The Impact of HAIs Overall National Incidence Trend port ... · Acute Care Hospitals (IPPS only)...
24
HAI: A Patient’s Worst Nightmare July 22, 2015 Peg Gilbert, RN, MS, CIC Outline • Background • Impact • National and state HAI incidence • Mandatory reporting • Measurement • Surveillance • Key terms • Definitions, CLABSI, CAUTI, CDI • HAI prevention strategies • Guidelines • Emerging issues - infection prevention . The Impact of HAIs • One in 25 U.S. patients/day contracts an HAI during the course of their hospital care • Steps can be taken to control and prevent HAI in a variety of settings • Research shows that when healthcare teams take specific steps to prevent them, rates can decrease by more than 70 percent CDC HAI Prevalence Survey Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care– Associated Infections. N Engl J Med 2014;370:1198-208 Major Site of Infection Estimated No. Pneumonia 157,500 Gastrointestinal Illness 123,100 Urinary Tract Infections 93,300 Primary Bloodstream Infections 71,900 Surgical site infections from any inpatient surgery 157,500 Other types of infections 118,500 Estimated total number of infections in hospitals 721,800 Estimates of HAIs Occurring in Acute Care Hospitals in the United States, 2011 Healthcare Facility HAI Reporting to CMS via NHSN – Current and Proposed Requirements HAI Event Facility Type Reporting Start Date CLABSI Acute Care Hospitals (IPPS only) Adult, Pediatric, and Neonatal ICUs Select Medical and Surgical Ward Locations January 2011 January 2015 CAUTI Acute Care Hospitals (IPPS only) Adult and Pediatric ICUs Select Medical and Surgical Ward Locations January 2012 January 2015 SSI Acute Care Hospitals (IPPS only) Colon and abdominal hysterectomy January 2012 I.V. antimicrobial start, Dialysis Facilities January 2012 Positive blood culture Dialysis Facilities January 2012 Signs of vascular access infection Dialysis Facilities January 2012 CLABSI, CAUTI Long Term Care Hospitals October 2012 CAUTI Inpatient Rehabilitation Facilities October 2012 MRSA Bacteremia LabID Event Acute Care Hospitals (IPPS only) Long Term Care Hospitals January 2013 January 2015 C. difficile LabID Event Acute Care Hospitals (IPPS only) Long Term Care Hospitals January 2013 January 2015 HCW Influenza Vaccination Acute Care Hospitals (IPPS only) Long Term Care Hospitals & IRF January 2013 October 2014 HCW Influenza Vaccination ASCs October 2015 CLABSI, CAUTI PPS Cancer Facilities, all special care locations January, 2013 Overall National Incidence Trend • 46 percent decrease in CLABSI between 2008 and 2013 • 19 percent decrease in SSI related to the 10 select procedures tracked in the report between 2008 and 2013 • 6 percent increase in CAUTI between 2009 and 2013 • 8 percent decrease in MRSA bacteremia between 2011 and 2013 • 10 percent decrease in C.difficile infections between 2011 and 2013 Centers for Disease Control and Prevention.2013 National and State Healthcare-Associated Infections Progress Report. Published January 14, 2015.Available at www.cdc.gov/hai/progress-report/index.html
Transcript of The Impact of HAIs Overall National Incidence Trend port ... · Acute Care Hospitals (IPPS only)...
HA
I: A
Pat
ient
’s W
orst
N
ight
mar
e Ju
ly 2
2, 2
015
Peg
Gilb
ert,
RN
, MS,
CIC
Out
line
•
Back
grou
nd
•Im
pact
•
Nat
iona
l and
stat
e HA
I inc
iden
ce
•M
anda
tory
repo
rtin
g •
Mea
sure
men
t •
Surv
eilla
nce
•Ke
y te
rms
•De
finiti
ons,
CLA
BSI,
CAU
TI, C
DI
•HA
I pre
vent
ion
stra
tegi
es
•Gu
idel
ines
•
Emer
ging
issu
es -
infe
ctio
n pr
even
tion
.
The
Impa
ct o
f HAI
s •
One
in 2
5 U.
S. p
atie
nts/
day
cont
ract
s an
HAI d
urin
g th
e co
urse
of t
heir
hosp
ital c
are
•
Step
s can
be
take
n to
con
trol
and
pr
even
t HAI
in a
var
iety
of
sett
ings
•Re
sear
ch sh
ows t
hat w
hen
heal
thca
re te
ams t
ake
spec
ific
step
s to
prev
ent t
hem
, rat
es c
an
decr
ease
by
mor
e th
an 7
0 pe
rcen
t
CDC
HAI P
reva
lenc
e Su
rvey
M
agill
SS,
Edw
ards
JR, B
ambe
rg W
, et a
l. M
ultis
tate
Poi
nt-P
reva
lenc
e Su
rvey
of H
ealth
Car
e–As
soci
ated
Infe
ctio
ns. N
Eng
l J M
ed 2
014;
370:
1198
-208
Maj
or S
ite o
f Inf
ectio
n Es
timat
ed N
o.
Pneu
mon
ia
157,
500
Gast
roin
test
inal
Illn
ess
123,
100
Urin
ary
Trac
t Inf
ectio
ns
93,3
00
Prim
ary
Bloo
dstr
eam
Infe
ctio
ns
71,9
00
Surg
ical
site
infe
ctio
ns fr
om a
ny
inpa
tient
surg
ery
157,
500
Oth
er ty
pes o
f inf
ectio
ns
118,
500
Estim
ated
tota
l num
ber o
f inf
ectio
ns in
ho
spita
ls
721,
800
Est
imat
es o
f HA
Is O
ccur
ring
in A
cute
C
are
Hos
pita
ls in
the
Uni
ted
Sta
tes,
201
1
He
alth
care
Fac
ility
HAI
Rep
ortin
g to
CM
S vi
a N
HSN
–
Curr
ent a
nd P
ropo
sed
Requ
irem
ents
HAI E
vent
Fa
cilit
y Ty
pe
Repo
rtin
g St
art D
ate
CLAB
SI
Acut
e Ca
re H
ospi
tals
(IPPS
onl
y)
Adul
t, Pe
diat
ric, a
nd N
eona
tal I
CUs
Sel
ect M
edic
al a
nd S
urgi
cal W
ard
Loca
tions
Janu
ary
2011
Janu
ary
2015
CAU
TI
Acut
e Ca
re H
ospi
tals
(IPPS
onl
y)
Adul
t and
Ped
iatr
ic IC
Us
Sel
ect M
edic
al a
nd S
urgi
cal W
ard
Loca
tions
Janu
ary
2012
Janu
ary
2015
SSI
Acut
e Ca
re H
ospi
tals
(IPPS
onl
y)
Colo
n an
d ab
dom
inal
hys
tere
ctom
y Ja
nuar
y 20
12
I.V. a
ntim
icro
bial
star
t, Di
alys
is Fa
cilit
ies
Janu
ary
2012
Posit
ive
bloo
d cu
lture
Di
alys
is Fa
cilit
ies
Janu
ary
2012
Sign
s of v
ascu
lar a
cces
s inf
ectio
n Di
alys
is Fa
cilit
ies
Janu
ary
2012
CLAB
SI, C
AUTI
Lo
ng Te
rm C
are
Hosp
itals
Oct
ober
201
2
CAU
TI
Inpa
tient
Reh
abili
tatio
n Fa
cilit
ies
Oct
ober
201
2
MRS
A Ba
cter
emia
Lab
ID E
vent
Ac
ute
Care
Hos
pita
ls (IP
PS o
nly)
L
ong
Term
Car
e Ho
spita
ls
Janu
ary
2013
Ja
nuar
y 20
15
C. d
iffic
ile L
abID
Eve
nt
Acut
e Ca
re H
ospi
tals
(IPPS
onl
y)
Long
Term
Car
e Ho
spita
ls
Janu
ary
2013
Ja
nuar
y 20
15
HCW
Influ
enza
Vac
cina
tion
Acut
e Ca
re H
ospi
tals
(IPPS
onl
y)
Lon
g Te
rm C
are
Hosp
itals
& IR
F Ja
nuar
y 20
13
O
ctob
er 2
014
HCW
Influ
enza
Vac
cina
tion
ASCs
O
ctob
er 2
015
CLAB
SI, C
AUTI
PP
S Ca
ncer
Fac
ilitie
s, a
ll sp
ecia
l car
e lo
catio
ns
Janu
ary,
2013
Ove
rall
Nat
iona
l Inc
iden
ce T
rend
•46
per
cent
dec
reas
e in
CLA
BSI b
etw
een
2008
and
201
3
•19
per
cent
dec
reas
e in
SSI
rela
ted
to th
e 10
sele
ct
proc
edur
es tr
acke
d in
the
repo
rt b
etw
een
2008
and
201
3
•6
perc
ent i
ncre
ase
in C
AUTI
bet
wee
n 20
09 a
nd 2
013
•
8 pe
rcen
t dec
reas
e in
MRS
A ba
cter
emia
bet
wee
n 20
11 a
nd
2013
•
10 p
erce
nt d
ecre
ase
in C
.diff
icile
infe
ctio
ns b
etw
een
2011
an
d 20
13
Ce
nter
s for
Dise
ase
Cont
rol a
nd P
reve
ntio
n.20
13 N
atio
nal a
nd S
tate
Hea
lthca
re-A
ssoc
iate
d In
fect
ions
Pr
ogre
ss R
epor
t. Pu
blish
ed Ja
nuar
y 14
, 201
5.Av
aila
ble
at w
ww
.cdc
.gov
/hai
/pro
gres
s-re
port
/inde
x.ht
ml
Ove
rall
Stat
e In
cide
nce
•Th
e nu
mbe
r of s
tate
s per
form
ing
bett
er th
an th
e na
tion
by in
fect
ion
type
: CL
ABSI
– 1
6 st
ates
SS
I, co
lon
surg
ery
– 9
stat
es
SSI,
abdo
min
al h
yste
rect
omy
– 8
stat
es
CAU
TI –
19
stat
es
MRS
A ba
cter
emia
– 1
9 st
ates
C.
diff
icile
infe
ctio
ns –
21
stat
es
•
The
num
ber o
f sta
tes p
erfo
rmin
g w
orse
than
the
natio
n by
infe
ctio
n ty
pe:
CLAB
SI –
14
stat
es
SSI,
colo
n su
rger
y –
13 st
ates
SS
I, ab
dom
inal
hys
tere
ctom
y –
3 st
ates
CA
UTI
– 1
7 st
ates
M
RSA
bact
erem
ia –
12
stat
es
C. d
iffic
ile in
fect
ions
– 1
8 st
ates
Cent
ers f
or D
iseas
e Co
ntro
l and
Pre
vent
ion.
2013
Nat
iona
l and
Sta
te H
ealth
care
-Ass
ocia
ted
Infe
ctio
ns P
rogr
ess R
epor
t. Pu
blish
ed
Janu
ary
14, 2
015.
Ava
ilabl
e at
ww
w.c
dc.g
ov/h
ai/p
rogr
ess-
repo
rt/in
dex.
htm
l
Stan
dard
ized
Infe
ctio
n Ra
tio (S
IR)
•Su
mm
ary
mea
sure
use
d to
trac
k HA
Is o
ver t
ime.
It
com
pare
s the
num
ber o
f rep
orte
d HA
Is to
the
num
ber o
f pre
dict
ed H
AIs,
bas
ed o
n N
HSN
ba
selin
e da
ta. T
he S
IR a
djus
ts fo
r sev
eral
fact
ors
that
may
impa
ct th
e ris
k of
acq
uirin
g an
HAI
•A
SIR
belo
w 1
mea
ns th
at th
e fa
cilit
y ha
d le
ss
than
the
pred
icte
d nu
mbe
r of i
nfec
tions
. Whi
le
an S
IR a
bove
1 m
eans
that
the
faci
lity
had
mor
e th
an p
redi
cted
CLAB
SI a
nd C
AUTI
Loca
tion
Loca
tion
L
ocat
ion
2013
NHS
N D
ata
Tabl
e
Type
of A
cute
Car
e Ho
spita
l Loc
atio
nNo
. of
loca
tions
†No
. of
CAUT
I
Urin
ary
cath
eter
-da
ysPo
oled
mea
n10
%25
%50
%(m
edia
n)75
%90
%Cr
itica
l car
e un
its
Med
ical
-Maj
or te
achi
ng24
82,
696
775,
684
3.5
0.9
1.7
2.9
4.8
6.0
Med
ical
-All
othe
r45
3 (4
49)
1,70
383
3,65
82.
00.
00.
01.
22.
63.
9M
edic
al c
ardi
ac38
4 (3
82)
1,49
465
8,34
52.
30.
00.
71.
93.
44.
9M
edic
al/S
urgi
cal
-
Maj
or te
achi
ng35
8 (3
56)
2,57
796
7,28
22.
70.
01.
02.
23.
55.
