Surveillance for Quality Assessment: II. Surveillance for Noninfectious Processes: Back to Basics

The first article in this series reviewed the type of surveillance currently used by most of the infection surveillance and control programs in acute care hospitals in the United States.' Five components were identified as critical to the widespread acceptance and continuing success of this surveillance methodology: targeting of events (diseases); early development of standardized definitions; wide acceptance of the criteria for these definitions; advocacy, leadership and education in methodology; and a high level of effectiveness in program practice. Using the framework of these key components, this article will discuss the potential for the application of similar methodology to noninfectious nosocomial adverse events and explore some current successes and problems associated with surveillance for such events. When surveillance for nosocomial infections began in the 1950s, these infections, marked by high incidence, significant case fatality and high costs of care, were a major epidemic problem.2 Their microbial etiology made them a readily-delineated group. They were also diseases of known natural history for which there were established diagnostic criteria and tests. Over the last two decades, surveillance has been linked to increasing numbers of micro control programs (specific to devices, procedures