• Know the following definitions: attack rate, case-fatality rate, endemic, epidemic, secular trends, incidence rate, prevalence rate, attack rate, index case, source, reservoir, risk factors, confounding factors, sensitivity, specificity, and positive/negative predictive values.

• Know the various forms of transmission: direct, indirect, vehicleborne, airborne, vectorborne and list common etiologic agents in each category.

• Know the various epidemiological study methods (descriptive-analytic, experimental) and be capable of stating the advantages and disadvantages of each.

• Know the following basic quantitative measures: incidence density, relative risk, odds ratio, mean, median, variance, and standard deviation.

• Know the numerator and denominator data used in infection control (eg. surgical site infections, line infections, ventilator-associated pneumonia).

• Being able to critically appraise literature at an advanced level. This includes understanding GRADE of the level of evidence risk of bias assessment in systematic reviews, an advanced understanding of potential limitations of studies and how this can affect generalizability to the Hamilton setting, and applying the methodological concepts to their own research/quality assurance projects.

• Know the components of the National Healthcare Safety Network (NHSN) system.

• Know the denominators used in NHSN.

• Know how common nosocomial infections are defined.

• Know what the purposes of surveillance are.

• Be capable of describing each of the following: active surveillance, passive surveillance, laboratory-based surveillance, patient-based surveillance, hospital-wide surveillance, and targeted surveillance; know the advantages and disadvantages of each.

• Know the definitions of incisional and organ space surgical site infections.

• Know the various surveillance methods for surgical site infections.

• Know the NNIS risk index for surgical site surveillance.

• Know the advantages and disadvantages of post-discharge surveillance.

• List interventions that may be needed to reduce SSI rates.

• Know how to summarize data in tabular and graphic form.

• Be aware of the issues of confidentiality in the dissemination of data.

• Know the definition of an outbreak, understand the importance of baseline rates, and how to statistically identify an outbreak.

• Know the steps involved in outbreak investigation including creating case definitions, case finding, confirming the outbreak, data collection, descriptive epidemiology (eg line listings, epidemic curve), developing a hypothesis, testing a hypothesis using analytic studies, the role of environmental investigation, the use of molecular microbiology, instituting control measures, importance/methods of communication/public relations.
• Know the specific control measures needed to effectively manage outbreaks caused by organisms in each of the transmission categories.

• Know the incubation periods of organisms from each of the four transmission categories that have been implicated in hospital, daycare, or long-term care facility outbreaks.

• Know the organisms frequently associated with outbreaks in daycare centres, schools, and long-term care facilities and know the specific control measures, investigations, and follow-up needed.

• Know the predisposing factors for hospital outbreaks of resistant Enterobacteriaceae (including those with Bush class 1 and extended-spectrum B-lactamases and CRE), non-fermentative gram-negative bacilli, MRSA, VRE.

• Know both the phenotypic and genotypic typing methodologies and the advantages and disadvantages of each.

• Know the typing method of choice for the common gram-positive and gram-negative organisms associated with hospital outbreaks.

• Be familiar with each of the following: category-specific isolation, universal precautions, body substance precautions, and transmission-based precautions.

• Know transmission-based precautions in detail and list the organisms associated with each of the categories (standard, airborne, droplet, contact).

• Know the special considerations for pediatric patients including precautions for each of the following: RSV, parvovirus, and Pseudomonas cepacia in CF patients.

• List the components of standard precautions including the 4 moments for hand hygiene.

• Describe in detail precautions required for isolating patients with MRSA, VRE, difficile-associated diarrhea, and Febrile Respiratory Illness including decision-making about isolation based on follow-up testing.

• Know the organisms in which the environment has been implicated in transmission and justify the control measures needed.

• Define the following: disinfection, sterilization, cleaning, and germicide.

• Know the Spaulding classification and give examples of critical, semi-critical, and non-critical items.

• Know the methods and controversies pertaining to the disinfection of endoscopes, laparoscopes, and arthroscopes.

• Know how to disinfect the following: previously incubated bacterial cultures from the microbiology lab, broken blood collection tube after being dropped, corrugated ventilator tubing, implantable orthopedic devices, and broken vial in an open centrifuge.

• List and describe methods for sterilization (including chemical sterilization), high-level disinfection, intermediate-level disinfection, and low-level disinfection.

• Know the specific properties of the specific agent used for chemical sterilization, high-level disinfection, and intermediate/low-level disinfection and list the advantages and disadvantages of each.