1M
edic
al/S
urgi
cal
-All
othe
r, ≤1
5 be
ds1,
645
(1,6
19)
2,42
91,
910,
118
1.3
0.0
0.0
0.4
1.7
3.1
Med
ical
/Sur
gica
l
-A
ll ot
her,
>15
beds
804
4,66
62,
758,
180
1.7
0.0
0.6
1.4
2.3
3.4
Neu
rolo
gic
58 (5
7)53
011
7,42
44.
50.
01.
74.
06.
07.
8N
euro
surg
ical
180
(178
)2,
482
470,
403
5.3
1.8
3.1
4.4
6.7
9.1
Sur
gica
l
-M
ajor
teac
hing
192
1,98
958
0,42
03.
40.
71.
63.
04.
65.
9S
urgi
cal
-All
othe
r18
991
244
5,83
02.
00.
00.
51.
63.
04.
4S
urgi
cal c
ardi
otho
raci
c45
3 (4
52)
1,71
594
2,85
21.
80.
00.
71.
52.
43.
4Tr
aum
a14
71,
996
460,
280
4.3
0.9
2.4
4.1
5.6
7.1
Urin
ary
cath
eter
-ass
ocia
ted
UTI r
ate
*Pe
rcen
tile
http
://w
ww
.cdc
.gov
/nhs
n/da
taS
tat.h
tml
SSI
Fact
or
Para
met
er E
stim
ate
O
R p-
valu
e
Inte
rcep
t -5
.448
-
-
•Ag
e (≤
44 v
s >44
) 0.
520
1.65
9 <0
.000
1
•
ASA
(3/4
/5 v
s 1/2
) 0.
425
1.52
9 0.
0415
•
Dura
tion
(>10
0 vs
≤10
0) 0
.501
1.
650
0.00
19
•M
ed sc
hool
affi
liatio
n (Y
vs N
)
1.
069
2.91
2 <0
.000
1
This
tabl
e re
pres
ents
a p
artia
l list
of 1
00 h
ypot
hetic
al p
atie
nts
who
hav
e un
derg
one
this
par
ticul
ar p
roce
dure
, and
the
risk
fact
ors p
rese
nt fo
r eac
h. (A
GE +
ASA
for C
MS
risk)
Patie
nt
Age
Dura
tion
ASA
Med
Scho
ol
SSI
Prob
abili
ty o
f SSI
1
40
117
4 Y
0 0.
050
2 53
95
2
N
0 0.
004
3 30
10
7 2
Y 1
0.03
3
-
- -
- -
- -
- -
- -
- -
- 10
0 37
12
8 4
Y 1
0.05
0
TO
TAL
O
bser
ved
(O) 3
Ex
pect
ed (E
) 2.9
1
SIR
= O
/E =
3/2.
91 =
1.0
3
CDI
Tabl
e 3.
Mod
el to
pre
dict
hea
lthca
re fa
cilit
y-on
set (
HO) C
DI L
abID
ev
ents
, NHS
N, 2
010-
2011
.
Effe
ct
Par
amet
er E
stim
ate
p-v
alue
Inte
rcep
t -7
.898
3 <0
.000
1
CDI T
est T
ype
(NAA
T vs
. non
-NAA
T/EI
A ot
hers
) 0.
3850
<0
.000
1
CDI T
est T
ype
(EIA
vs.
non
-NAA
T/EI
A ot
hers
) 0.
1606
0.
0013
CO A
dmiss
ion
prev
alen
ce ra
te (c
ontin
uous
)
* 0.
3338
<0
.000
1
Faci
lity
Beds
ize (>
245
vs. ≤
100)
0.
2164
<0
.000
1
Faci
lity
Beds
ize (1
01-2
45 v
s. ≤
100
) 0.
0935
0.
0022
Med
ical
Sch
ool A
ffilia
tion
(Maj
or te
achi
ng v
s. U
nder
grad
uate
/Non
-Tea
chin
g
0.18
70
<0.0
001
M
edic
al S
choo
l Affi
liatio
n (G
radu
ate
vs. U
nder
grad
uate
/Non
-Tea
chin
g)
0.
0918
0.
0038
Scar
y
cdiTe
st
Met
h cd
iTest
M
ethD
esc
cdiTe
st
Met
h O
th
OTH
O
TH
PCR
GDH2
AAT
GDH2
AAT
GDH
GDH
Answ
er o
n An
nual
/Qua
rter
ly S
urve
y
•Lo
w R
isk A
djus
tmen
t To
xin
enzy
me
imm
unoa
ssay
(EIA
)
C. d
iffic
ile to
xin
A an
d/or
B
GDH
plus
EIA
for t
oxin
(2 st
ep a
lgor
ithm
)
•
High
er-R
isk A
djus
tmen
t N
ucle
ic a
cid
ampl
ifica
tion
test
[NAA
T](e
.g.,
PCR,
LAM
P)
C. d
iffic
ile to
xin
B ge
ne
GDH
plu
s NAA
T (2
step
alg
orith
m)
GDH
plu
s EIA
for t
oxin
, fol
low
ed b
y N
AAT
for d
iscre
pant
re
sults
De
finiti
on C
DI P
ositi
ve L
abor
ator
y As
say
•
A po
sitiv
e la
bora
tory
test
resu
lt fo
r C. d
iffic
ile
toxi
n A
and/
or B
, (in
clud
es m
olec
ular
ass
ays
[PCR
] and
/or t
oxin
ass
ays)
O
R
•A
toxi
n pr
oduc
ing
C. d
iffic
ile o
rgan
ism
dete
cted
by
cultu
re o
r oth
er la
bora
tory
m
eans
per
form
ed o
n a
stoo
l sam
ple
MRS
A Ta
ble
4. M
odel
to p
redi
ct h
ealth
care
faci
lity-
onse
t (HO
) MRS
A ba
cter
emia
La
bID
even
ts, N
HSN
, 201
0-20
11.
Effe
ct
P
aram
eter
Est
imat
e
p-v
alue
Inte
rcep
t
-10.
2368
<
0.00
01
Ad
miss
ion
prev
alen
ce ra
te (c
ontin
uous
)*
2.
2760
<0.
0001
Fa
cilit
y Be
dsize
(>40
0 vs
. ≤40
0)
0
.367
2
<0
.000
1
Med
ical
Sch
ool A
ffilia
tion
(Maj
or te
achi
ng v
s. a
ll ot
hers
)
0.32
48
<
0.00
01
Sout
h Da
kota
HAI
Rep
ort C
ard
Futu
re T
rend
ing
of N
umbe
rs
•CL
ABSI
incr
ease
•
CAU
TI d
ecre
ase
•SS
I sam
e •
CDI a
nd M
RSA
bact
erem
ia d
ecre
ase
•M
anda
tory
stat
e re
port
ing
issue
s
Bu
sine
ss C
ase
for I
nfec
tion
Prev
entio
n
CMS
Qua
lity
Repo
rtin
g Pr
ogra
m: 2
%
Hosp
itals
Inpa
tient
Reh
abili
tatio
n Ce
nter
In
patie
nt P
sych
iatr
ic F
acili
ties
Ambu
lato
ry S
urge
ry C
ente
rs
Valu
e Ba
sed
Purc
hasin
g: 2
%
Hosp
ital A
cqui
red
Cond
ition
s: 1
%
Read
miss
ion
pena
lty: 1
%
Hosp
ital A
cqui
red
Cond
ition
s •
Poss
ible
10
poin
ts
>7 p
oint
s = P
enal
ty
•Ra
nk re
sults
: Low
est 2
5% o
f Hos
pita
ls Pe
naliz
ed
•
PSI –
90
is Do
mai
n 1
•
NHS
N m
easu
res D
omai
n 2
CA
UTI
– C
LABS
I (20
15)
Add
2016
– S
SI C
olon
and
A. H
yst
Add
2017
– C
DI a
nd M
RSA
Bact
erem
ia
•W
eigh
ting
of D
omai
ns
Curr
ently
25%
- 75
%
Prop
ose
15%
- 85
%
•Cu
rren
tly a
vera
ged
toge
ther
and
then
wei
ghte
d •
FY 2
017
scor
ing
chan
ge –
prop
oses
to tr
eat e
ach
Dom
ain
2 m
easu
re
inde
pend
ently
whe
n de
term
inin
g if
a sc
ore
of 1
0 (m
ax sc
ore)
shou
ld b
e as
signe
d fo
r non
subm
issio
n of
dat
a
Dom
ain
1 •
PSI –
90
•
PSI 3
pre
ssur
e ul
cer r
ate
•PS
I 6 Ia
trog
enic
pne
umot
hora
x ra
te
•
PSI 7
cen
tral
ven
ous c
athe
ter-
rela
ted
bloo
d st
ream
infe
ctio
n ra
te
•
PSI 8
pos
tope
rativ
e hi
p fr
actu
re ra
te
•
PSI 1
2 po
st-o
pera
tive
pulm
onar
y em
bolis
m (P
E) o
r dee
p ve
in
thro
mbo
sis ra
te (D
VT)
•
PSI 1
3 po
stop
erat
ive
seps
is ra
te
•
PSI 1
4 w
ound
deh
iscen
ce ra
te
•PS
I 15
acci
dent
al p
unct
ure
and
lace
ratio
n ra
te
Sout
h Da
kota
Res
ults
•22
hos
pita
ls •
4 w
ith p
enal
ty
How
Can
I U
se T
his?
•
The
HAC
is de
term
ined
for 2
cal
enda
r yea
rs
2016
Fisc
al Y
ear p
aym
ent,
75 p
erce
nt b
ased
upo
n th
e SI
R fo
r ca
lend
ar y
ear 2
013
and
2014
for C
LABS
I, CA
UTI
&
SSI (
com
bine
d Co
lon
Surg
erie
s and
Abd
omin
al H
yste
rect
omie
s)
2017
pay
men
t, CD
I and
MRS
A Ba
cter
emia
will
be
adde
d to
the
HAC
dete
rmin
atio
n
•Ca
lcul
ate
a tw
o-ye
ar S
IR fo
r the
app
ropr
iate
tim
e pe
riod
usin
g th
e An
alys
is se
ctio
n of
NHS
N
•De
term
ine
if ra
tes a
re h
ighe
r tha
n ex
pect
ed/s
tatis
tical
ly
signi
fican
t
•Ke
ep a
dmin
istra
tion
info
rmed
and
use
the
info
rmat
ion
to
leve
rage
thei
r pos
ition
VBP
•M
inim
um o
f 3 m
easu
res a
re sc
ored
in th
e sa
fety
dom
ain
•
Wei
ght v
arie
s by
how
man
y m
easu
res y
ou
qual
ify (3
.33%
to 1
3.33
%)
•
Scar
y th
ough
t…
If yo
u di
d w
ell o
ne y
ear,
ther
e is
no g
uara
ntee
of
the
futu
re…
.
Valid
atio
n
•In
crea
se w
eigh
t of H
AI m
easu
res
Surv
eilla
nce
Basi
cs
•Se
ek o
ut in
fect
ions
dur
ing
a pa
tient
’s st
ay
•Sc
reen
ing
a va
riety
of d
ata
sour
ces,
such
as l
abor
ator
y, ph
arm
acy,
adm
issio
n/di
scha
rge/
tran
sfer
, rad
iolo
gy/im
agin
g, a
nd p
atho
logy
da
taba
ses,
as w
ell a
s pat
ient
cha
rts,
incl
udin
g hi
stor
y an
d ph
ysic
al e
xam
no
tes,
nur
ses/
phys
icia
ns n
otes
, tem
pera
ture
cha
rts,
etc
. (tim
e co
nsum
ing)
•
Roun
ding
, roo
m c
heck
s, su
rger
y sc
hedu
les
•La
bora
tory
-bas
ed su
rvei
llanc
e sh
ould
not
be
used
alo
ne, u
nles
s ide
ntify
ing
an in
fect
ion
is so
lely
det
erm
ined
by
labo
rato
ry e
vide
nce
(e.g
., La
bID
even
t de
tect
ion
in th
e M
DRO
/CDI
Mod
ule)
•
Retr
ospe
ctiv
e ch
art r
evie
ws s
houl
d be
use
d on
ly w
hen
patie
nts a
re
disc
harg
ed b
efor
e al
l inf
orm
atio
n ca
n be
gat
here
d •
NHS
N fo
rms s
houl
d be
use
d to
col
lect
all
requ
ired
data
, usin
g th
e N
HSN
de
finiti
ons o
f eac
h da
ta fi
eld
•U
tilize
you
r ele
ctro
nic
reco
rds.
