Identifying Healthcare-associated Infections Chapter 2
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Questions and Answers

What is the purpose of Chapter 2 of the NHSN Protocol Manual?

To standardize the classification of an infection as present on admission (POA) or a healthcare-associated infection (HAI), using objective surveillance definitions and guidance for NHSN surveillance.

Which organisms are typically causes of community-associated infections and are excluded from NHSN definitions?

  • Histoplasma (correct)
  • Paracoccidioides (correct)
  • Cryptococcus (correct)
  • Blastomyces (correct)
  • Pneumocystis (correct)
  • Coccidioides (correct)

    • If a patient has a reactivation of a latent infection can you count this as a HAI?

    False

    Date of event is critical because it is used to determine all but which of the following?

    <p>The 7 day IWP</p> Signup and view all the answers

    Where can we find the site specific criterion?

    <p>Chapter 17 of the NHSN manual.</p> Signup and view all the answers

    What is considered a laboratory-identified (LabID) event?

    <p>An event using laboratory testing data without clinical evaluation of the patient.</p> Signup and view all the answers

    Are NHSN definitions autopsy specimens/reports eligible for use?

    <p>False</p> Signup and view all the answers

    Hospice, palliative, or comfort care patients are excluded from NHSN surveillance.

    <p>False</p> Signup and view all the answers

    What days are the POA and the HAI for newborns?

    <p>For newborns: POA is day 1 or 2 of hospitalization and HAI is day 3 or later.</p> Signup and view all the answers

    In determining IWP, what would you use if the patient does not have a positive diagnostic test in their chart?

    <p>Use the date of the FIRST documented localized sign or symptom.</p> Signup and view all the answers

    What is the Infection Window Period for Endocarditis?

    <p>The ENDO IWP is 21 days.</p> Signup and view all the answers

    Why is the IWP for endocarditis lengthened to 21 days?

    <p>To accommodate the extended diagnostic timeframe needed to reach a clinical determination of endocarditis.</p> Signup and view all the answers

    Which of these are NOT considered a HAI?

    <p>All of the above</p> Signup and view all the answers

    If there is not a diagnostic test, a fever can be used to define the IWP.

    <p>False</p> Signup and view all the answers

    What is the Infection Window Period?

    <p>The 7 days during which all site-specific infection criteria must be met.</p> Signup and view all the answers

    Is fever considered a localized sign/symptom?

    <p>False</p> Signup and view all the answers

    What is the date of event (DOE)?

    <p>The date the first element used to meet an NHSN site-specific infection criterion occurs for the first time within the seven-day infection window period.</p> Signup and view all the answers

    When is an infection considered a healthcare-associated infection (HAI)?

    <p>If the date of event of the NHSN site-specific infection criterion occurs on or after the 3rd calendar day of admission.</p> Signup and view all the answers

    What does CIDT stand for?

    <p>Culture Independent Diagnostic Testing.</p> Signup and view all the answers

    What does AST stand for?

    <p>Antimicrobial Susceptibility Testing.</p> Signup and view all the answers

    Can a physician diagnosis be accepted as evidence of an infection?

    <p>True</p> Signup and view all the answers

    Physician diagnosis is not an element of any UTI definition; therefore, physician diagnosis of a UTI may not be used to satisfy the UTI definition.

    <p>True</p> Signup and view all the answers

    Non-bedded patient locations, for example, Operating Room (OR) or Interventional Radiology (IR) are NOT eligible for assignment of LOA for HAI events.

    <p>True</p> Signup and view all the answers

    What is LOA?

    <p>The inpatient location where the patient was assigned on the date of event (DOE).</p> Signup and view all the answers

    A patient undergoing stent placement in the radiology department is eligible for assignment of LOA for HAI events.

    <p>False</p> Signup and view all the answers

    Define the Transfer Rule.

    <p>Attribute the infection to the FIRST LOCATION the patient was housed THE DAY BEFORE the Date of Event (DOE).</p> Signup and view all the answers

    The date of event (DOE) is Day 1 of the 14-day RIT.

    <p>True</p> Signup and view all the answers

    In which scenarios does the Transfer Rule not apply?

    <p>SSI or LabID events.</p> Signup and view all the answers

    What is a SUTI?

    <p>Symptomatic urinary tract infection.</p> Signup and view all the answers

    What are LabID events?

    <p>Events that allow laboratory testing data to be used without clinical evaluation of the patient.</p> Signup and view all the answers

    If a patient has been transferred to more than one location on the date of an infection, where would you attribute the infection?

    <p>To the first location in which the patient was housed the day before the infection's date of event.</p> Signup and view all the answers

    The operating room can be used as a location of attribution (LOA).

    <p>False</p> Signup and view all the answers

    What does SBAP stand for?

    <p>Secondary BSI Attribution Period.</p> Signup and view all the answers

    Does the device association change with a new pathogenic bacterium found in a patient's urine?

    <p>No, the device association does not change.</p> Signup and view all the answers

    What does LCBI stand for?

    <p>Laboratory Confirmed Bloodstream Infection.</p> Signup and view all the answers

    The RIT applies to both POA and HAI determinations.

    <p>True</p> Signup and view all the answers

    List the three types of infections mentioned in Chapter 2 that can be reported only once during the RIT.

    <p>BSI, UTI, and PNEU.</p> Signup and view all the answers

    You can assign a BSI secondary to Necrotizing Enterocolitis (NEC) even though the NEC criteria does not include site-specific specimens.

