2013 nhsn surveillance definition updates 010313

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					          Connecticut
Healthcare Associated Infections
     Training Program 2013


 2013 NHSN Updates
    for Reporting
CLABSI, CAUTI, & SSI
              (01/03/13)

      Lauren A. Backman, RN, MHS
          lauren.backman@ct.gov




                      Connecticut Department of Public Health
 2013 NHSN Surveillance Definition
           Updates:
Conference Call – January 23 & 29, 2013

  Question and Answer sessions will be held
  several times throughout the presentation.

  Please hold all questions and comments
  until you see the      slide.




                         Connecticut Department of Public Health
NHSN Updates: January 2013
   Updated guidance, definitions, rules and
    criteria are effective Jan 1, 2013
     The  dates of each protocols reads: Jan 2013
     The release of the updated NHSN software
      application will occur 2/16/13

   Annual Facility Survey to be entered after
    2/16/13
     Use updated Jan 2013 survey when you collect
      2012 data


                              Connecticut Department of Public Health
NHSN Updates: January 2013
   Location Mapping
     As  of Jan 2013, 14 new Oncology locations
      were added
     If you use these new locations, you can’t add
      them until 2/16/13
   VAE Reporting available 2/16/13
     Excellent Premier webinar: CDC-NHSN's new
      ventilator-associated events surveillance definitions: Are you
      ready? By Michael Klompas MD, MPH, Harvard Medical
      School. Brigham And Women's Hospital, Boston, MA
    https://www.premierinc.com/wps/wcm/connect/5e493f41-3c7c-4eb9-bb4c-
    38ce47395a2a/011513-Advisor-Live-NHSN-VAE_final_post.pdf?MOD=AJPERES

                                          Connecticut Department of Public Health
Updated NHSN “Terms”
   Definition for HAI – updated for 1/1/13
   Definition for POA - updated for 1/1/13
   Definition for Date of Event – updated for 1/1/13
   Definition for Date of Onset - updated for 1/1/13




                             Connecticut Department of Public Health
                                                               1
Updated NHSN “Rules”
   Device-Associated Rule – updated for 1/1/13
   Patient Transfer Rule – updated for 1/1/13
   Location of Attribution Rule - updated for 1/1/13




                             Connecticut Department of Public Health
                                                               2
NHSN Key “Terms” and “Rules”




               Connecticut Department of Public Health
                                                 3
Investigating an Infection

           Ask yourself questions in this order:
  1. Is it a HAI? If not, stop

  2. If an HAI, which NHSN site-specific criterion is met?

  3. Is this a device-associated HAI?

  4. Attributable to what location/facility/procedure?



Depending on the specifics of your surveillance, (i.e., only device associated,
only certain locations), the order may differ.



                                               Connecticut Department of Public Health
                                                                                  4
NHSN Key Terms:




   Please Note as of 1/1/13: “Present on Admission (POA)” has been eliminated


                                            Connecticut Department of Public Health
                                                                                5
Healthcare Associated
Infection (HAI)




New Rule: 1). For an HAI, element can be present on day 1 or 2 as long as it is also present on/after Day 3.
2). There cannot be a gap of more than 1 calendar day between elements.


                                                             Connecticut Department of Public Health
                                                                                                           6
Applying the HAI definition




                Connecticut Department of Public Health
                                                  7
QUESTIONS?




      Connecticut Department of Public Health
               Key Term:
         Device Associated Rule
  □     An infection meeting the HAI definition is
       considered a device-associated HAI if the device has
       been in place for > 2 calendar days when all elements
       of a CDC/NHSN site-specific infection criterion were
       first present together.
  □    HAIs occurring on day of device discontinuation or the
       following days, are considered device-associated
       HAIs if the device had been in place already for > 2
       calendar days.
Old Rule: Device in place on date of event or day before.
New Rule: Device in place when all elements of infection criterion were first present
together

                                             Connecticut Department of Public Health
                                                                                8
Applying the Device-
association Rule




                Connecticut Department of Public Health
                                                  9
QUESTIONS?