Man
y co
des a
vaila
ble
for s
urve
illan
ce
Stan
dard
ized
Mea
sure
men
t
NHS
N S
truc
ture
& R
esou
rces
•
Met
hod
of S
urve
illan
ce
•De
finiti
ons o
f HAI
•
Data
Col
lect
ion
Form
s •
Anal
ysis
of D
ata
•Be
nchm
arks
Ac
ute
Care
Hos
pita
ls Cr
itica
l Acc
ess H
ospi
tals
Long
-Ter
m C
are
Hosp
ital
Long
-Ter
m C
are
Faci
litie
s Am
bula
tory
Sur
gery
Cen
ters
In
patie
nt R
ehab
ilita
tion
Cent
ers
Out
patie
nt D
ialy
sis C
ente
rs
http
://w
ww
.cdc
.gov
/nhs
n/
Clas
sific
atio
n of
Infe
ctio
ns
•14
maj
or ty
pes
•Bi
g 5
UTI
, BSI
, SSI
, VAE
, PN
EU
•9
othe
r spe
cific
infe
ctio
n ty
pes (
CNS,
CVS
, EEN
T...)
Bo
ne a
nd Jo
int I
nfec
tion
BO
NE
– O
steo
mye
litis
DI
SC –
Disc
spac
e in
fect
ion
JN
T –
Join
t or b
ursa
infe
ctio
n
PJI –
Pro
sthe
tic jo
int i
nfec
tion
•
Site
spec
ific
mos
t det
aile
d de
finiti
on
Sele
ct M
odul
e Co
mpo
nent
Cl
ick
on:
LTC
and
Acut
e Ca
re
optio
ns a
re id
entic
al
Date
of E
vent
•Th
e da
te th
e fir
st e
lem
ent u
sed
to m
eet a
n N
HSN
site
-spe
cific
infe
ctio
n cr
iterio
n oc
curs
for
the
first
tim
e w
ithin
the
seve
n-da
y in
fect
ion
win
dow
per
iod
Pres
ent o
n Ad
mis
sion
•W
hen
the
date
of e
vent
occ
urs
durin
g th
e PO
A tim
e pe
riod
•
Day
of a
dmiss
ion
to a
n in
patie
nt
loca
tion
(cal
enda
r day
1),
the
2 da
ys b
efor
e ad
miss
ion,
and
the
cale
ndar
day
afte
r adm
issio
n
Pat
ien
t D
ayP
OA
Pre
ad
mit
Pre
ad
mit
Ad
mit
Dat
eA
dm
it D
ate
Day
2D
ay 3
Day
4
Heal
thca
re A
ssoc
iate
d In
fect
ion
•Th
e da
te o
f eve
nt o
f the
N
HSN
site
-spe
cific
infe
ctio
n cr
iterio
n oc
curs
on
or a
fter
the
3rd
cale
ndar
day
of
adm
issio
n to
an
inpa
tient
lo
catio
n, w
here
day
of
adm
issio
n is
cale
ndar
day
1
Patie
nt D
ayPO
AHA
IPr
e ad
mit
Pre
adm
itAd
mit
Date
Adm
it Da
teAd
mit
Date
Day 2
Day 3
Day 4
Day 5
Infe
ctio
n W
indo
w P
erio
d
•7
days
dur
ing
whi
ch a
ll sit
e-sp
ecifi
c in
fect
ion
crite
ria m
ust b
e m
et
Incl
udes
the
day
the
first
pos
itive
dia
gnos
tic te
st th
at is
an
elem
ent o
f the
sit
e-sp
ecifi
c in
fect
ion
crite
rion
was
obt
aine
d 3
cale
ndar
day
s bef
ore
3 ca
lend
ar d
ays a
fter
•
For s
ite-s
peci
fic in
fect
ion
crite
ria th
at d
o no
t inc
lude
a
diag
nost
ic te
st, t
he fi
rst d
ocum
ente
d lo
caliz
ed si
gn o
r sym
ptom
th
at is
an
elem
ent o
f NHS
N in
fect
ion
crite
rion
shou
ld b
e us
ed to
de
fine
the
win
dow
(i.e
., di
arrh
ea, s
ite sp
ecifi
c pa
in, p
urul
ent
exud
ate)
Infe
ctio
n W
indo
w P
erio
d
•Di
agno
stic
test
s:
labo
rato
ry
spec
imen
col
lect
ion
im
agin
g te
st
proc
edur
e or
exa
m
phys
icia
n di
agno
sis
initi
atio
n of
tr
eatm
ent
Repe
at In
fect
ion
Tim
e Fr
ame
•14
-day
tim
efra
me
durin
g w
hich
no
new
infe
ctio
ns o
f th
e sa
me
type
are
repo
rted
. The
dat
e of
eve
nt is
day
1
of th
e 14
-day
RIT
•
If PO
A th
e RI
T tim
e fra
me
begi
ns w
ith h
ospi
tal d
ay 1
, ev
en if
the
date
of e
vent
on
2 da
ys p
rior t
o ad
miss
ion
Seco
ndar
y BS
I Att
ribut
ion
Perio
d
•Th
e pe
riod
in w
hich
a p
ositi
ve b
lood
cul
ture
mus
t be
colle
cted
to b
e co
nsid
ered
as a
seco
ndar
y bl
oods
trea
m
infe
ctio
n to
a p
rimar
y sit
e in
fect
ion
•In
clud
es th
e In
fect
ion
Win
dow
Per
iod
com
bine
d w
ith th
e Re
peat
Infe
ctio
n Ti
mef
ram
e (R
IT)
14-1
7 da
ys in
leng
th d
epen
ding
upo
n th
e da
te o
f eve
nt
•Se
cond
ary
BSI
One
org
anism
mus
t mat
ch
Site
spec
ific
cultu
re m
ust m
atch
•
Excl
uded
pat
hoge
ns ca
nnot
hav
e a
seco
ndar
y BS
I (ye
ast –
SU
TI)
Putt
ing
it al
l to
geth
er
Exam
ple
Tim
e Fr
ames
for N
HSN
Sur
veill
ance
Patie
nt D
ayPO
AHA
IIn
fect
ion
Win
dow
Repe
at
Infe
ctio
n Ti
mef
ram
e
Seco
ndar
y BS
I At
trib
utio
n W
indo
wPr
e ad
mit
Pre
adm
itAd
mit
Date
Adm
it Da
teAd
mit
Date
Adm
it Da
teAd
mit
Date
Adm
it Da
teDa
y 2
Day
3Da
y 4
Day
5Da
y 6
Day
7Sy
mpt
omDa
te o
f Eve
ntDa
te o
f Eve
ntDa
y 8
Date
of T
est
Day
9Da
y 10
Day
11Da
y 12
Day
13Da
y 14
Day
15Da
y 16
Day
17Da
y 18
Day
19Da
y 20
Day
21Da
y 22
Disc
harg
eDa
y 23
Tota
l Day
s4
Days
LOS
min
us
2 Da
ys7
Days
14 D
ays
14 -
17 D
ays
Not
eN
ot u
sed
Not
use
d N
ot u
sed
Not
use
d N
ot u
sed
with
with
w
ith
with
w
ith
LAB
ID o
r VAE
SSI,
LABI
D,SS
I, LA
BID,
SSI,
LABI
D,SS
I, LA
BID,
May
be
used
or
VAE
or V
AEor
VAE
or V
AEw
ith S
SI
Not
e: e
xclu
sions
to
defin
ition
s
Prac
tice
Exam
ple
Tim
e Fr
ames
for N
HSN
Sur
veill
ance
Patie
nt D
ayPO
AHA
IIn
fect
ion
Win
dow
Repe
at
Infe
ctio
n Ti
mef
ram
e
Seco
ndar
y BS
I At
trib
utio
n W
indo
wPr
e ad
mit
Pre
adm
itAd
mit
Date
Adm
it Da
teAd
mit
Date
Adm
it Da
teAd
mit
Date
Adm
it Da
teDa
y 2
Day
3Da
y 4
Day
5Da
y 6
Day
7Sy
mpt
omDa
te o
f Eve
ntDa
te o
f Eve
ntDa
y 8
Date
of T
est
Day
9Da
y 10
Day
11Da
y 12
Day
13Da
y 14
Day
15Da
y 16
Day
17Da
y 18
Day
19Da
y 20
Day
21Da
y 22
Disc
harg
eDa
y 23
Tota
l Day
s4
Days
LOS
min
us
2 Da
ys7
Days
14 D
ays
14 -
17 D
ays
Not
eN
ot u
sed
Not
use
d N
ot u
sed
Not
use
d N
ot u
sed
with
with
w
ith
with
w
ith
LAB
ID o
r VAE
SSI,
LABI
D,SS
I, LA
BID,
SSI,
LABI
D,SS
I, LA
BID,
May
be
used
or
VAE
or V
AEor
VAE
or V
AEw
ith S
SI
E.C
oli U
rine
Rt f
lank
pai
n
UC
Sta
ph A
BC
Sta
ph A
NHS
N W
orks
heet
Dow
nloa
d: h
ttp://
ww
w.cd
c.go
v/nh
sn/a
cute
-car
e-ho
spita
l/CA
UTI
/inde
x.ht
ml
Devi
ce A
ssoc
iate
d HA
I CLA
BSI -
CAU
TI
•HA
I, if
the
devi
ce w
as in
pla
ce fo
r >2
cale
ndar
day
s on
the
date
of
eve
nt
•
An H
AI o
ccur
ring
on th
e da
y of
dev
ice
disc
ontin
uatio
n or
the
follo
win
g ca
lend
ar d
ay is
HAI
if th
e de
vice
had
bee
n in
pla
ce fo
r >2
cal
enda
r day
s
•Fo
r a p
atie
nt w
ho h
as a
cen
tral
line
in p
lace
on
hosp
ital
adm
issio
n, d
ay o
f firs
t acc
ess i
s con
sider
ed d
evic
e Da
y 1
•
Phys
icia
n di
agno
sis c
an b
e ac
cept
ed a
s evi
denc
e of
an
infe
ctio
n on
ly w
hen
phys
icia
n di
agno
sis is
an
elem
ent o
f the
spec
ific
infe
ctio
n de
finiti
on
Spec
ific
Defin
ition
s:20
15
Labo
rato
ry C
onfir
med
Blo
od S
trea
m
Infe
ctio
n •
Type
s: L
CBI –
1, 2
or 3
•
LCBI
1
Pa
tient
has
a re
cogn
ized
path
ogen
cul
ture
d fr
om o
ne o
r m
ore
bloo
d cu
lture
s
AN
D
Org
anism
cul
ture
d fr
om b
lood
is n
ot re
late
d to
an
infe
ctio
n at
ano
ther
site
(S
ee A
ppen
dix
1 Se
cond
ary
BSI G
uide
)
LCBI
2
•Pa
tient
has
at l
east
one
of t
he fo
llow
ing
signs
or s
ympt
oms:
feve
r (>
38.0
C),
chill
s or h
ypot
ensio
n
AND
•
Org
anism
cul
ture
d fr
om b
lood
is n
ot re
late
d to
an
infe
ctio
n at
an
othe
r site
AN
D
•Th
e sa
me
com
mon
com
men
sal (
i.e.,
diph
ther
oids
[Cor
yneb
acte
rium
sp
p. n
ot C
. dip
hthe
riae]
, Bac
illus
spp.
[not
B. a
nthr
acis]
, Pr
opio
niba
cter
ium
spp.
, coa
gula
se-n
egat
ive
stap
hylo
cocc
i [in
clud
ing
S. e
pide
rmid
is], v
irida
ns g
roup
stre
ptoc
occi
, Aer
ococ
cus s
pp.,
and
Micr
ococ
cus s
pp.)
is cu
lture
d fr
om tw
o or
mor
e bl
ood
cultu
res d
raw
n on
sepa
rate
occ
asio
ns. B
oth
BC m
ust b
e dr
awn
in In
fect
ion
Win
dow
Com
mon
Com
men
sals
•N
ote:
The
mat
chin
g co
mm
on co
mm
ensa
ls re
pres
ent a
sing
le
elem
ent;
ther
efor
e, th
e co
llect
ion
date
of t
he fi
rst c
omm
on
com
men
sal i
s the
dat
e of
the
elem
ent u
sed
to d
eter
min
e th
e da
te o
f eve
nt
•ht
tp:/
/ww
w.c
dc.g
ov/n
hsn/
XLS/
mas
ter-
orga
nism
-Com
-Co
mm
ensa
ls-Li
sts.
xlsx
) Se
lect
the
com
mon
com
men
sal t
ab
6/1/
2014
6/
2/20
14
6/
3/20
14
6/
4/20
14
Da
te o
f Eve
nt
S. e
pide
rmid
is (1
of 2
) S.
epi
derm
idis
(2 o
f 2)
No
LCBI
el
emen
ts
Feve
r > 3
8.0
°C
6/
1/20
14
LCBI
3
•Pa
tient
≤ 1
yea
r of a
ge h
as a
t lea
st o
ne o
f the
follo
win
g sig
ns o
r sym
ptom
s:
feve
r (>3
8.0
C), h
ypot
herm
ia (<
36.0
C),
apne
a, o
r bra
dyca
rdia
AN
D
•O
rgan
ism c
ultu
red
from
blo
od is
not
rela
ted
to a
n in
fect
ion
at a
noth
er si
te
A
ND
•
The
sam
e co
mm
on c
omm
ensa
l (i.e
., di
phth
eroi
ds [C
oryn
ebac
teriu
m sp
p. n
ot
C. d
ipht
heria
e], B
acill
us sp
p. [n
ot B
. ant
hrac
is], P
ropi
onib
acte
rium
spp.
