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?
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?
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Where can we find the site specific criterion?
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What is considered a laboratory-identified (LabID) event?
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Are NHSN definitions autopsy specimens/reports eligible for use?
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Hospice, palliative, or comfort care patients are excluded from NHSN surveillance.
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What days are the POA and the HAI for newborns?
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In determining IWP, what would you use if the patient does not have a positive diagnostic test in their chart?
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What is the Infection Window Period for Endocarditis?
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Why is the IWP for endocarditis lengthened to 21 days?
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Which of these are NOT considered a HAI?
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If there is not a diagnostic test, a fever can be used to define the IWP.
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What is the Infection Window Period?
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Is fever considered a localized sign/symptom?
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What is the date of event (DOE)?
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When is an infection considered a healthcare-associated infection (HAI)?
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What does CIDT stand for?
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What does AST stand for?
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Can a physician diagnosis be accepted as evidence of an infection?
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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.
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Non-bedded patient locations, for example, Operating Room (OR) or Interventional Radiology (IR) are NOT eligible for assignment of LOA for HAI events.
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What is LOA?
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A patient undergoing stent placement in the radiology department is eligible for assignment of LOA for HAI events.
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Define the Transfer Rule.
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The date of event (DOE) is Day 1 of the 14-day RIT.
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In which scenarios does the Transfer Rule not apply?
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What is a SUTI?
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What are LabID events?
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If a patient has been transferred to more than one location on the date of an infection, where would you attribute the infection?
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The operating room can be used as a location of attribution (LOA).
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What does SBAP stand for?
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Does the device association change with a new pathogenic bacterium found in a patient's urine?
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What does LCBI stand for?
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The RIT applies to both POA and HAI determinations.
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List the three types of infections mentioned in Chapter 2 that can be reported only once during the RIT.
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You can assign a BSI secondary to Necrotizing Enterocolitis (NEC) even though the NEC criteria does not include site-specific specimens.
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If a patient has been discharged and readmitted to the same facility, does the RIT carry over?
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How do you determine the RIT for a patient with endocarditis during their admission?
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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.
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What happens if a blood culture obtained during a secondary BSI attribution period cannot be used as an element for meeting the infection definition?
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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.
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Does a RIT carry over from one admission to another even if readmission is to the same facility?
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In a scenario where a SUTI and a secondary BSI are identified, what is the relationship between them?
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Where would Yolanda's Location of Attribution be after her surgical procedure and subsequent findings?
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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?
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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?
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Both primary and secondary BSIs can be used to create a BSI RIT.
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What should you do if you find an excluded organism for pathogen assignment?
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After determining the IWP, do all elements to meet the NHSN definition have to occur within the Infection Window Period (IWP)?
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Pathogens excluded from specific infection definitions are also excluded as pathogens for BSI secondary to that infection.
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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).