      Connecticut Department of Public Health
                          Key Term:
                         Date of Event




Old Rule: Date when first s & s appeared or date of + specimen, whichever came first.
New Rule: Date when last element used to meet infection criterion.


                                                 Connecticut Department of Public Health
                                                                                        10
Applying the Date of Event
Term




  Old Rule – Date of event was 08/05 (first elemtn
  New Rule – Date of event is 08/06; date when last
  element used to meet criteria occurred




                                Connecticut Department of Public Health
QUESTIONS?




      Connecticut Department of Public Health
Key Terms:
Location of Attribution
   Location of Attribution:
   ■ The location where the patient was
     assigned on the date of the event, which
     is further defined as the date when the
     last element used to meet the infection
     criterion occurred

Old Rule: Location when first s & s appeared or date of + specimen, whichever came first.
New Rule: Location when last element used to meet infection criterion.




                                                   Connecticut Department of Public Health
                                                                                        12
Key Terms:
Transfer Rule
Transfer Rule:
■ If all elements of an HAI are present within 2 calendar
    days of transfer from one inpatient location to another in
    the same facility (i.e., on the day of transfer or the next
    day), the HAI is attributed to the transferring location.

■ If all elements of an HAI are present within 2 calendar
  days of transfer from one inpatient location to another,
  the HAI is attributed to the transferring location.
  Receiving facilities should share information about such
  HAIs with the transferring facility to enable reporting.
New Rule: All elements occur on day of transfer or next day, infection attributed
to transferring location.

                                             Connecticut Department of Public Health
                                                                              13
Applying Transfer Rule




                Connecticut Department of Public Health
                                                14
QUESTIONS?




      Connecticut Department of Public Health
Key Terms:
Date of Onset

■ Date of Onset: Beginning in 2013, the term
  ‘Date of Onset’ will be used for VAE
  (ventilator-associated event) reporting only
  and this definition will no longer be a
  synonym for ‘Date of Event’.




                        Connecticut Department of Public Health
Specific Changes to CAUTI
Criteria and Application




               Connecticut Department of Public Health
                                                  15
Key Question for CAUTI Surveillance –
     Is this catheter associated?




                   Connecticut Department of Public Health
QUESTIONS?




      Connecticut Department of Public Health
Update 12/31/12




          Connecticut Department of Public Health
                                             16
Connecticut Department of Public Health
                                  17
SUTI 1a: Symptomatic UTI




               Connecticut Department of Public Health
                                                  18
SUTI 1a: Criteria Rationale –
Catheter in place
  Patient had an indwelling urinary catheter in place for >
  2 calendar days, with day of device placement being
  Day 1, and catheter was in place when all elements of
  this criterion were first present together.



   Urgency, frequency and dysuria are not reliable indicators of
     UTI in this population therefore NOT included in criteria.




                                    Connecticut Department of Public Health
                                                                   19
SUTI 2a: Symptomatic UTI




               Connecticut Department of Public Health
                                               20
Symptomatic UTI:
Criteria 3 & 4 (<1 year old)




                 Connecticut Department of Public Health
                                                 21
Asymptomatic Bacteremic UTI
        (ABUTI)




              Connecticut Department of Public Health
                                               22
Secondary BSI




       Connecticut Department of Public Health
                                         23
               Secondary BSI
                  Examples
New Examples




                       Connecticut Department of Public Health
                                                        24
               Secondary BSI
New Examples
                  Examples




                       Connecticut Department of Public Health
                                                        25
QUESTIONS?




