys

  • Presumably the name and contact details of the person completing the survey online is required for any error correction or clarification purposes and is no longer needed once data validation and analysis are completed?
    • Yes, this is true
  • The protocol states that the information will be collected using a secure online data submission system using Lime Survey at WHO - I presume this utilises SSL / https secure data transmission?
    • Having consulted with our IT staff we believe this is correct
  • The server(s) are physically located in WHO in Geneva and thus are they subject to Swiss Data Protection legislation?
    • YES
  • Does the WHO server utilise any Cloud Service such as Amazon etc with servers located outside the European Economic Area?
    • NO
  • 'In all cases, WHO commits to keeping the individual facility names and results strictly confidential.' Will you delete any potentially personally identifiable information once this is no longer required?
    • YES
  • It will be possible to upload to the WHO site, all the data from a excel sheet in place to fill in the web form? If yes, do you have a excel spread sheet prepared?
    • Unfortunately this is not possible. You need to use the electronic online submission. Thanks for your understanding.
  • I want to insert my data and it is asking for a username and password.
    • USERNAME and PASSWORDs ARE PROVIDED IN THE INVITATION LETTER sent out to all who can participate in the survey – if you have not received an invitation with user name and password please email savelives@who.int
  • We have to get ethical committee approval for the surveys – can you guide us?
    • This survey is approved by WHO Research Ethics Review Committee and if your Ministry of Health wishes to review, you can find the approval on http://www.who.int/gpsc/5may/MDRO_ERC-approval.pdf?ua=1. If a further local approval is required by your Ministry of Health, this procedure should be withheld locally.
  • I want to know how to change or delete data after submission.
    • You can send us an email to savelives@who.int clarifying what data specifically you want to change (i.e. information about patient etc) then we change it on our survey.

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Questions on surgical antibiotic prophylaxis survey

