Chapter 13.4 : Outbreak Investigations: Laboratory and Epidemiologic Concepts

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Outbreak Investigations: Laboratory and Epidemiologic Concepts, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555817435/9781555815271_Chap13_4-1.gif /docserver/preview/fulltext/10.1128/9781555817435/9781555815271_Chap13_4-2.gif


Epidemiologic investigations may be performed in response to a change in the rate of an event or outcome compared with a community or facility's baseline or to evaluate a rate that is considered unacceptable compared with published rates in similar populations ( ). The degree of departure from baseline needed to identify an outbreak is variable, depending on factors such as the population in which it occurs and the organism or agent responsible. A single case of a rare or virulent infection, e.g., West Nile encephalitis, rabies, measles, or cholera, may be enough to herald an outbreak. For more common or endemic organisms, like methicillin-resistant (MRSA), an outbreak may mean a significant increase above baseline rates of clinical isolates or illness. Thus, specific thresholds for concern vary from case to case. If a particularly fragile population is involved, e.g., low-birth-weight infants in the neonatal intensive care unit or patients in a burn unit, the threshold for investigation may be lower. In addition to the pathogen and the population involved, outbreaks may be defined by a change in prevalence of certain organism characteristics, e.g., antimicrobial susceptibility or toxin production. In each of the above cases, meaningful surveillance data against which to measure a change are a critical component of outbreak investigation ( ).

Citation: Garcia L. 2010. Outbreak Investigations: Laboratory and Epidemiologic Concepts, p 440-444. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.4
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Armstrong, B. K.,, E. White,, and R. Saracci. 1992. Principles of Exposure Measurement in Epidemiology. Oxford University Press, New York, NY.
2. Bates, D. W.,, A. C. O’Neil,, D. Boyle,, J. Teich,, G. M. Chertow,, A. L. Kormarof,, and T. A. Brennan. 1994. Potential identifiability and preventability of adverse events using information systems. J. Am. Med. Info. Assoc. 1: 404 411.
3. Boyce, J. M. 1995. Hospital epidemiology in smaller hospitals. Infect. Control Hosp. Epidemiol. 16: 600 606.
4. Buffington, J.,, R. Reporter,, B. A. Lasker,, M. M. McNeil,, J. M. Lanson,, L. A. Ross,, L. Mascola,, and W. R. Jarvis. 1994. Investigation of an outbreak of invasive aspergillosis: utility of molecular typing with the use of random amplified polymorphic DNA probes. Pediatr. Infect. Dis. J. 13: 386 393.
5. Centers for Disease Control and Prevention. 1991. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. A report from the National Nosocomial Infections Surveillance System. Infect. Control Hosp. Epidemiol. 12: 609621.
6. Centers for Disease Control and Prevention. 1995. Recommendations for preventing the spread of vancomycin resistance. Hospital Infection Control Practices Advisory Committee. Infect. Control Hosp. Epidemiol. 16: 105113.
7. Emori, T. G.,, and R. P. Gaynes. 1993. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin. Microbiol. Rev. 6: 428 442.
8. Freeman, J.,, and J. E. McGowan, Jr. 1978. Risk factors for nosocomial infections. J. Infect. Dis. 138: 811 819.
9. French, G. L.,, A. F. Cheng,, S. L. Wong,, and S. Donnan. 1989. Repeated prevalence surveys for monitoring effectiveness of hospital infection control. Lancet ii: 1021 1023.
10. Garner, J. S.,, W. R. Jarvis,, T. G. Emori,, T. C. Horan,, and J. M. Hughes. 1988. CDC definitions for nosocomial infections. Am. J. Infect. Control 16: 128 140.
11. Goldmann, D. A.,, R. A. Weinstein,, R. P. Wenzel,, O. C. Tablan,, R. J. Duma,, R. P. Gaynes,, J. Schlosser,, and W. J. Martone. 1996. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 275: 234 240.
12. Haley, R. W.,, D. H. Culver,, J. W. White,, W. M. Morgan,, T. G. Emori,, V. P. Munn,, and T. M. Hooten. 1984. The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals. Am. J. Epidemiol. 121: 282 287.
13. Jarvis, W. R. 1991. Nosocomial outbreaks, the Centers for Disease Control’s Hospital Infections Program experience. Am. J. Med. 9: 3B101S 3B106S.
14. Jarvis, W. R. 1994. Usefulness of molecular epidemiology for outbreak investigations. Infect. Control Hosp. Epidemiol. 15: 500 503.
15. Rhame, F. S.,, and W. D. Sudderth. 1981. Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections. Am. J. Epidemiol. 113: 1 11.
16. Rudnick, J. R.,, C. M. Beck-Sague,, R. L. Anderson,, B. Schable,, J. M. Miller,, and W. R. Jarvis. 1996. Gram-negative bacteremia in open heart surgery patients traced to probable tap water contamination of pressure monitoring equipment. Infect. Control Hosp. Epidemiol. 17: 272 275.
17. Sadler, H. S.,, R. H. Hollis,, and M. A. Pfaller. 1995. The use of molecular techniques in the epidemiology and control of infectious diseases. Clin. Lab. Med. 15: 407 431.
18. Scheckler, W. E. 1992. Continuous quality improvement in a hospital system: implications for hospital epidemiology. Infect. Control Hosp. Epidemiol. 13: 288 292.
19. Simmons, B.,, J. Bryant,, K. Nieman,, L. Spencer,, and K. Arheart. 1990. The role of hand washing in prevention of endemic intensive care unit infection. Infect. Control Hosp. Epidemiol. 11: 589 594.
20. Stamm, W. E.,, R. A. Weinstein,, and R. E. Dixon. 1981. Comparison of endemic and epidemic nosocomial infections. Am. J. Med. 70: 393 397.
21. Weems, J. J.,, B. J. Davis,, O. C. Tablan,, L. Kaufman,, and W. J. Martone. 1987. Construction activity: an independent risk factor for invasive aspergillosis and zygomycosis in patients with hematologic malignancy. Infect. Control 8: 71 75.
22. Wenzel, R. P.,, and S. A. Streed. 1989. Surveillance and use of computers in hospital infection control. J. Hosp. Infect. 13: 217 229.
23. Wilson, M. L. 1996. General principles of specimen collection and transport. Clin. Infect. Dis. 22: 766 777.

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error