(e.g., CDC, National Institutes of Health, U.S. Department of Agriculture). Approaches for consideration could include simplifying current reporting forms and procedures, establishing a telephone hotline by which physicians could report unusual syndromes, and using electronic patient data collected by insurance companies to assist in infectious disease surveillance.

The committee believes that an excellent example of appropriate coordination of surveillance (and other) activities related to the emergence of a microbial threat to the U.S. population is the recent effort spearheaded by the CDC. Recognizing the seriousness of the emerging multidrug-resistant TB (MDRTB) epidemic, the CDC convened a federal task force in December 1991 at the request of James Mason, the Assistant Secretary for Health. This effort resulted in the National Action Plan to Combat Multidrug-Resistant Tuberculosis (National MDR-TB Task Force, 1992). The plan lays out a series of objectives, in the areas of epidemiology and surveillance, laboratory diagnosis, patient management, screening and preventive therapy, infection control, outbreak control, program evaluation, information dissemination/training and education, and research. These objectives are based on specific problems identified by the task force to meet these objectives. The plan specifies a series of activities, responsible organizations, and time frames for implementation. The committee feels that a similar task force could be convened to implement the above recommendation, as well as the one presented later in this chapter on U.S. international efforts in surveillance.

Nosocomial Infections Surveillance

A second major domestic disease surveillance effort is the National Nosocomial Infections Surveillance System (NNISS), which gathers data from approximately 120 sentinel hospitals. The NNISS is operated by the CDC's Hospital Infections Program (HIP); it is the nation's only database devoted to tracking nosocomial infections, which annually affect some 2 million hospitalized patients. The system allows estimates to be made about the incidence of nosocomial infections in the United States, and it provides data that help to detect changes in patterns of incidence, distribution, antibiotic drug resistance, sites of infection, outcomes of infection, and risk factors for nosocomial infections.

Each year, the HIP receives more than 5,000 inquiries about nosocomial infections, including a small number that involve the management of acute outbreaks. In the past 10 years, HIP staff have investigated approximately 120 hospital outbreaks of infectious disease (Centers for Disease Control, 1991b).

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