  • Is specific patient identification data (ie; patient initials and patient record number) essential for the survey?
    • The information asked is mainly for your data collection and for us to get back to you to correct possible errors. When you start entering the data to online system you will realise that these questions are not mandatory except the patient initials. Therefore, we do encourage you just to complete the mandatory fields, this can include for patient initials using a code rather than true initials to ensure there are no issues in your country and keep the data collection form in hand just in case if we need to get back to you for possible errors.
  • If a patient (who meets the criteria of the surgical antibiotic prophylaxis survey) has been transferred to Intensive Care Unit (ICU) after their operation should they be included on the day of data collection?
    • Patients who are transferred to ICU after the operation can be included. Also, include those identified ward patients (during the day of data collection) that were on the ward (having had the named procedure) but have been transferred to ICU in the past 3 days.
  • What is the difference between ambulatory procedures and 1-day procedures?
    • YES
  • Ambulatory procedure: A surgical procedure performed in ambulatory/outpatient service where patient goes home on the same day
    One day procedure: A surgical procedure performed where patient goes home on the same day or the next day
    Surgical procedure requiring more than 24 h hospitalization: A surgical procedure performed where patient stays in the hospital longer than 24 hours
    • NO
  • Can we include specialized surgeries such as neurosurgery and cardiac surgeries or is the survey only restricted to general surgery, obs/gyn, urosurgery and orthopaedic surgeries as mentioned in the protocol?
    • We would like to focus the survey on the types of surgery that are indicated in the protocol but, YES you can include other types of surgeries by clicking on “Others” option.
  • How do I include the surgical procedures they are not listed?
    • For the kind of surgical procedures that are not listed please use the “other” option and write the name of the procedure on the blank box that appears when you choose the other option.
  • The patients to be included in the survey may already have been discharged. Should they be included or only the inpatients are to be included?
    • They can be included.
  • Is it only the situations where prophylaxis is given correctly that should be included or also those that did not have indication for prophylaxis but the surgeon gave antibiotic for prophylaxis?
    • Any patient who was given prophylaxis according to the definition on the survey which is “administration of systemic antibiotics before a surgical procedure (within 60 min) with possible repetition during the operation” should be included.
  • If antibiotics are prescribed every 12, 8 or every 6 hours on the day of the patient’s operation it would mean that antibiotics continued after the operation as per the survey definitions?
    • Yes this is true, in this case the question “antibiotics continued after the operation in absence of any infection(s)” should be answered as “YES” and the reason for continuation should be stated in the final field.
  • I work in an area where a number are hospitals are part of an organisation/board. The question at the top of the form asks about 'Type of Facility' and total number of hospital beds. Should I complete a form per hospital?
    • Please fill out a form for each hospital and each type of ward separately.
  • Prophylaxis antibiotics are administered at pre-operation and 6 hour post-operation. Can you tell me how to code it this information on the form?
    • Please say Yes to Antibiotics continued after the operation in absence of any infection(s) and then choose a reason for it; such as ‘following departmental guidelines’.
  • We do not know if we should include ‘dirty’ surgery? Antibiotics are often given in these cases as a treatment and are given for longer than a day.
    • You may include these patients choosing the appropriate (dirty) wound classification and also choosing the appropriate reason for prolongation of antibiotics. However, if the antibiotics are started before the defined time period for antibiotic prophylaxis which is “administration of systemic antibiotics before a surgical procedure (within 60 min) with possible repetition during the operation”, then it should not be included.
  • I want to enter more than one antibiotic for prophylaxis or continuation – how do I do this?
    • In the list of antibiotics, you can choose more than one antibiotic (attention: enter only the ones used for surgical prophylaxis according to our definition!). Then, in the “antibiotic dose administered” you can write in text the doses of each one (e.g. Antibiotic 1, 2 g + Antibiotic 2, 500 mg). If the frequency is different for each antibiotic, you should select the appropriate answer for the first one and state any additional comments on the dose box as , i.e. “Antibiotic 1, 2 g every 12 h+ Antibiotic 2, 500mg every 6h”.
  • On the form it asks for data per ward which cannot be altered once entered. One ward may have 24 beds of whom only 4 will be on prophylactic antibiotics. Which figure do I enter here - the number of beds on the ward or the number on antibiotics?
    • You can include all surgical patients regardless of prophylaxis. You can choose “no” option if no prophylaxis was given.
  • In the case of C-section, although our national guideline indicates that this is not correct, some hospitals still give the antibiotic after clamping the umbilical cord - the intention of the antibiotic administration is for prophylaxis. So should these cases be included or excluded?
    • Antibiotic prophylaxis is defined as administration of systemic antibiotics before a surgical procedure (within 60 min) with possible repetition during the operation, depending on its duration, so any administration after the surgery should not be included.
  • For some specialties we could have more than 25 patients (in 3 days there are around 60 orthopedics procedures in our facility - without the ambulatory activity), but 25 is the maximum noted for data collection - do you confirm we only have to fill in 25 procedures, not more?
    • If you have 60 patients in one ward this means that you need to fill out the form 3 times meaning 25+25+10 per form. Each form can include up to 25 patients; if you need to enter more than 25 from the same ward, you need to complete the form repeatedly until you have included all relevant patients - we strongly encourage to do this.
  • I have inquiry regarding whether to include surgical procedures where patient is admitted one day prior to surgery and discharged the next day of the operation. Since this is the situation in all Laparoscopic cholecystectomies done in our hospital, we were wondering if these can be included as they have more than 24 hours of hospital stay?
    • If the patient is discharged the day after the surgery they can be included.
  • Are all of the questions below asking about the same facility or the ward? One day or during the whole survey or in 2013? Total number of surgical procedures performed in this facility in 2013
    Number of ambulatory procedures:
    Number of 1-day procedures:
    Number of surgical procedures requiring > 24 h hospitalization:
    • Yes, they all are asking about the facility selected and the total number in the year 2013. If you do not have the information for all, you do not have to fill all in. Only the first question is mandatory on the online system.
  • Traitement antibiotique poursuivi après intervention : Sur la version française du questionnaire l'item est absent!
    • Attention ! Une erreur s’est glissée dans la version française en ligne de l’enquête ”Antibioprophylaxie en chirurgie dans le cadre des soins”. Sur la page où figurent les informations sur le patient, la question « Fréquence d’administration durant la période périopératoire » figure deux fois. La première occurrence devrait se lire comme suit : « Traitement antibiotique poursuivi après l’intervention en l’absence de toute infection? (O/N) ». Les champs de réponse sont, eux, corrects. Veuillez donc répondre à la première question comme s’il s’agissait de celle prévue au départ. Nous vous prions de bien vouloir nous excuser.

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Questions on the Laboratory-based Survey on MULTIDRUG-RESISTANT ORGANISMS (MDROs) in Health Care

  • Regarding "blood Cultures... processed per year" - do you want to include, only blood cultures that has been tacked in inpatients services, or, into the whole hospital/facility? (including blood cultures that has been tacked for example, in Urgency and in ambulatory care)?
    • As per the survey protocol, samples should only be collected on inpatients
  • In the description for urine specimens, you refer to "inpatients", but it is not so clear for blood cultures
    • For both samples, collect data on inpatients only please.
  • The hospital labs registers blood culture bottles and not sets. How can we get around this?
    • Most hospital use 2 bottles per patient (aerobic and anaerobic). If this is the case then 2 bottles should be counted as one set per patient. However, if the hospital uses only one bottle per patient that it should be count as one.
  • We decided that hospital centres should put in the data separately for each hospital because the ecology is different. However, the microbiologists are the same. How should we do?
    • This is not a problem. Data from different hospitals should be entered separately even if it is the same microbiologist name
  • What are the non-bacterial, non-fungal species?
    • Isolates of any ‘unusual pathogen’. If there are not any then you can leave it blank, this is not a mandatory question.
  • The data are about CRE but in the questionnaire the question is about CPE. What is the difference?
    • Carbapenem-resistant means it is resistant to carbapenem and CPE means this strain is ‘producing’ carbapenem enzyme.

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