, co
agul
ase-
nega
tive
stap
hylo
cocc
i [in
clud
ing
S. e
pide
rmid
is], v
irida
ns g
roup
st
rept
ococ
ci, A
eroc
occu
s spp
., an
d M
icroc
occu
s spp
.) is
cultu
red
from
two
or
mor
e bl
ood
cultu
res d
raw
n on
sepa
rate
occ
asio
ns a
nd w
ithin
Infe
ctio
n W
indo
w
•M
ucos
al B
arrie
r Inj
ury
- LCB
I
Bloo
d Cu
lture
s
•As
eptic
ally
obt
aine
d •
Cont
amin
atio
n ra
te <
3%
•Pe
riphe
ral a
nd C
L •
2 Se
para
te p
orts
on
CL
•Ca
n be
dra
wn
with
in m
inut
es
•St
aff c
ompe
tenc
y EN
A Cl
inic
al P
ract
ice
Guid
elin
e 20
12 (r
evie
wed
3/2
014
NGC
)
view
ed 3d
/201
4 N
GC)
SUTI
1a
(CAU
TI)
Patie
nt m
ust m
eet 1
, 2, a
nd 3
bel
ow:
1)Pa
tient
had
an
indw
ellin
g ur
inar
y ca
thet
er th
at h
ad b
een
in p
lace
for >
2da
ys o
n th
e da
te o
f ev
ent (
day
of d
evic
e pl
acem
ent =
Day
1) A
ND
was
eith
er:
•St
ill p
rese
nt o
n th
e da
te o
f eve
nt†,
OR
•Re
mov
ed th
e da
y be
fore
the
date
of e
vent
‡ 2)
Patie
nt h
as a
t lea
st o
ne o
f the
follo
win
g sig
ns o
r sym
ptom
s:
•fe
ver (
>38.
0°C)
•
supr
apub
ic te
nder
ness
* •
cost
over
tebr
al a
ngle
pai
n or
tend
erne
ss*
•ur
inar
y ur
genc
y*
•ur
inar
y fr
eque
ncy*
•
dysu
ria*
3)Pa
tient
has
a u
rine
cultu
re w
ith n
o m
ore
than
two
spec
ies o
f org
anism
s, a
t lea
st o
ne o
f w
hich
is a
bac
teria
of ≥
105 C
FU/m
l. Al
l ele
men
ts o
f the
UTI
crit
erio
n m
ust o
ccur
dur
ing
the
Infe
ctio
n W
indo
w P
erio
d
•
† W
hen
ente
ring
even
t int
o N
HSN
choo
se “
INPL
ACE”
for R
isk F
acto
r for
Urin
ary
Cath
eter
•
‡ W
hen
ente
ring
even
t int
o N
HSN
choo
se “
REM
OVE
” fo
r Risk
Fac
tor f
or U
rinar
y Ca
thet
er
•*W
ith n
o ot
her r
ecog
nize
d ca
use
(can
not i
nclu
de fe
ver o
r hyp
othe
rmia
)
Sym
ptom
s Var
y in
Def
initi
on
•Ca
thet
er in
pla
ce
Feve
r (>3
8.0°
C)
Supr
apub
ic te
nder
ness
(no
othe
r cau
se)
Cost
over
tebr
al a
ngle
pai
n or
tend
erne
ss (n
o ot
her c
ause
) •
Cath
eter
rem
oved
add
Fr
eque
ncy
Urg
ency
Dy
suria
•
Infa
nt <
1yea
r add
ition
al
Apne
a Br
adyc
ardi
a Le
thar
gy
Vom
iting
Hy
poth
erm
ia <
36.0
°C
Feve
r
•Ca
nnot
be
attr
ibut
ed to
som
ethi
ng e
lse
•Fe
ver a
nd h
ypot
herm
ia a
re n
on-s
peci
fic
sym
ptom
s of i
nfec
tion
and
cann
ot b
e ex
clud
ed fr
om U
TI d
eter
min
atio
n be
caus
e th
ey a
re c
linic
ally
dee
med
due
to a
noth
er
reco
gnize
d ca
use
•M
ust b
e >3
8.0C
or 1
00.4
F in
the
rout
e th
e te
mpe
ratu
re w
as ta
ken
iiiningg gg
elelses
-spe
cific
no
tbe
Cath
eter
Rem
oved
•U
TIs w
ith e
vent
dat
e on
the
day
of d
evic
e di
scon
tinua
tion
or
the
follo
win
g ca
lend
ar d
ay a
re c
onsid
ered
dev
ice-
asso
ciat
ed
UTI
s if t
he d
evic
e ha
d be
en in
pla
ce a
lread
y fo
r >2
cale
ndar
da
ys
•Fo
r thi
s crit
erio
n ur
genc
y, fr
eque
ncy
and
dysu
ria a
re
sym
ptom
s
Day
1 Da
y 2
Day
3 Da
y 4
CAU
TI?
Fole
y Pl
aced
Fo
ley
in
Fole
y in
par
t of
day
Da
te o
f Eve
nt
Fole
y Pl
aced
Fole
y in
par
t of
day
N
o Fo
ley
Date
of E
vent
Fole
y Pl
aced
Fole
y in
par
t of
day
Da
te o
f Eve
nt
SUTI
1b
(Non
-CAU
TI)
Patie
nt m
ust m
eet 1
, 2, a
nd 3
bel
ow:
1. O
ne o
f the
follo
win
g is
true
: •
Patie
nt h
as/h
ad a
n in
dwel
ling
urin
ary
cath
eter
but
it h
as/h
ad n
ot b
een
in p
lace
>2
cale
ndar
day
s on
the
date
of e
vent
† O
R •
Patie
nt d
id n
ot h
ave
a ur
inar
y ca
thet
er in
pla
ce o
n th
e da
te o
f eve
nt n
or th
e da
y be
fore
the
date
of
even
t‡
2. P
atie
nt h
as a
t lea
st o
ne o
f the
follo
win
g sig
ns o
r sym
ptom
s:
•fe
ver (
>38°
C) in
a p
atie
nt th
at is
≤ 6
5 ye
ars o
f age
•
supr
apub
ic te
nder
ness
* •
cost
over
tebr
al a
ngle
pai
n or
tend
erne
ss*
•ur
inar
y fr
eque
ncy*
•
urin
ary
urge
ncy*
•
dysu
ria*
3. P
atie
nt h
as a
urin
e cu
lture
with
no
mor
e th
an tw
o sp
ecie
s of o
rgan
isms,
at l
east
one
of w
hich
is a
bac
teria
of
≥105
CFU
/ml.
All e
lem
ents
of t
he S
UTI
crit
erio
n m
ust o
ccur
dur
ing
the
Infe
ctio
n W
indo
w P
erio
d
† W
hen
ente
ring
even
t int
o N
HSN
choo
se “
NEI
THER
” for
Risk
Fac
tor f
or U
rinar
y Ca
thet
er
•*W
ith n
o ot
her r
ecog
nize
d ca
use
SUTI
2 (C
AUTI
or N
on-C
AUTI
≤
1-ye
ar-o
ld)
Patie
nt m
ust m
eet 1
, 2, a
nd 3
bel
ow:
1. P
atie
nt is
≤1
year
of a
ge (w
ith‡
or w
/o in
dwel
ling
cath
eter
) 2.
Pat
ient
has
at l
east
one
of t
he fo
llow
ing
signs
or s
ympt
oms:
•
feve
r (>3
8.0°
C)
• hy
poth
erm
ia (<
36.0
°C)
• ap
nea*
•
brad
ycar
dia*
•
leth
argy
* •
vom
iting
* •
supr
apub
ic te
nder
ness
* 3.
Pat
ient
has
a u
rine
cultu
re w
ith n
o m
ore
than
two
spec
ies o
f org
anism
s, a
t le
ast o
ne o
f whi
ch is
a b
acte
ria o
f ≥10
5 CFU
/ml.
All e
lem
ents
of t
he S
UTI
cr
iterio
n m
ust o
ccur
dur
ing
the
Infe
ctio
n W
indo
w P
erio
d
Asym
ptom
atic
Bac
tere
mic
UTI
(ABU
TI)
Patie
nt m
ust m
eet 1
, 2, a
nd 3
bel
ow:
1.Pa
tient
with
* or
with
out a
n in
dwel
ling
urin
ary
cath
eter
has
no
signs
or s
ympt
oms o
f SU
TI 1
or 2
acc
ordi
ng to
age
(Not
e:
Patie
nts >
65
year
s of a
ge w
ith a
non
-cat
hete
r-as
soci
ated
ABU
TI
may
hav
e a
feve
r and
still
mee
t the
ABU
TI c
riter
ion)
2.
Patie
nt h
as a
urin
e cu
lture
with
no
mor
e th
an tw
o sp
ecie
s of
orga
nism
s, a
t lea
st o
ne o
f whi
ch is
a b
acte
ria o
f ≥10
5 CFU
/ml
3.Pa
tient
has
a p
ositi
ve b
lood
cul
ture
with
at l
east
one
mat
chin
g ba
cter
ia to
the
urin
e cu
lture
, or m
eets
LCB
I crit
erio
n 2
(with
out
feve
r) a
nd m
atch
ing
com
mon
com
men
sal(s
) in
the
urin
e. A
ll el
emen
ts o
f the
ABU
TI c
riter
ion
mus
t occ
ur d
urin
g al
l ele
men
ts
of th
e SU
TI c
riter
ion
mus
t occ
ur d
urin
g th
e In
fect
ion
Win
dow
Pe
riod
* Pa
tient
had
an
indw
ellin
g ur
inar
y ca
thet
er in
pla
ce fo
r >2
cale
ndar
da
ys, w
ith d
ay o
f dev
ice
plac
emen
t bei
ng D
ay 1
, and
cat
hete
r was
in
plac
e on
the
date
of e
vent
or t
he d
ay b
efor
e
Prac
tice
•75
yea
r-ol
d ad
mitt
ed fo
r a C
VA, F
oley
in
sert
ed
•Da
y 4:
Tem
p 10
0.4 F
•
Day
6: U
rine
cultu
re c
olle
cted
•
Day
7: U
rine
cultu
re re
port
: P. A
erug
inos
a >1
0,00
0 CF
U/m
l •
Is th
is a
CAU
TI, i
f so,
wha
t is t
he D
OE?
Prac
tice
•75
yea
r-ol
d ad
mitt
ed fo
r a C
VA, F
oley
inse
rted
•
Day
4: Te
mp
100.
4 F
•Da
y 6:
Urin
e cu
lture
col
lect
ed
•Da
y 7:
Urin
e cu
lture
repo
rt: P
. Aer
ugin
osa
>100
,000
CF
U/m
l with
mod
erat
e ye
ast
•Is
this
a CA
UTI
, if s
o, w
hat i
s the
DO
E?
•Da
y 8:
Tem
p 10
0.6 F
•
Is th
is a
CAU
TI, i
f so,
wha
t is t
he D
OE?
•
Day
19: U
rine
Cultu
re c
olle
cted
and
repo
rted
E. c
oli
•N
ew o
r RIT
?
•Da
y 20
: Blo
od c
ultu
re c
olle
cted
: P. A
erug
inos
a an
d ye
ast
Prac
tice
Adm
it PO
A/HA
I In
fect
ion
Win
dow
RI
T 20
BSI
Day
1
Day
2
Da
y 3
Da
y 4
Da
y 5
Da
y 6
Da
y 7
Da
y 8
Da
y 9
Da
y 10
Day
11
Da
y 12
Day
13
Da
y 14
Day
15
Da
y 16
Day
17
Da
y 18
Day
19
Day
20
Assi
gnin
g th
e Co
rrec
t Loc
atio
n
•In
patie
nt lo
catio
n as
signe
d on
dat
e of
Eve
nt
•
Tran
sfer
Rul
es: I
f the
dat
e of
eve
nt fo
r the
U
TI is
the
day
of tr
ansf
er o
r the
nex
t day
, the
U
TI is
att
ribut
ed to
the
tran
sfer
ring
loca
tion
or fa
cilit
y
•Di
scha
rge:
If th
e da
te o
f eve
nt is
the
day
of
disc
harg
e or
the
next
day
, the
infe
ctio
n is
attr
ibut
ed to
the
disc
harg
ing
loca
tion
Prac
tice
•75
yea
r-ol
d ad
mitt
ed fo
r a C
VA, F
oley
inse
rted
•
Day
4: Te
mp
100.