      Connecticut Department of Public Health
Specific Changes to CLABSI
  Criteria and Application




             Connecticut Department of Public Health
                                               26
         Key Term:
    Central Line-associated
Bloodstream Infection (CLABSI)




                Connecticut Department of Public Health
                                                27
Laboratory Confirmed
Bloodstream Infection Criteria
             LCBI

  LCBI 1     LCBI 2           LCBI 3

     MBI-     MBI –                 MBI -
    LCBI 1    LCBI 2               LCBI 3



                 Connecticut Department of Public Health
                                                 28
Key Term: Secondary BSI
   A culture-confirmed BSI associated with a
    documented HAI at another site
                     AND
   Primary infection must meet one of the
    CDC/NHSN infection definitions (Ch 17)
                     AND
   BSI and other site must be related according to
    the culture guidelines provided in the next few
    slides


                             Connecticut Department of Public Health
                                                             29
         Next 12 slides
     Appendix 1: Secondary
Bloodstream Infection (BSI) Guide
           (all added by NHSN for 1/1/13)




Found in NHSN Device Associated Module: CLABSI
        January 2013 Chapter 4-14 to 4-17


                            Connecticut Department of Public Health
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
    What is the meaning of the statement “not related to infection
      at another site” in relation to a positive blood culture?




   “When assessing positive blood cultures in particular, one
    must be sure there is no other CDC-defined primary site of
    HAI that may have seeded the bloodstream secondarily;
    otherwise the bloodstream infection my be misclassified
    as a primary BSI or erroneously associated with the use of
    a central line, i.e., called a CLABSI.”

* Chapter 4 CLABSI Event of the NHSN Patient Safety Component Manual


                                              Connecticut Department of Public Health
                                                                              30
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
     What is the meaning of the statement “not related to infection
       at another site” in relation to a positive blood culture?

   Possible Scenarios and Guidance:
    1. Blood and site-specific specimen cultures match for at
       least one organism:
       In a patient suspected of having an infection, blood and a site-
       specific specimen are collected for culture and both are
       positive for at least one matching organism. If the site-
       specific culture is an element used to meet the infection site
       criterion, then the BSI is considered secondary to that site-
       specific infection.

See examples next slide



                                      Connecticut Department of Public Health
                                                                      31
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   32
QUESTIONS?




      Connecticut Department of Public Health
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   33
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   34
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   35
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   36
QUESTIONS?




      Connecticut Department of Public Health
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   37
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   38
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   39
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   40
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   41
QUESTIONS?




      Connecticut Department of Public Health
Appendix 1: Secondary Bloodstream
Infection (BSI) Guide*
  What is the meaning of the statement “not related to infection
    at another site” in relation to a positive blood culture?




                                   Connecticut Department of Public Health
                                                                   42
                      NOTE:




   Criteria 1 & 2 may be used for patients of
    ANY age, including those 1 year or less

   Criterion 3 only applies to patients who are 1
    year or less (before or on their first birthday.)

                              Connecticut Department of Public Health
                                                              43
MBI – LCBI Criteria




                Connecticut Department of Public Health
                                                44
Specific Changes to SSI
Criteria and Application




              Connecticut Department of Public Health
                                                45
POA slides eliminated

                Please Note:
 Slides on the definition of SSI “Present on
  Admission” with POA Example 1 and 2
             were eliminated..




                         Connecticut Department of Public Health
                                                           46
Exception to HAI Rule for
Certain Organ/Space SSIs




                Connecticut Department of Public Health
                                                 47
Example




          Connecticut Department of Public Health
                                           48
QUESTIONS?




      Connecticut Department of Public Health
1/1/13 Change: Added code OTH to the 30-day list and code
VSHN to the 90-day list

                               Connecticut Department of Public Health
                                                                49
      Additional SSI Info
NHSN Principal Operative Procedure
    Category Selection Lists




                  Connecticut Department of Public Health
                                                   50
SSI – Event Details




                                         1/1/13
                                        change




             Connecticut Department of Public Health
                                               51
SSI – Event Details

      1/1/13
     change




               Connecticut Department of Public Health
                                                52
Secondary BSI



       1/1/13: The word “EXACTLY” eliminated




            Connecticut Department of Public Health
                                               53
Secondary BSI (cont.)


                                            1/1/13:
                                            Example
                                            modified




             Connecticut Department of Public Health
                                               54
   1/1/13:
Slide added   Secondary BSI (cont.)




                           Connecticut Department of Public Health
                                                           55
Lauren A. Backman, RN, MHS
    lauren.backman@ct.gov

                  Connecticut Department of Public Health
                                                    56

				
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