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Connecticut Healthcare Associated Infections Training Program 2013

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. 2013 NHSN Surveillance Definition Updates: Conference Call – January 23 & 29, 2013.

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Connecticut Healthcare Associated Infections Training Program 2013

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  1. Connecticut Healthcare Associated Infections Training Program 2013 2013 NHSN Updates for Reporting CLABSI, CAUTI, & SSI (01/03/13) Lauren A. Backman, RN, MHSlauren.backman@ct.gov

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. NHSN Key “Terms” and “Rules”

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

  9. NHSN Key Terms: Please Note as of 1/1/13: “Present on Admission (POA)” has been eliminated

  10. 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.

  11. Applying the HAI definition Calendar Days 7

  12. QUESTIONS?

  13. 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

  14. Applying the Device-association Rule

  15. QUESTIONS?

  16. 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.

  17. 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 11

  18. QUESTIONS?

  19. 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.

  20. 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.

  21. Applying Transfer Rule

  22. QUESTIONS?

  23. 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’.

  24. Specific Changes to CAUTI Criteria and Application 15

  25. Key Question for CAUTI Surveillance –Is this catheter associated?

  26. QUESTIONS?

  27. Update 12/31/12 16

  28. 17

  29. SUTI 1a: Symptomatic UTI 18

  30. 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. 19

  31. SUTI 2a: Symptomatic UTI 20

  32. Symptomatic UTI:Criteria 3 & 4 (<1 year old) 21

  33. Asymptomatic Bacteremic UTI(ABUTI) 22

  34. Secondary BSI 23

  35. Secondary BSIExamples NewExamples 24

  36. Secondary BSIExamples NewExamples 25

  37. QUESTIONS?

  38. Specific Changes to CLABSI Criteria and Application 26

  39. Key Term:Central Line-associated Bloodstream Infection (CLABSI)

  40. Laboratory Confirmed Bloodstream Infection Criteria LCBI LCBI 3 LCBI 2 LCBI 1 MBI –LCBI 2 MBI - LCBI 3 MBI- LCBI 1

  41. 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

  42. 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

  43. 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

  44. 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

  45. 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?

  46. QUESTIONS?

  47. 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?

  48. 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?

  49. 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?

  50. 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?

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