4 F
•Da
y 6:
Urin
e cu
lture
col
lect
ed
•Da
y 7:
Urin
e cu
lture
repo
rt: P
. Aer
ugin
osa
>100
,000
CF
U/m
l with
mod
erat
e ye
ast
•Is
this
a CA
UTI
, if s
o, w
hat i
s the
DO
E?
•Da
y 8:
Tem
p 10
0.6 F
•
Is th
is a
CAU
TI, i
f so,
wha
t is t
he D
OE?
•
Day
12: T
rans
ferr
ed to
IRF
•Da
y 19
: Urin
e cu
lture
col
lect
ed a
nd re
port
ed E
. col
i •
Day
20: B
lood
cul
ture
col
lect
ed: P
. Aer
ugin
osa
and
yeas
t •
New
or R
IT, H
ow d
o I c
ount
with
tran
sfer
??
Tran
sfer
Rul
e
•IR
F is
map
ped
as a
loca
tion
in a
n ac
ute
care
fa
cilit
y, yo
u us
e th
e tr
ansf
er ru
le a
nd th
e tim
e fra
mes
wou
ld c
ontin
ue
•
If IR
F is
enro
lled
in N
HSN
as a
stan
d al
one
faci
lity
(eve
n if
conn
ecte
d to
an
acut
e ca
re
hosp
ital),
they
are
a d
ischa
rge
and
none
of
the
time
fram
es c
arry
ove
r
SSI r
epor
ting
•Le
ngth
of s
urve
illan
ce 3
0-90
day
s •
Clos
ure
defin
ition
•
New
var
iabl
es fo
r risk
ad
just
men
t •
Rem
inde
r: PO
A, H
AI,
Infe
ctio
n w
indo
w, R
IT a
re
not u
sed
with
SSI
•
Does
hav
e 20
BSI
Attr
ibut
ion
perio
d 3
day
s bef
ore
and
13 d
ays
afte
r DO
E
Leng
th o
f Su
rvei
llanc
e O
ptio
ns 3
0 or
90
day
All s
uper
ficia
l are
30
days
rega
rdle
ss o
f de
pth
SSI p
roto
col m
anua
l, pg
9-1
5, A
pril
2015
Prim
ary
vs N
on-P
rimar
y Cl
osur
e •
Prim
ary
Clos
ure
Prim
ary
Clos
ure
is de
fined
as c
losu
re o
f th
e sk
in le
vel d
urin
g th
e or
igin
al su
rger
y,
rega
rdle
ss o
f the
pre
senc
e of
wire
s,
wic
ks, d
rain
s, o
r oth
er d
evic
es o
r obj
ects
ex
trud
ing
thro
ugh
the
inci
sion.
Thi
s ca
tego
ry in
clud
es su
rger
ies w
here
the
skin
is c
lose
d by
som
e m
eans
. Thu
s, if
an
y po
rtio
n of
the
inci
sion
is cl
osed
at
the
skin
leve
l, by
any
man
ner,
a de
signa
tion
of p
rimar
y cl
osur
e sh
ould
be
assig
ned
to th
e su
rger
y.
NO
TE: I
f a p
roce
dure
has
mul
tiple
in
cisio
n/la
paro
scop
ic tr
ocar
site
s and
an
y of
the
inci
sions
are
clo
sed
prim
arily
, th
en th
e pr
oced
ure
is en
tere
d as
hav
ing
been
clo
sed
prim
arily
. Th
is ch
ange
rem
oved
the
phra
se “a
ll tis
sue
leve
ls” fr
om th
e de
finiti
on..
•N
on-P
rimar
y Cl
osur
e N
on-p
rimar
y Cl
osur
e is
defin
ed a
s clo
sure
that
is o
ther
th
an p
rimar
y an
d in
clud
es su
rger
ies i
n w
hich
the
skin
le
vel i
s lef
t com
plet
ely
open
dur
ing
the
orig
inal
surg
ery
and
ther
efor
e ca
nnot
be
clas
sifie
d as
hav
ing
prim
ary
clos
ure.
For
surg
erie
s with
non
-prim
ary
clos
ure,
the
deep
tis
sue
laye
rs m
ay b
e cl
osed
by
som
e m
eans
(with
the
skin
le
vel l
eft o
pen)
, or t
he d
eep
and
supe
rfic
ial l
ayer
s may
bo
th b
e le
ft c
ompl
etel
y op
en.
An e
xam
ple
of a
surg
ery
with
non
-prim
ary
clos
ure
wou
ld
be a
lapa
roto
my
in w
hich
the
inci
sion
was
clo
sed
to th
e le
vel o
f the
dee
p tis
sue
laye
rs, s
omet
imes
cal
led
“fas
cial
la
yers
” or
“dee
p fa
scia
,” bu
t the
skin
leve
l was
left
ope
n.
Anot
her e
xam
ple
wou
ld b
e an
“ope
n ab
dom
en”
case
in
whi
ch th
e ab
dom
en is
left
com
plet
ely
open
afte
r the
su
rger
y. W
ound
s with
non
-prim
ary
clos
ure
may
or m
ay
not b
e de
scrib
ed a
s "pa
cked
” w
ith g
auze
or o
ther
m
ater
ial,
and
may
or m
ay n
ot b
e co
vere
d w
ith p
last
ic,
“wou
nd v
acs,”
or o
ther
synt
hetic
dev
ices
or m
ater
ials.
NH
SN
pre
sent
atio
n, J
. Bro
oks,
Feb
201
5
Prim
ary
vs N
on-P
rimar
y Cl
osur
e
Prim
ary
Non
-Prim
ary
New
Var
iabl
e
•De
nom
inat
or fo
rm
•He
ight
•
Wei
ght
•Cl
osur
e qu
estio
ns?
•Di
abet
es:
Can
use
disc
harg
e IC
D-9-
CM
code
s in
the
250
to
250.
93 ra
nge
to a
nsw
er
YES
•W
hat i
f you
don
’t kn
ow?
Clos
trid
ium
Diff
icile
Infe
ctio
n (C
DI)
Gra
m-p
ositi
ve C
. diff
icile
bac
teria
fr
om a
sto
ol s
ampl
e cu
lture
C
onte
nt s
ourc
e: C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n,
Offi
ce o
f the
Ass
ocia
te D
irect
or fo
r Com
mun
icat
ions
, Div
isio
n of
P
ublic
Affa
irs. P
HIL
ID 9
999
Clos
trid
ium
Diff
icile
Infe
ctio
n (C
DI)
•LA
B ID
is o
nly
a su
rvei
llanc
e m
easu
re
•Cr
iteria
onl
y by
lab
resu
lt •
Loca
tion
– Lo
catio
n - L
ocat
ion
Lab
resu
lt fro
m E
R La
b re
sult
from
Ski
lled
Uni
t W
hat i
s a 2
4-ho
ur o
bser
vatio
n un
it
Labo
rato
ry Id
entif
ied
(Lab
ID) E
vent
s in
NHS
N
N
HSN
det
erm
ines
Cat
egor
y •
Heal
thca
re F
acili
ty-O
nset
(HO
): La
bID
even
t spe
cim
en c
olle
cted
>
3 da
ys a
fter a
dmiss
ion
to th
e fa
cilit
y (i.
e., o
n or
afte
r day
4)
•Co
mm
unity
-Ons
et (C
O):
LabI
D ev
ent s
peci
men
col
lect
ed a
s an
inpa
tient
≤ 3
day
s afte
r adm
issio
n to
the
faci
lity
(i.e.
, day
s 1
(adm
issio
n), 2
, or 3
) •
Com
mun
ity-O
nset
Hea
lthca
re F
acili
ty-A
ssoc
iate
d (C
O-H
CFA)
: CO
Lab
ID e
vent
col
lect
ed fr
om a
pat
ient
who
was
disc
harg
ed
from
the
faci
lity ≤
4 w
eeks
prio
r to
the
date
cur
rent
stoo
l sp
ecim
en w
as co
llect
ed
•Ba
sed
on In
patie
nt A
dmiss
ion
& S
peci
men
Co
llect
ion
Date
s
CDI M
easu
res
•He
alth
care
Fac
ility
-Ons
et In
cide
nce
Rate
= N
umbe
r of
all I
ncid
ent H
O C
DI L
abID
eve
nts p
er p
atie
nt p
er m
onth
/ n
umbe
r of p
atie
nt d
ays f
or th
e fa
cilit
y x
10,0
00
•
Stan
dard
ized
Infe
ctio
n Ra
tio (S
IR) =
Risk
-adj
uste
d su
mm
ary
mea
sure
that
com
pare
s the
obs
erve
d nu
mbe
r of L
abID
eve
nts t
o th
e ex
pect
ed n
umbe
r of
LabI
D ev
ents
bas
ed o
n N
HSN
agg
rega
te d
ata
from
20
10-2
011
CMS
Surv
eyor
Wor
kshe
et
CM
S.g
ov
Gene
ral P
reve
ntio
n St
rate
gies
Hand
Hyg
iene
•St
anda
rdize
pla
cem
ent o
f soa
p an
d m
oist
urize
r So
ap o
n rig
ht, m
oist
urize
r lef
t “H
esita
tion
and
erro
r: Do
es p
rodu
ct p
lace
men
t in
an
emer
genc
y de
part
men
t inf
luen
ce h
and
hygi
ene
perfo
rman
ce?”
A
JIC, J
une
11, 2
015,
Sta
ckel
roth
, J, S
inno
tt, M
, Sha
ban,
R
Tool
w
ww
.pat
ient
safe
ty.o
rg
Hand
Hyg
iene
Mea
sure
men
t •
Com
paris
on o
f han
d hy
gien
e m
onito
ring
usin
g th
e 5
mom
ents
for H
H m
etho
d vs
a w
ash
in-w
ash
out
met
hod,
Ven
kata
C.K
l, et
al,
AJIC
, 43
(201
5) 1
6-19
•
Sam
ple:
283
•
Resu
lts:
72%
com
plia
nce
Was
h in
-Was
h ou
t
70
% c
ompl
ianc
e 5
Mom
ents
•
Not
es:
Still
nee
d to
do
som
e ro
om o
bser
vatio
n O
bser
ver r
elia
bilit
y (p
revi
ous 9
4%)
Purp
ose
is to
edu
cate
- ed
ucat
e
Tran
sfor
min
g H
ealth
care
, Bey
ond
the
Col
labo
rativ
e: S
prea
ding
Effe
ctiv
e Im
prov
emen
t in
Han
d H
ygie
ne C
ompl
ianc
e,
The
Join
t Com
mis
sion
Jou
rnal
on
Qua
lity
and
Pat
ient
Saf
ety,
Janu
ary
2015
, Vol
ume
41 N
umbe
r 1
Lead
ersh
ip F
irst
Han
d H
ygie
ne in
Out
patie
nt a
nd H
ome-
base
d C
are
and
Long
-term
Car
e Fa
cilit
ies,
Wor
ld H
ealth
O
rgan
izat
ion
2012
Don’
t For
get t
he P
atie
nts
•St
udy:
27
9 pa
tient
s – e
lect
roni
c m
onito
ring
30%
afte
r bat
hroo
m
40%
with
mea
ls 3
– 7%
ent
erin
g or
leav
ing
room
M
cMas
ter U
nive
rsity
, Dr.
Joce
lyn
Srig
ley,
Oct
, 201
4 •
Actio
ns fo
r pat
ient
s O
ffer H
H w
ith ro
undi
ng, m
eals
Patie
nt w
ears
glo
ves w
ith to
iletin
g (C
DI)
Empo
wer
fam
ily to
use
AHR
whe
n en
terin
g/le
avin
g ro
om
Glov
e U
se
•
Rule
s:
Was
h an
d dr
y ha
nds b
efor
e do
nnin
g Ba
cter
ia c
an m
ultip
ly ra
pidl
y in
moi
st e
nviro
nmen
ts u
nder
neat
h gl
oves
W
ash
whe
n re
mov
e G
love
s may
hav
e sm
all,
unap
pare
nt d
efec
ts o
r may
be
torn
dur
ing
use
Chan
ge
Afte
r con
tact
with
blo
od o
r bod
y flu
ids
Afte
r com
plet
ing
task
s at o
ne p
atie
nt st
atio
n be
fore
mov
ing
to
anot
her s
tatio
n
Afte
r con
tact
ing
a po
tent
ially
con
tam
inat
ed si
te b
efor
e m
ovin
g to
a
clea
n sit
e Im
med
iate
ly if
pun
ctur
ed o
r tor
n
Glov
es
•Is
it sa
fe to
was
h gl
oves
bef
ore
use?
W
ashi
ng o
f lat
ex g
love
s with
pla
in so
ap,
chlo
rhex
idin
e, o
r alc
ohol
can
cau
se
mic
ropu
nctu
res.