    <p>True</p> Signup and view all the answers

    If a patient has been discharged and readmitted to the same facility, does the RIT carry over?

    <p>False</p> Signup and view all the answers

    How do you determine the RIT for a patient with endocarditis during their admission?

    <p>The RIT for endocarditis is extended to include the entire current admission.</p> Signup and view all the answers

    If a patient has been transferred to multiple locations on the date of an infection, attribute the infection to the last location in which the patient was housed.

    <p>False</p> Signup and view all the answers

    What happens if a blood culture obtained during a secondary BSI attribution period cannot be used as an element for meeting the infection definition?

    <p>The BSI must be evaluated as a new BSI event.</p> Signup and view all the answers

    If criteria for the same type of infection are met and the date of event is within the 14-day RIT, a new event is not identified or reported.

    <p>True</p> Signup and view all the answers

    Does a RIT carry over from one admission to another even if readmission is to the same facility?

    <p>False</p> Signup and view all the answers

    In a scenario where a SUTI and a secondary BSI are identified, what is the relationship between them?

    <p>YES, the secondary BSI can be attributed to the SUTI.</p> Signup and view all the answers

    Where would Yolanda's Location of Attribution be after her surgical procedure and subsequent findings?

    <p>C. Med Surg.</p> Signup and view all the answers

    If Staph aureus is identified in a blood culture during the attribution periods for both UTI and JNT HAI, to which infections is this blood culture assigned?

    <p>Both the UTI and the JNT.</p> Signup and view all the answers

    If a pathogen is excluded as an organism for an infection criterion, but is found on a Secondary BSI, will this excluded organism be reported for that infection?

    <p>False</p> Signup and view all the answers

    Both primary and secondary BSIs can be used to create a BSI RIT.

    <p>False</p> Signup and view all the answers

    What should you do if you find an excluded organism for pathogen assignment?

    <p>Assign the excluded organism to either a primary BSI or secondary BSI attributed to another primary infection.</p> Signup and view all the answers

    After determining the IWP, do all elements to meet the NHSN definition have to occur within the Infection Window Period (IWP)?

    <p>True</p> Signup and view all the answers

    Pathogens excluded from specific infection definitions are also excluded as pathogens for BSI secondary to that infection.

    <p>True</p> Signup and view all the answers

    Study Notes

    Purpose of Chapter 2

    • Standardizes classification of infections as present on admission (POA) or healthcare-associated infections (HAI).
    • Utilizes objective surveillance definitions and guidance for NHSN surveillance.

    Excluded Organisms for HAI

    • Organisms like Blastomyces, Histoplasma, Coccidioides, Paracoccidioides, Cryptococcus, and Pneumocystis are typically associated with community infections and excluded from HAI definitions.
    • Antifungal treatments are relevant, as opposed to antimicrobial treatments.

    Reactivation of Latent Infections

    • Reactivation of latent infections (e.g., herpes, shingles, TB) cannot be counted as HAIs.

    Date of Event Importance

    • Critical for determining HAI or POA status, device association, and the start of the Repeat Infection Timeframe (RIT).
    • Not used for the 7-day Infection Window Period (IWP).

    Site-Specific Criteria

    • Found in Chapter 17 of the NHSN manual.

    LabID Events

    • Defined as events using lab testing data without clinical evaluation.
    • Focuses on tracking positive lab results, not to include antimicrobial susceptibility testing (AST).

    Autopsy Specimens

    • Only autopsy specimens meeting CNS/intracranial infection or pneumonia criteria can be used in NHSN surveillance.

    Patient Categories in Surveillance

    • Hospice, palliative, or comfort care patients are included in NHSN surveillance.

    POA and HAI Day Definitions for Newborns

    • POA is considered on day 1 or 2, while HAI is defined as day 3 onward.

    Infection Window Period (IWP)

    • Extended to accommodate diagnostic timeframes for endocarditis to 21 days, encompassing 10 days before and after the positive diagnostic test.

    Infection Definitions

    • Herpes, shingles, syphilis, and TB are not considered HAIs.
    • Non-specific symptoms, such as fever, cannot define the IWP.

    Location of Attribution (LOA)

    • The LOA is the inpatient location where the patient was at the Date of Event (DOE).
    • Non-bedded locations like Operating Rooms or Interventional Radiology are not eligible for LOA assignment.

    Transfer Rule

    • Infections should be attributed to the first location where the patient was housed the day before the DOE.

    Situational Rules

    • RIT does not carry over from one admission to another.
    • LabID events allow tracking without clinical evaluations but exclude certain pathogens.

    Bloodstream Infections (BSI)

    • A secondary BSI can occur with specific pathogen conditions related to primary infections.
    • BSIs must be closely examined if linked to previously identified infections or pathogens.

    Pathogen Assignments

    • Assign site-specific pathogens before considering secondary BSI pathogens.
    • Excluded organisms for specific site infections cannot be reported as pathogens for a secondary BSI.

    Infection Criteria Compliance

    • All elements required for NHSN definition must occur within the IWP for it to be classified as an NHSN event.

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    Description

    This quiz focuses on Chapter 2 of the NHSN Protocol Manual, which aims to standardize the classification of infections. It covers key definitions and guidance for identifying healthcare-associated infections (HAIs) and infections present on admission (POA).

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