APIC NHSN Webinar Kathy Allen-Bridson, Janet Brooks, Cindy Gross, Denise Leaptrot, Susan Morabit, & Eileen Scalise Subject Matter Experts April 27, 2015 National Center for Emerging and Zoonotic Infectious Diseases Place Descriptor Here Learning Objectives General: Identify the correct method to determine if an infection is present on admission or healthcare-associated. CAUTI: Describe how a patient transferring from one facility to another facility impacts or changes the repeat infection timeframe BSI: Identify the relationship of site-specific infections to secondary BSI LabID: Indicate if patients in swing beds should be included with inpatient counts for LabID Event Reporting VAE: Describe baseline period of stability or improvement and the period of worsening oxygenation in meeting the VAC definition SSI: Indicate if an SSI that meets the definition for present at the time of surgery (PATOS) should be entered into NHSN as an SSI 1
GENERAL NHSN QUESTIONS 1. How do I determine if an infection is present on admission or healthcareassociated? Date of Event 2 days before admit 1 day before admit 1 st hospital day 2 nd hospital day 3 rd hospital day 4 th hospitalday 5 th hospital day Classification POA HAI 2
2. What is the meaning of evidence of infection on gross anatomical exam found in several of the NHSN infection criteria? 3. My patient had a Foley catheter placed on admission and in place until day 4. On the 4 th day, the Foley was removed and then reinserted the next day. The patient subsequently developed an NHSN UTI with date of event on day 6. Is this UTI catheterassociated, or since the second catheter had not been in place for greater than 2 days, is this a non-catheter associated UTI for NHSN purposes? 3
4. The CAUTI modifications shared in the March 2015 NHSN Newsletter go into effect April 1 st, and the SSI modifications on January 1 st. When do the other changes take effect? CATHETER-ASSOCIATED URINARY TRACT INFECTION QUESTIONS 4
5. If a patient is identified with an NHSN UTI at Facility A and during the Repeat Infection Timeframe (RIT) of that UTI is transferred to Facility B, how are positive urine cultures collected at the new facility handled? Can positive urine cultures at Facility B that occur in what would have been the UTI RIT at Facility A be considered a part of the previously identified UTI and therefore not considered in Facility B s UTI surveillance? 6. Please clarify the following scenario. A patient presents with an E. coli UTI with date of event on the day of admission and is treated with antibiotics. On day 8 a urine culture that is collected is negative for growth. On day 21 (beyond the 14 day repeat infection timeframe [or RIT]) another positive urine culture that is collected is positive for E coli > 100K colony forming units/ml. Would this be considered an extension of the UTI from day 1 despite the negative urine on day 8 if an infectious disease doctor says it could be an extension of the existing UTI from admission? 5
7. Please clarify the role of fever and age in the UTI definitions. How does fever and age > 65 years affect the CAUTI criteria? CENTRAL-LINE ASSOCIATED BLOODSTREAM QUESTIONS 6
8. How do I determine if a bloodstream infection (BSI) is primary in nature or secondary to another site and therefore not reported as a central line-associated BSI (CLABSI)? 9. When will mucosal-barrier injurylaboratory-confirmed bloodstream infection (MBI-LCBI) data be removed from the CLABSI data that is submitted to CMS? 7
10. A patient has a blood culture collected on hospital day 4 that meets LCBI criteria. No central line is in place and a BSI event is identified. On hospital day 5 a central line is inserted. Another blood culture is collected on hospital day 8, that is positive for a pathogen, and the patient meets CLABSI criteria. Should the primary non-centralline-associated event be changed to a CLABSI within NHSN? LABID EVENT QUESTIONS 8
11. If I have an inpatient psychiatric facility (IPF) located within my acute care hospital and it has a different CCN, do I have to map and report separately for this IPF location? 12. Should patients in swing beds be included with inpatient counts for LabID Event reporting? 9
13. Am I required to add FacWideOUTto my NHSN Monthly Reporting Plan since acute care hospitals (ACH) are required to include 24-hour observation and emergency department locations when reporting inplan FacWideINLabIDEvents? 14. LabIDreporting is so time consuming because it requires everything to be entered manually. Is there a way to upload all of the required denominators and events? 10
SURGICAL SITE INFECTION QUESTIONS 15. Can a patient develop a surgical site infection per NHSN definitions following a dirty/infected surgical procedure or would such an infection be considered present or incubating on admission or at the time of surgery? If yes, does this SSI need to be reported to NHSN? 11
16. If a patient is felt to have an organ/space SSI, but doesn t meet a sitespecific infection criteria, can a deep incisional SSI be reported instead? 17. When will the new mappings for the upcoming transition to ICD-10-CM codes be available from NHSN? 12
VENTILATOR-ASSOCIATED EVENT/VENTILATOR-ASSOCIATED PNEUMONIA QUESTIONS 18. What lower respiratory tract event surveillance can be done in-plan for NHSN reporting? 13
19. Why am I required to report an Infection-related ventilator-associated complication (IVAC) when the qualifying antimicrobial day parameter is met based on antimicrobial agents that were not administered to treat a respiratory infection? 20. Can you explain baseline period of stability or improvement and the period of worsening oxygenation that is required to meet the VAC definition? 14
Baseline Period and Evidence of Worsening Oxygenation MV Day PEEP FiO 2 1 10 30 2 10 30 3 8 35 4 8 70 5 8 70 6 8 60 Baseline Period and Evidence of Worsening Oxygenation MV Day PEEP FiO 2 1 10 30 2 10 30 3 8 30 4 8 55 5 8 55 6 8 60 15
Baseline Period and Evidence of Worsening Oxygenation MV Day PEEP FiO 2 1 10 35 2 10 35 3 8 30 4 8 70 5 8 70 6 8 60 Baseline Period and Evidence of Worsening Oxygenation MV Day PEEP FiO 2 1 10 100 2 7 90 3 5 90 4 8 50 5 8 50 6 8 50 16
Baseline Period and Evidence of Worsening Oxygenation MV Day PEEP FiO 2 1 10 100 2 5 90 3 5 90 4 10 50 5 8 50 6 8 50 21. Many times a period of stability or improvement is established and subsequently the VAC definition is met using this baseline period when in fact the patient is not at all clinically stable. Why must I report such an event? 17
Frequently Asked Questions Topic-specific documents can be found in a dedicated section on the topic specific page of the NHSN website Other pertinent FAQs are also available on each page, e.g. locations questions, analysis questions, etc. 18
Questions? NHSN@cdc.gov New! Training Materials Are Posted to NHSN. Go to: http://www.cdc.gov/nhsn/training/ 19