Thi
s con
ditio
n, k
now
n as
"w
icki
ng,"
may
allo
w li
quid
s to
pene
trat
e th
roug
h un
dete
cted
hol
es in
the
glov
es.
http
://w
ww.
cdc.
gov/
dial
ysis
/pre
vent
ion-
tool
s/P
roto
col-h
and-
hygi
ene-
glov
e-ob
serv
atio
ns.h
tml
The
Chal
leng
e
•W
hat a
re y
our r
eal r
ates
?
•Do
you
thor
ough
ly in
vest
igat
e ev
ery
HAI?
•Ar
e pa
tient
’s pa
rt o
f the
team
that
inve
stig
ate
and
wor
k to
war
ds so
lutio
n?
•
Do y
ou p
ost h
ow lo
ng si
nce
last
HAI
on
the
unit?
Antib
iotic
Ste
war
dshi
p
Antib
iotic
Use
in O
P se
ttin
gs
Hic
ks L
A et
al.
N E
ngl J
M
ed 2
013;
368
:146
1-14
62
Plan
for A
ctio
n
•20
17 M
easu
res a
dded
to
CoP
for h
ospi
tals
and
nurs
ing
hom
es
•N
atio
nwid
e re
port
ing
by 2
020
•Ad
d to
VBP
pro
gram
CLAB
SI: H
ow it
hap
pens
M
ore
Com
mon
Mec
hani
sms
1. P
atho
gen
mig
ratio
n al
ong
exte
rnal
su
rface
- mor
e co
mm
on e
arly
(< 7
days
) 2.
Hub
con
tam
inat
ion
with
in
tralu
min
al c
olon
izat
ion
-m
ore
com
mon
>10
day
s Le
ss C
omm
on M
echa
nism
s 1.
Hem
atog
enou
s se
edin
g fro
m a
noth
er s
ourc
e 2.
Con
tam
inat
ed in
fusa
tes
H
ICPA
C. G
uide
line
for P
reve
ntio
n of
In
trava
scul
ar D
evic
e-R
elat
ed
Infe
ctio
ns. 1
996
http
://w
ww.
cdc.
gov/
HA
I/pdf
s/bs
i/che
cklis
t-for
-C
LAB
SI.p
df
CLAB
SI
Prev
entio
n In
sert
ion
CLAB
SI P
reve
ntio
n •
Mai
nten
ance
Di
sinfe
ct h
ubs,
por
ts p
rior t
o ac
cess
, vig
orou
s fric
tion
– 5
seco
nds
Mea
sure
if d
one
(hal
f fou
nd to
be
colo
nize
d)
Dres
sing
chan
ge 5
-7 d
ays (
Gauz
e 2
days
) inc
lude
site
car
e w
ith
CHG
(non
-tun
nele
d ca
thet
ers)
An
timic
robi
al o
intm
ents
for h
emod
ialy
sis c
athe
ter-
inse
rtio
n sit
es
Pol
yspo
rin “
trip
le”
povi
done
iodi
ne o
intm
ent (
no m
upiro
cin)
•
High
Rat
es
Cons
ider
impr
egna
ted
cath
eter
s, sp
onge
s, d
ress
ings
and
por
t co
vers
An
timic
robi
al lo
ck so
lutio
ns
Jo
nas
Mar
scha
ll, L
eona
rd A
. Mer
mel
, Moh
amad
Fak
ih, L
ynn
Had
away
, Ale
xand
er K
alle
n, N
aom
i P. O
’Gra
dy, A
nn M
arie
Pet
tis, M
ark
E. R
upp,
Th
omas
San
dora
, Lis
a L.
Mar
agak
is a
nd D
ebor
ah S
. Yok
oe (2
014)
. Stra
tegi
es to
Pre
vent
Cen
tral L
ine–
Asso
ciat
ed B
lood
stre
am In
fect
ions
in
Acu
te C
are
Hos
pita
ls: 2
014
Upd
ate.
Infe
ctio
n C
ontro
l & H
ospi
tal E
pide
mio
logy
, 35,
pp
753-
771
doi:1
0.10
86/5
9105
9
CAU
TI P
hysi
olog
y
•
* So
urce
of
mic
roor
gani
sms m
ay b
e en
doge
nous
mea
tal,
rect
al, o
r vag
inal
co
loni
zatio
n) o
r ex
ogen
ous,
usu
ally
via
co
ntam
inat
ed h
ands
of
heal
thca
re p
erso
nnel
du
ring
cath
eter
inse
rtio
n or
man
ipul
atio
n of
the
colle
ctin
g sy
stem
Figu
re fr
om: M
aki D
G, T
amby
ah P
A.
Em
erg
Infe
ct D
is 2
001;
7:1-
6
Biof
ilm
•
Form
atio
n of
bio
film
s by
urin
ary
path
ogen
s com
mon
on
the
surf
aces
of c
athe
ters
an
d co
llect
ing
syst
ems
•Ba
cter
ia w
ithin
bio
film
s re
sista
nt to
ant
imic
robi
als a
nd
host
def
ense
s •
Som
e no
vel s
trat
egie
s in
CAU
TI p
reve
ntio
n ha
ve
targ
eted
bio
film
s
Sca
nnin
g el
ectro
n m
icro
grap
h of
S. a
ureu
s ba
cter
ia o
n th
e lu
min
al s
urfa
ce o
f an
indw
ellin
g ca
thet
er w
ith in
terw
oven
com
plex
mat
rix o
f ext
race
llula
r pol
ymer
ic
subs
tanc
es k
now
n as
a b
iofil
m
Pho
togr
aph
from
CD
C P
ublic
Hea
lth Im
age
Libr
ary:
http
://ph
il.cd
c.go
v/ph
il/de
tails
.asp
CAU
TI P
reve
ntio
n St
rate
gies
•Pr
ovid
e an
d im
plem
ent w
ritte
n gu
idel
ines
for c
athe
ter u
se, i
nser
tion
and
mai
nten
ance
. Exa
mpl
e of
app
ropr
iate
indi
catio
ns in
clud
e th
e fo
llow
ing:
Perio
pera
tive
use
for s
elec
ted
surg
ical
pro
cedu
res,
such
as u
rolo
gic
surg
ery
or
surg
ery
on c
ontig
uous
stru
ctur
es o
f the
gen
itour
inar
y tr
act;
prol
onge
d su
rger
y; la
rge
volu
me
infu
sions
or d
iure
tics d
urin
g su
rger
y; in
trao
pera
tive
mon
itorin
g of
urin
e ou
tput
nee
ded
Hour
ly a
sses
smen
t of u
rine
outp
ut in
pat
ient
s in
an IC
U
Man
agem
ent o
f acu
te u
rinar
y re
tent
ion
and
urin
ary
obst
ruct
ion
Assis
tanc
e in
hea
ling
of o
pen
pres
sure
ulc
ers o
r ski
n gr
afts
for s
elec
ted
patie
nts w
ith u
rinar
y in
cont
inen
ce
As a
n ex
cept
ion,
at p
atie
nt re
ques
t to
impr
ove
com
fort
(i.e
., en
d-of
-life
car
e)
CAU
TI P
reve
ntio
n St
rate
gies
•
Ensu
re th
at o
nly
trai
ned,
ded
icat
ed p
erso
nnel
inse
rt u
rinar
y ca
thet
ers
- 2 p
eopl
e •
Ensu
re th
at su
pplie
s nec
essa
ry fo
r ase
ptic
tech
niqu
e fo
r ins
ertio
n ar
e av
aila
ble
and
conv
enie
ntly
loca
ted
Im
plem
ent a
syst
em fo
r doc
umen
ting
the
follo
win
g in
the
patie
nt re
cord
: Ph
ysic
ian
orde
r, in
dica
tions
, dat
e an
d tim
e, n
ame
of in
divi
dual
who
in
sert
ed c
athe
ter
Daily
pre
senc
e of
a c
athe
ter a
nd m
aint
enan
ce c
are
task
s Da
te a
nd ti
me,
crit
eria
for c
athe
ter r
emov
al
Just
ifica
tion
for c
ontin
ued
use
En
sure
that
ther
e ar
e su
ffici
ent t
rain
ed p
erso
nnel
and
tech
nolo
gy re
sour
ces t
o su
ppor
t sur
veill
ance
for c
athe
ter u
se a
nd o
utco
mes
CAU
TI P
reve
ntio
n St
rate
gies
•U
se a
ppro
pria
te te
chni
que
for c
athe
ter i
nser
tion
Inse
rt u
rinar
y ca
thet
ers o
nly
whe
n ne
cess
ary
for p
atie
nt c
are
and
leav
e in
pla
ce o
nly
as lo
ng a
s ind
icat
ions
rem
ain
Co
nsid
er o
ther
met
hods
for b
ladd
er m
anag
emen
t, su
ch a
s in
term
itten
t cat
hete
rizat
ion,
whe
re a
ppro
pria
te
Prac
tice
hand
hyg
iene
bef
ore
inse
rtio
n of
the
cath
eter
and
bef
ore
and
afte
r any
man
ipul
atio
n of
the
cath
eter
site
or a
ppar
atus
In
sert
cat
hete
rs fo
llow
ing
asep
tic te
chni
que
and
usin
g st
erile
eq
uipm
ent
Use
ster
ile g
love
s, d
rape
, and
spon
ges;
a st
erile
or a
ntise
ptic
so
lutio
n fo
r cle
anin
g th
e ur
ethr
al m
eatu
s; a
nd a
ster
ile si
ngle
-use
pa
cket
of l
ubric
ant j
elly
for i
nser
tion
U
se a
s sm
all a
cath
eter
as p
ossib
le co
nsist
ent w
ith p
rope
r dr
aina
ge, t
o m
inim
ize u
reth
ral t
raum
a
CAU
TI P
reve
ntio
n St
rate
gies
•Sp
ecia
l app
roac
hes f
or p
reve
ntin
g CA
UTI
Im
plem
ent a
n or
gani
zatio
n-w
ide
prog
ram
to id
entif
y an
d re
mov
e ca
thet
ers t
hat a
re n
o lo
nger
nec
essa
ry
usin
g on
e or
mor
e m
etho
ds d
ocum
ente
d to
be
effe
ctiv
e
Deve
lop
and
impl
emen
t ins
titut
iona
l pol
icy
requ
iring
pe
riodi
c (u
sual
ly d
aily
) rev
iew
of t
he n
eces
sity
of
cont
inue
d ca
thet
eriza
tion
–Au
tom
atic
stop
ord
ers r
equi
ring
revi
ew o
f cur
rent
indi
catio
ns a
nd
rene
wal
of o
rder
for c
ontin
uatio
n of
the
indw
ellin
g ca
thet
er.
–St
anda
rdize
d el
ectr
onic
or p
aper
rem
inde
rs o
f per
siste
nt c
athe
ters
to
geth
er w
ith c
urre
nt c
athe
ter i
ndic
atio
ns ta
rget
ing
eith
er
phys
icia
ns o
r nur
ses.
–
Cond
uct d
aily
revi
ew d
urin
g ro
unds
CAU
TI P
reve
ntio
n St
rate
gies
•De
velo
p a
prot
ocol
for m
anag
emen
t of
post
oper
ativ
e ur
inar
y re
tent
ion,
incl
udin
g nu
rse-
dire
cted
use
of i
nter
mitt
ent c
athe
teriz
atio
n an
d us
e of
bla
dder
scan
ners
If
blad
der s
cann
ers a
re u
sed,
cle
arly
stat
e in
dica
tions
, tra
in n
ursin
g st
aff i
n th
eir u
se, a
nd
disin
fect
bet
wee
n pa
tient
s acc
ordi
ng to
m
anuf
actu
rers
’ ins
truc
tions
.
•St
rate
gies
to P
reve
nt C
athe
ter-
Asso
ciat
ed U
rinar
y Tr
act I
nfec
tions
in A
cute
Car
e Ho
spita
ls:
2014
Upd
ate,
Aut
hor(
s): E
vely
n Lo
, MD,
et a
l.
CDI P
reve
ntio
n St
rate
gies
•
Antim
icro
bial
usa
ge re
stric
tion
and
stew
ards
hip.
Do
not
trea
t or d
ecol
onize
asy
mpt
omat
ic C
. diff
icile
carr
iers
. Ant
imic
robi
al th
erap
y is
not e
ffect
ive
for
deco
loni
zatio
n M
ost p
atie
nts w
ho a
re c
linic
ally
cur
ed w
ith tr
eatm
ent w
ill c
ontin
ue to
hav
e to
xige
nic
C. d
iffic
ile in
thei
r sto
ol
for m
ultip
le w
eeks
. Thi
s is n
ot a
n in
dica
tion
of tr
eatm
ent f
ailu
re
•M
etho
ds to
pre
vent
the
patie
nt fr
om e
xpos
ure
to C
. diff
icile
(disi
nfec
tion
and
barr
ier m
etho
ds).
Avoi
d us
e of
ele
ctro
nic
ther
mom
eter
s De
dica
ted
patie
nt c
are
item
s and
equ
ipm
ent
Use
full-
barr
ier p
reca
utio
ns (g
owns
and
glo
ves)
for c
onta
ct w
ith C
DI p
atie
nts a
nd fo
r con
tact
with
thei
r bod
y su
bsta
nces
and
env
ironm
ent (
cont
act p
reca
utio
ns).