• Describe the recommendations for the inactivation of the Creutzfeldt-Jacob Agent.

• Discuss the factors that affect the efficacy of germicides.

• Know the specific factors that can affect the efficacy of sterilization.

• Know the limitations of flash sterilization.

• Know the physical, chemical, and biological methods and recommendations for monitoring the sterilization process.

• Discuss the reuse of disposable devices.

• Understand what the role of the ventilation system and water supply is in causing certain nosocomial infections.

• Know the specific environmental controls needed for the control of tuberculosis.

• Know the specific environmental controls needed for control of legionellosis and know the recommendations for when the environmental investigation is needed.

• Understand how the environment is implicated in the transmission of VRE and Clostridium difficile.

• Know the survival times of HIV and other blood-borne pathogens on environmental surfaces.

• Be familiar with the various agents used in hand washing.

• Know the efficacy of the various agents for hand washing and surgical hand disinfection.

• Know the procedures for the surgical scrub.

• Know the 4 moments of hand hygiene and how to audit hand hygiene.

Nosocomial tuberculosis

• Know how to assess and classify risk of nosocomial tuberculosis.

• Know how to develop a tuberculosis screening and surveillance program.

• Know the infection control management of a patient with suspected/confirmed tuberculosis.

• Know the engineering controls and personnel respiratory protection requirements.

Legionellosis

• Know how to proceed when nosocomial transmission of legionella is suspected.

• Know the criteria used to warrant environmental investigation.

• Know the environmental controls available and know their advantages and disadvantages.

MRSA

• Understand how MRSA is detected in the laboratory and know the common problems that occur in the identification.

• Understand the epidemiology of MRSA (transmission patterns, infectivity rates, role of the environment).

• Know what control measures need to be in place to prevent the spread of MRSA.

• Understand the role of screening and discuss the pros and cons of various strategies.

• Know about the eradication protocols available for MRSA, and list the advantages and disadvantages of each.

• Understand what the concern is about preventing the spread of MRSA (including VISA strains).

VRE

• Understand how VRE is detected in the laboratory and know the common problems that occur in the identification.

• Understand the epidemiology of VRE (transmission patterns, infectivity rates and patterns, role of the environment).

• Know about the controversy on control measures needed to prevent the spread of VRE (including the PIDAC guidelines).

• Understand the role of screening and discuss the pros and cons of various approaches.

Clostridium difficile

• Understand how Clostridium difficile is detected in the laboratory and know the limitation of current test methods.

• Understand the epidemiology of Clostridium difficile (transmission patterns, infectivity rates and patterns, role of the environment).

• Know what control measures need to be in place to prevent the spread of Clostridium difficile (including the PIDAC guidelines).

• Understand reporting requirements for Clostridium difficile.

As above for MRSA’s and VRE’s, for ESBL’s and other multi-resistant gram negative bacilli, especially Pseudomonas aeruginosa, Acinetobacter baumannii complex, Serratia marcescens.

• Know the specific risks associated with hospital construction with regard to patients on bone marrow transplant/hematology-oncology units and know how to monitor these risks.

• Know the risks associated with blood-borne pathogens in renal dialysis units and know the precautions used to reduce the risks.

• Know the relevant infection control issues that arise in endoscopy units and know how to reduce the potential for cross-transmission in this setting.

• Know what the evidence is for the use of scrub brush, gowns, hats, environmental cleaning of OR, shoe covers.

• Know the exposures/outbreaks that commonly occur in NICUs and how to manage them.

• Know how to manage illness/exposure due to chicken pox among staff.

• Know how to manage illness/exposure due to red measles among staff.

• Know how to manage needle stick exposures among staff members.

• Know how to manage staff exposures to HIV, Hepatitis B, Hepatitis C.

• Understand the significance of and know the management of the following exposures to pregnant staff: chicken pox, CMV, parvovirus, TB.

• Know the basic principles and goals of antimicrobial stewardship programs (ASP).

• Know the potential collateral damage of antimicrobial (over-)use.

• Know target areas and how antimicrobial usage can be optimized.

• Understand the importance of collaboration and approaches to collaborate to meet the goals of an ASP.

• Understand the terms and concepts of streamlining, empiric, pre-emptive, and definitive/targeted treatment.

• Understands the importance of microbiological evidence in streamlining antimicrobials.