Identifying Healthcare-associated Infections Chapter 2

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?

The 7 day IWP Signup and view all the answers

Where can we find the site specific criterion?

Chapter 17 of the NHSN manual. Signup and view all the answers

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

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

Are NHSN definitions autopsy specimens/reports eligible for use?

False Signup and view all the answers

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

False Signup and view all the answers

What days are the POA and the HAI for newborns?

For newborns: POA is day 1 or 2 of hospitalization and HAI is day 3 or later. 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?

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

What is the Infection Window Period for Endocarditis?

The ENDO IWP is 21 days. Signup and view all the answers

Why is the IWP for endocarditis lengthened to 21 days?

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

Which of these are NOT considered a HAI?

All of the above Signup and view all the answers

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

False Signup and view all the answers

What is the Infection Window Period?

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

Is fever considered a localized sign/symptom?

False Signup and view all the answers

What is the date of event (DOE)?

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. Signup and view all the answers

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

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

What does CIDT stand for?

Culture Independent Diagnostic Testing. Signup and view all the answers

What does AST stand for?

Antimicrobial Susceptibility Testing. Signup and view all the answers

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

True 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.

True 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.

True Signup and view all the answers

What is LOA?

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

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

False Signup and view all the answers

Define the Transfer Rule.

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

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

True Signup and view all the answers

In which scenarios does the Transfer Rule not apply?

SSI or LabID events. Signup and view all the answers

What is a SUTI?

Symptomatic urinary tract infection. Signup and view all the answers

What are LabID events?

Events that allow laboratory testing data to be used without clinical evaluation of the patient. 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?

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

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

False Signup and view all the answers

What does SBAP stand for?

Secondary BSI Attribution Period. Signup and view all the answers

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

No, the device association does not change. Signup and view all the answers

What does LCBI stand for?

Laboratory Confirmed Bloodstream Infection. Signup and view all the answers

The RIT applies to both POA and HAI determinations.

True 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.

BSI, UTI, and PNEU. 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.

True Signup and view all the answers

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

False Signup and view all the answers

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

The RIT for endocarditis is extended to include the entire current admission. 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.

False 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?

The BSI must be evaluated as a new BSI event. 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.

True Signup and view all the answers

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

False Signup and view all the answers

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

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

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

C. Med Surg. 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?

Both the UTI and the JNT. 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?

False Signup and view all the answers

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

False Signup and view all the answers

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

Assign the excluded organism to either a primary BSI or secondary BSI attributed to another primary infection. 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)?

True Signup and view all the answers

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

True 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).