Plac
e pa
tient
s w
ith C
DI in
priv
ate
room
s if a
vaila
ble.
•
Hand
hyg
iene
with
soap
and
wat
er o
r an
alco
hol-b
ased
han
d hy
gien
e pr
oduc
t P
erfo
rm h
and
hygi
ene
with
soap
and
wat
er p
refe
rent
ially
afte
r car
ing
for a
pat
ient
with
CDI
in o
utbr
eak
or
hype
rend
emic
set
tings
. •
Perf
orm
env
ironm
enta
l dec
onta
min
atio
n of
room
s of p
atie
nts w
ith C
DI u
sing
sodi
um h
ypoc
hlor
ite (h
ouse
hold
bl
each
) dilu
ted
1 : 1
0 w
ith w
ater
or a
n EP
A–ap
prov
ed sp
oric
idal
pro
duct
in a
n ou
tbre
ak o
r hyp
eren
dem
ic s
ettin
g.
•Ed
ucat
e he
alth
care
per
sonn
el (H
CP) a
nd h
ospi
tal a
dmin
istra
tion
on c
linic
al fe
atur
es, t
rans
miss
ion,
and
ep
idem
iolo
gy o
f CDI
.
Erik
R. D
ubbe
rke,
Phi
lip C
arlin
g, R
uth
Car
rico,
Cur
tis J
. Don
skey
, Viv
ian
G. L
oo, L
. Clif
ford
McD
onal
d, L
isa
L. M
arag
akis
,Tho
mas
J.
Sand
ora,
Dav
id J
. Web
er, D
ebor
ah S
. Yok
oe a
nd D
ale
N. G
erdi
ng (2
014)
. Stra
tegi
es to
Pre
vent
Clo
strid
ium
dif f
cile
Infe
ctio
ns in
Ac
ute
Car
e H
ospi
tals
: 201
4 U
pdat
e. In
fect
ion
Con
trol &
Hos
pita
l Epi
dem
iolo
gy, 3
5, p
p 62
8-64
5 do
i:10.
1086
/522
262
Eval
uate
and
opt
imize
test
-ord
erin
g pr
actic
es a
nd d
iagn
ostic
met
hods
and
co
mm
unic
atio
n of
resu
lts
Test
ing
Reje
ct p
olic
y un
form
ed st
ool
(If th
e st
ick
stan
ds
the
test
is b
anne
d)
Imm
edia
te la
b tr
ansp
ort.
Do n
ot re
peat
afte
r tr
eatm
ent
Cont
act I
sola
tion
•Ra
pid
reco
gniti
on a
nd im
plem
enta
tion
•Ap
prop
riate
sign
age
•Is
olat
e th
roug
h di
arrh
ea
•Re
com
men
d at
leas
t 2 d
ays m
ore
•So
me
sugg
estin
g al
l of h
ospi
taliz
atio
n 70
% h
ave
skin
con
tam
inat
ion
for 6
day
s afte
r di
arrh
ea
40%
- 9
days
afte
r dia
rrhe
a
Ra
tiona
le fo
r Con
side
ring
Exte
ndin
g Is
olat
ion
Beyo
nd D
urat
ion
of D
iarr
hea
Bob
ulsk
y et
al.
Clin
Infe
ct D
is 2
008;
46:4
47-5
0.
Hand
Hyg
iene
– S
oap
vs. A
lcoh
ol G
el
•Al
coho
l not
effe
ctiv
e in
era
dica
ting
C. d
iffici
le sp
ores
•
How
ever
, one
hos
pita
l stu
dy fo
und
that
from
200
0-20
03, d
espi
te in
crea
sing
use
of a
lcoh
ol h
and
rub,
th
ere
was
no
conc
omita
nt in
crea
se in
CDI
rate
s
•Di
scou
ragi
ng a
lcoh
ol g
el u
se m
ay u
nder
min
e ov
eral
l ha
nd h
ygie
ne p
rogr
am w
ith u
ntow
ard
cons
eque
nces
fo
r HAI
s in
gene
ral
Boy
ce e
t al.
Infe
ct C
ontro
l Hos
p E
pide
mio
l 200
6;27
:479
-83.
Hand
Hyg
iene
– A
lcoh
ol H
and
Rub
Use
20
00-2
003
Boy
ce e
t al.
Infe
ct C
ontro
l Hos
p E
pide
mio
l 200
6; 2
7:47
9-83
.
Hand
Hyg
iene
– C
DI R
ates
200
0-20
03
Boy
ce J
M e
t al.
Infe
ct C
ontro
l Hos
p E
pide
mio
l 200
6; 2
7:47
9-83
.
Ratio
nale
for S
oap
and
Wat
er: L
ack
of e
ffica
cy o
f al
coho
l-bas
ed h
andr
ub a
gain
st C
. diff
icile
Oug
hton
et a
l. In
fect
Con
trol H
osp
Epi
dem
iol 2
009;
30:9
39-4
4.
Hand
Was
hing
: Pro
duct
Com
paris
on
Prod
uct
Log1
0 R
educ
tion
Tap
Wat
er
0.76
4%
CH
G a
ntim
icro
bial
han
d w
ash
0.77
N
on-a
ntim
icro
bial
han
d w
ash
0.78
N
on-a
ntim
icro
bial
bod
y w
ash
0.86
0.
3% tr
iclo
san
antim
icro
bial
han
d w
ash
0.99
H
eavy
dut
y ha
nd c
lean
er u
sed
in m
anuf
actu
ring
envi
ronm
ents
1.
21*
* O
nly
valu
e th
at w
as s
tatis
tical
ly b
ette
r tha
n ot
hers
Edm
onds
, et a
l. P
rese
nted
at:
SH
EA
2009
; Abs
tract
43.
Con
clus
ion:
Spo
res
may
be
diffi
cult
to e
radi
cate
ev
en w
ith h
and
was
hing
Hand
Was
h Pr
oduc
ts a
nd P
roto
type
s Te
sted
for R
educ
ing
C. d
iff S
pore
s
Edm
onds
, et.a
l IC
HE
201
3; 3
4;30
2-30
5
*Sig
nific
antly
bet
ter t
han
tap
wat
er
Hand
Hyg
iene
Met
hods
http
://w
ww.
shea
-onl
ine.
org/
Por
tals
/0/C
DI%
20ha
nd%
20hy
gien
e%20
Upd
ate.
Hand
Hyg
iene
Met
hods
“Alth
ough
soa
p an
d w
ater
is s
uper
ior t
o re
mov
ing
C. d
iffic
ile
spor
es fr
om h
ands
of v
olun
teer
s co
mpa
red
to a
lcoh
ol-b
ased
ha
nd h
ygie
ne p
rodu
cts,
ther
e ha
ve b
een
no s
tudi
es in
acu
te
care
set
tings
that
hav
e de
mon
stra
ted
an in
crea
se in
CD
I with
al
coho
l-bas
ed h
and
hygi
ene
prod
ucts
or a
dec
reas
e in
CD
I w
ith s
oap
and
wat
er. T
his
is w
hy p
refe
rent
ial u
se o
f soa
p an
d w
ater
for h
and
hygi
ene
afte
r car
ing
for a
pat
ient
with
CD
I is
not
reco
mm
ende
d in
non
-out
brea
k se
tting
s. T
he re
com
men
datio
n to
use
soa
p an
d w
ater
pre
fere
ntia
lly in
out
brea
k se
tting
s af
ter
carin
g fo
r a p
atie
nt w
ith C
DI i
s ba
sed
on e
xper
t opi
nion
as
ther
e ar
e no
dat
a th
at d
emon
stra
te p
refe
rent
ial u
se o
f soa
p an
d w
ater
for h
and
hygi
ene
afte
r car
ing
for a
pat
ient
with
CD
I in
an
outb
reak
set
ting
is e
ffect
ive
at p
reve
ntin
g C
DI.”
Gl
ove
Use
“I
t is r
ecom
men
ded
to d
on g
love
s prio
r to
ente
ring
the
room
of a
pat
ient
with
CDI
. Glo
ve
use
is th
e on
ly C
DI p
reve
ntio
n re
com
men
datio
n w
ith th
e hi
ghes
t str
engt
h of
reco
mm
enda
tion
and
qual
ity o
f evi
denc
e ra
ting
of “A
I”. G
love
s de
crea
se ri
sk o
f C. d
iffici
le tr
ansm
issio
n by
pr
even
ting
the
cont
amin
atio
n of
hea
lthca
re
wor
ker h
ands
with
C. d
iffici
le sp
ores
. “
http
://w
ww.
shea
-onl
ine.
org/
Por
tals
/0/C
DI%
20ha
nd%
20hy
gien
e%20
Upd
ate.
R
iggs
et a
l. C
lin In
fect
Dis
200
7;45
:992
–8.
Rol
e of
Asy
mpt
omat
ic C
arrie
rs?
Rat
iona
le fo
r Uni
vers
al G
love
Use
on
Uni
ts w
ith H
igh
CD
I Rat
es
Asse
ss A
dequ
acy
of C
lean
ing
Befo
re
Chan
ging
to N
ew C
lean
ing
Prod
uct
•
One
stud
y us
ing
a flu
ores
cent
env
ironm
enta
l mar
ker
show
ed:
only
47%
of h
igh-
touc
h su
rfac
es in
3 h
ospi
tals
wer
e cl
eane
d
sust
aine
d im
prov
emen
t in
clea
ning
of a
ll ob
ject
s,
espe
cial
ly in
pre
viou
sly p
oorly
cle
aned
obj
ects
, fo
llow
ing
educ
atio
nal i
nter
vent
ions
with
the
envi
ronm
enta
l ser
vice
s sta
ff
•U
se e
nviro
nmen
tal m
arke
rs to
impr
ove
clea
ning
Car
ling
et a
l. C
lin In
fect
Dis
200
6;42
:385
-8.
Asse
ss A
dequ
acy
of C
lean
ing
Befo
re C
hang
ing
to
New
Cle
anin
g Pr
oduc
t
Car
ling
et a
l. C
lin In
fect
Dis
20
06;4
2:38
5-8.
Envi
ronm
enta
l Sur
viva
l of K
ey
Path
ogen
s on
Hosp
ital S
urfa
ces
Ada
pted
from
Hot
a B
, et a
l. C
lin In
fect
Dis
200
4;39
:118
2-9
and
Kra
mer
A, e
t al.
BM
C In
fect
ious
Dis
ease
s 20
06;6
:130
Rela
tive
Risk
of P
atho
gen
Acqu
isiti
on if
Prio
r Ro
om O
ccup
ant I
nfec
ted
* Prio
r roo
m oc
cupa
nt inf
ected
; ^An
y roo
m oc
cupa
nt in
prior
2 we
eks i
nfecte
d
Wip
es
Wip
es s
houl
d ha
ve s
uffic
ient
wet
ness
to a
chie
ve th
e di
sinf
ecta
nt c
onta
ct ti
me
(e.g
. >1
min
ute)
Kno
w y
our p
rodu
ct
http
://di
sinf
ectio
nand
ster
ilizat
ion.
org/
Touc
h –v
s- N
o To
uch
http
://di
sinf
ectio
nand
ster
ilizat
ion.
org/
Clea
ning
Bes
t Pra
ctic
es
•Fo
llow
the
CDC
Guid
elin
e fo
r Disi
nfec
tion
and
Ster
iliza
tion
with
rega
rd to
cho
osin
g an
ap
prop
riate
ger
mic
ide
and
best
pra
ctic
es fo
r env
ironm
enta
l disi
nfec
tion
•Ap
prop
riate
ly tr
ain
envi
ronm
enta
l ser
vice
wor
kers
on
prop
er u
se o
f PPE
and
cl
ean/
disin
fect
ion
of th
e en
viro
nmen
t •
Have
env
ironm
enta
l ser
vice
wor
kers
use
che
cklis
ts to
ens
ure
all r
oom
surfa
ces a
re
clea
ned/
disin
fect
ed
•As
sure
that
nur
sing
and
envi
ronm
enta
l ser
vice
hav
e ag
reed
wha
t ite
ms (
e.g.
, sen
sitiv
e eq
uipm
ent)
are
to b
e cl
ean/
disin
fect
ed b
y nu
rsin
g an
d w
hat i
tem
s (e.
g.,
envi
ronm
enta
l sur
face
s) a
re to
be
clea
ned/
disin
fect
ed b
y en
viro
nmen
tal s
ervi
ce
wor
kers
•
Staf
f mus
t hav
e su
ffici
ent t
ime.
