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NHSN SSI and CAUTI Training Course Surveillance Highlights. February 2012 Molly Hale. Surveillance Highlights. All NHSN forms have been updated January 12, 2012. Be sure you are working from the most current forms and definitions. Surveillance Highlights. Consistency
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NHSN SSI and CAUTI Training CourseSurveillance Highlights February 2012 Molly Hale
Surveillance Highlights • All NHSN forms have been updated January 12, 2012. Be sure you are working from the most current forms and definitions.
Surveillance Highlights • Consistency • Consistently apply criteria • “promise” to NHSN • Identify patients meeting criteria • Active > Passive • Strengthens the validity of the data • Validate, Validate, Validate! • i.e. surgical procedures that are not primarily closed would not count as SSI’s, but should also not be counted in denominator data.
SSI Surveillance Highlights • A new change to hysterectomy definition: Not sure how to count lap hysts---guidance coming within the next month.
SSI Surveillance Highlights • Organ/Space SSI: If patient meets this criteria, must attribute infection to a specific site and their criteria must be met (i.e. patient with KPRO and develops infection of the joint, must meet specific Joint SSI criteria. If not, does not count as an SSI).
SSI Surveillance Highlights • When a patient with an SSI has had more than one operation-report the operation that was performed most closely in time to the infection date. Once an area has been manipulated, cannot attribute the infection to the original surgery. • i.e Patient underwent a COLO on 2/12/10. Three days later, he went back to surgery to repair a leaking anastomosis (OTH). He developed an intraabdominal abscess on 3/1/10. This SSI is attributed to the second procedure (OTH), not the COLO.
Things that ARE considered SSI’s: • Post-op implant patient has skin condition (e.g., dermatitis, blister, impetigo) near intact incision and develops deep incisional infection months later, but within a year. • Post-op patient has an intact incision or status of incision is unknown (e.g., dressing never changed so nobody has seen the incision). • Patient showered/bathed “too early” post-op. • Patient was incontinent and incision was or may have been contaminated.
Things that ARE considered SSI’s: • Patient injured incision area but incision didn’t open, but later incision became infected. • Patient has remote site infection, either prior to or after implant surgery, and subsequently develops infection (this is a complication of implant surgery). • Patient has a procedure after implant surgery that “seeds” the operative site (e.g., dental work which leads to subsequent endocarditis after valve replacement surgery).
Things that ARE NOT considered SSI’s: • Post-op patient is still hospitalized following surgery and the upper aspect of his incision opens due to fall or other reasons (e.g. coughing or moving suddenly; patient picking at incision). This is mechanical dehiscence of wound; not an infectious dehiscence. Would attribute as HAI to facility but as SSI.
Things that ARE NOT considered SSI’s: • After patient has been discharged from the index hospital, if the incision opens due to fall or other reasons and there was no evidence of incisional infection at the time of its opening. • Implies mechanical reason or non-healing for dehiscence. • If patient was in a rehab or other facility when this occurred, it would be an HAI, but not an SSI, for that facility.
CAUTI Surveillance Highlights • CAUTI Key Term: A UTI in a patient who had an indwelling urinary catheter in place at the time of or within 48 hours prior to onset of infection. NOTE: there is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter-associated. • Update: this requirement may change next January. For now: educate ER and other staff to document if UTI is present on admission; if found 5 hours after catheter insertion must count as CAUTI.
CAUTI Surveillance Highlights • U/A’s may be positive for many non-infectious reasons (such as colonization). Therefore, a positive U/A on admission is not enough to call a UTI present-on-admission.
CAUTI Surveillance Highlights • 2012 CAUTI definition change: • 2011 criteria stated, “Patient had an indwelling urinary catheter at the time of specimen collection…” • 2012 criteria state, “Patient had an indwelling urinary catheter in place at the time of specimen collection or onset of signs or symptoms…”
CAUTI Surveillance Highlights • If your facility gets device days electronically, NHSN recommends validating with manual counts for 3 months and rejecting electronic data if difference is +/- 5%.
CAUTI Surveillance Highlights • Fever is a nonspecific symptom and can be used to meet more than one NHSN infection criteria. • The language “fever with no other recognized cause” may be removed in the future. Too big of a headache.
CAUTI Surveillance Highlights • Definition of an indwelling catheter for NHSN purposes: catheter inserted into the urethra and is connected to a closed system. For this reason, 3-way catheters (which are used for irrigation; not a closed system) should be removed from denominators and not counted as CAUTI’s
Standardized Infection Ratio (SIR) • SIR=Observed HAI’s/Expected HAI’s • Observed HAI’s are what we collect • Expected HAI’s comes from NHSN standardized aggregate population data • If high SIR is based on low number of cases, it is not very meaningful. • If the p-value and CI do not agree, then the message is we need more data (it’s too soon to tell).
Example: SSI SIR What does this NHSN output tell us? • SIR of 0.951 means there were 5% fewer infections than expected from national data. • P-value of 0.3170 means this is not a significant finding. There is about a 32% chance of this randomly occurring.