Incr
easin
g w
orkl
oad
com
prom
ising
infe
ctio
n co
ntro
l ac
tiviti
es
•U
se a
met
hod
(e.g
., flu
ores
cent
dye
, ATP
) to
ensu
re p
rope
r cle
anin
g •
Cons
ider
use
of H
P/U
V du
ring
outb
reak
s or
afte
r CDI
pat
ient
s
Sam
ple
Size
for C
lean
ing
•Ba
selin
e ev
alua
tion
of a
ll av
aila
ble
surf
aces
in a
10-
15%
sam
ple
of
repr
esen
tativ
e pa
tient
room
s in
a ho
spita
l with
≥15
0 be
ds
•O
ngoi
ng: W
hen
achi
eve
a th
orou
ghne
ss o
f cle
anin
g ra
te o
f >80
%,
the
num
ber o
f sur
face
s to
be m
onito
red
can
be d
ecre
ased
to th
ose
avai
labl
e in
a 5
% sa
mpl
e of
room
s per
eva
luat
ion
cycl
e un
less
ther
e is
a de
terio
ratio
n in
pra
ctic
e •
In h
ospi
tals
with
less
than
150
beds
, all
avai
labl
e su
rfac
es in
a
min
imum
of 1
5 ro
oms m
ay b
e m
onito
red
for b
asel
ine
and
ongo
ing
eval
uatio
n
Opt
ions
for E
valu
atin
g En
viro
nmen
tal C
lean
ing,
Alic
e Gu
h, M
D, M
PH1,
Ph
ilip
Carli
ng, M
D2, E
nviro
nmen
tal E
valu
atio
n W
orkg
roup
3, D
ecem
ber
2010
Tool
En
viro
nmen
tal
Chec
klist
for T
erm
inal
Cl
eani
ng
Man
y m
ore
avai
labl
e
Guid
elin
es
•AP
IC Im
plem
enta
tion
Guid
es
Guid
e to
Pre
vent
ing
Cath
eter
-Ass
ocia
ted
Urin
ary
Trac
t Inf
ectio
ns (2
014)
Gu
ide
to P
reve
ntin
g Cl
ostr
idiu
m d
iffic
ile In
fect
ions
(201
3)
Guid
e to
Infe
ctio
n Pr
even
tion
in E
mer
genc
y M
edic
al S
ervi
ces (
2013
) Gu
ide
to th
e El
imin
atio
n of
Infe
ctio
ns in
Hem
odia
lysis
(201
0)
Guid
e to
the
Elim
inat
ion
of M
RSA
Tran
smiss
ion
in H
ospi
tal S
ettin
gs, 2
nd
Editi
on (2
010)
Gu
ide
to th
e El
imin
atio
n of
Mul
tidru
g-re
sista
nt A
cine
toba
cter
bau
man
nii
Tran
smiss
ion
in H
ealth
care
Set
tings
(201
0)
Guid
e to
the
Elim
inat
ion
of O
rtho
pedi
c Su
rgic
al S
ite In
fect
ions
(201
0)
Guid
e to
the
Elim
inat
ion
of M
RSA
in th
e Lo
ng-T
erm
Car
e Fa
cilit
y (2
009)
Gu
ide
to th
e El
imin
atio
n of
MRS
A Tr
ansm
issio
n in
Hos
pita
l Set
tings
- Ca
lifor
nia
Supp
lem
ent (
2009
•ht
tp:/
/ww
w.a
pic.
org/
Prof
essio
nal-P
ract
ice/
Impl
emen
tatio
n-gu
ides
Scie
ntifi
c Gu
idel
ines
•HI
CPAC
ht
tp:/
/ww
w.c
dc.g
ov/h
icpa
c/pu
bs.h
tml
•SH
EA
Com
pend
ium
of S
trat
egie
s to
Prev
ent H
ealth
care
-Ass
ocia
ted
Infe
ctio
ns in
Acu
te C
are
Hosp
itals
(201
4)
http
://w
ww
.she
a-on
line.
org/
Prio
rityT
opic
s/Co
mpe
ndiu
mof
Stra
tegi
esto
Prev
entH
AIs.
aspx
All r
ecen
tly u
pdat
ed
Prac
tice
Reso
urce
s
•AP
IC
Gel n
ails
Anim
als i
n he
alth
care
•
CDC
ht
tp:/
/ww
w.c
dc.g
ov/v
acci
nes/
pubs
/pin
kboo
k/in
dex
.htm
l •
IDSA
ht
tp:/
/ww
w.id
soci
ety.
org/
Antim
icro
bial
_Age
nts/
#An
timic
robi
al P
roph
ylax
is fo
r Sur
gery
Emer
ging
Issu
es
Con
tent
sou
rce:
Cen
ters
for D
isea
se C
ontro
l and
Pre
vent
ion,
Offi
ce o
f the
Ass
ocia
te D
irect
or fo
r C
omm
unic
atio
ns, D
ivis
ion
of P
ublic
Affa
irs, P
JHIL
ID 1
8172
, 118
78,
CRE
in D
uode
nosc
opy
Scop
es
AP
IC a
nd S
HE
A ar
e co
ncer
ned
abou
t rec
ent
repo
rts o
f car
bape
nem
-re
sist
ant E
nter
obac
teria
ceae
(C
RE
) inf
ectio
ns re
late
d to
en
dosc
opic
retro
grad
e ch
olan
giop
ancr
eato
grap
hy
(ER
CP
) duo
deno
scop
es. M
ost
rece
ntly,
the
Ron
ald
Rea
gan
UC
LA M
edic
al C
ente
r not
ified
17
9 pa
tient
s w
ho u
nder
wen
t E
RC
P th
at th
ey m
ay h
ave
been
exp
osed
to C
RE
from
co
ntam
inat
ed d
uode
nosc
opes
. A
s of
Feb
ruar
y 24
, a to
tal o
f se
ven
UC
LA p
atie
nts
wer
e in
fect
ed a
nd tw
o ha
ve d
ied
ht
tp://
ww
w.sg
na.o
rg/E
duca
tion/
Sta
nda
rdsa
ndG
uide
lines
.asp
x
Ebol
a
•FD
A ap
prov
es R
apid
PCR
test
Re
sults
~3
hour
s Em
erge
ncy
use
in U
S
•Sp
ecifi
c st
ate
asse
ssm
ent
and
regi
onal
trea
tmen
t site
s •
Libe
ria re
mov
ed fr
om a
ctiv
e m
onito
ring
and
will
per
form
se
lf ob
serv
atio
n w
hen
ente
ring
US
•Ju
ne 1
7, C
DC K
ey M
essa
ge
bulle
tin
P
hoto
take
n at
CD
C m
useu
m, F
eb, 2
015
MER
S-Co
V •
Epid
emio
logy
of M
iddl
e Ea
st R
espi
rato
ry S
yndr
ome
Coro
navi
rus (
MER
S-Co
V) In
fect
ion
Loca
tion
: Hum
an in
fect
ion
in S
epte
mbe
r 201
2, c
ausin
g se
vere
resp
irato
ry il
lnes
s and
dea
th to
day,
mos
tly
in S
audi
Ara
bia
and
othe
r cou
ntrie
s in
or n
ear t
he A
rabi
an P
enin
sula
, rec
ent S
outh
Kor
ean
outb
reak
(154
ca
ses a
s of J
une
16)
Firs
t US
Case
May
, 201
4. T
rans
miss
ion
usua
lly h
uman
to h
uman
but
cam
els a
re a
rese
rvoi
r U
pdat
ed c
riter
ia fo
r scr
eeni
ng: a
ddin
g tr
avel
to K
orea
(Jun
e 11
CDC
Adv
isory
) Fe
ver a
nd P
neum
onia
with
rece
nt tr
avel
from
coun
trie
s in
or n
ear t
he A
rabi
an P
enin
sula
with
in 1
4 da
ys o
r cl
ose
cont
act t
o sy
mpt
omat
ic ca
rrie
r Is
olat
ion
Prec
autio
n: S
tand
ard,
Con
tact
, dro
plet
if sy
mpt
oms o
f acu
te re
spira
tory
infe
ctio
n an
d Ai
rbor
ne
with
aer
osol
gen
erat
ing
proc
edur
es
Cultu
re m
ultip
le si
tes f
or a
ccur
ate
diag
nosis
: lo
wer
resp
irato
ry sp
ecim
en (e
.g.,
sput
um, b
ronc
heoa
lveo
lar l
avag
e flu
id, o
r tra
chea
l asp
irate
),
a na
soph
aryg
eal/o
roph
aryg
eal s
wab
, se
rum
, via
the
CDC
MER
S-Co
V rR
T-PC
R as
say
Su
ppor
tive
care
As
of J
anua
ry 2
3, 2
015,
956
labo
rato
ry-c
onfir
med
case
s, in
clud
ing
at le
ast 3
51 d
eath
s, h
ave
been
repo
rted
w
orld
wid
e M
MW
R Ja
nuar
y 29
, 201
5
Hepa
titis
C
•In
ject
ion
Safe
ty
July,
201
2 GA
O re
port
on
inje
ctio
n sa
fety
M
ost a
re in
ASC
or p
hysic
ian
offic
es
Issu
es: S
yrin
ge re
use,
med
icat
ion
reus
e or
co
ntam
inat
ed m
edic
atio
n pr
epar
atio
n ar
ea
Test
ing
reco
mm
enda
tion:
You
wer
e bo
rn
from
194
5 th
roug
h 19
65
New
dru
gs: A
ntiv
iral a
gent
s com
bine
d w
ith
diffe
rent
mec
hani
sms o
f act
ion
Cost
Influ
enza
•
2015
-201
6 in
fluen
za v
acci
ne
prot
ects
aga
inst
thre
e vi
ruse
s:
A/C
alifo
rnia
/7/2
009
(H1N
1)pd
m09
-like
viru
s A
/Sw
itzer
land
/971
5293
/201
3 (H
3N2)
-like
viru
s B
/Phu
ket/
3073
/201
3-lik
e vi
rus.
(T
his i
s a B
/Yam
agat
a lin
eage
viru
s)
•Q
uadr
ival
ent v
acci
ne a
dds:
B
viru
s (B/
Brisb
ane/
60/2
008-
like
viru
s). B
/Vic
toria
line
age
viru
s P
hoto
take
n at
CD
C m
useu
m,
Febr
uary
201
5
Influ
enza
•
New
reco
mm
enda
tions
for t
his y
ear
Publ
ished
in M
MW
R (n
ot o
ut y
et)
•Dr
ople
t iso
latio
n •
Cont
agio
us 1
day
bef
ore
sym
ptom
s unt
il 5
– 7
days
af
ter
•In
cuba
tion
1 –
3 da
ys
•Re
port
ing
requ
irem
ents
for H
CW v
acci
natio
n (m
ask
if un
vacc
inat
ed?)
•
New
Tool
kit f
or LT
C av
aila
ble:
ht
tp:/
/ww
w.c
dc.g
ov/f
lu/t
oolk
it/lo
ng-te
rm-c
are/
inde
x.ht
m
Mea
sles
•
High
ly c
onta
giou
s res
pira
tory
dise
ase
•Ai
rbor
ne p
reca
utio
ns
•Co
ugh,
Cor
yza
and
Conj
unct
iviti
s (3
C’s)
•
Incu
batio
n pe
riod
rang
es fr
om 7
to 2
1 da
ys
•Re
serv
oir:
Hum
ans,
con
tagi
ous f
rom
4 d
ays b
efor
e to
4 d
ays a
fter
rash
•
Caus
es im
mun
osup
pres
sion
so b
acte
rial i
nfec
tions
are
com
mon
, en
ceph
aliti
s, re
spira
tory
and
neu
rolo
gic
com
plic
atio
ns
•Ca
se-fa
talit
y ra
tio: 0
.1%
–10%
•
Suba
cute
scle
rosin
g pa
nenc
epha
litis
(SSP
E) is
a ra
re, b
ut fa
tal
dege
nera
tive
dise
ase
of th
e ce
ntra
l ner
vous
syst
em c
hara
cter
ized
by b
ehav
iora
l and
inte
llect
ual d
eter
iora
tion
and
seizu
res t
hat
gene
rally
dev
elop
7 to
10
year
s afte
r mea
sles i
nfec
tion
•VA
CCIN
ATE
P
hoto
: PH
IL P
hoto
ID#
989,
http
://w
ww.
cdc.
gov/
mea
sles
/hcp
/inde
x.ht
ml
Mea
sles
•
In 2
000,
mea
sles w
as
decl
ared
elim
inat
ed fr
om
the
Uni
ted
Stat
es.
Elim
inat
ion
is de
fined
as
the
abse
nce
of e
ndem
ic
mea
sles v
irus t
rans
miss
ion
in a
def
ined
geo
grap
hic
area
, suc
h as
a re
gion
or
coun
try,
for 1
2 m
onth
s or
long
er in
the
pres
ence
of a
w
ell-p
erfo
rmin
g su
rvei
llanc
e sy
stem
•Ph
oto
take
n at
CDC
m
useu
m, F
eb, 2
015
Mea
sles
20
11
2014
2015
Mea
sles
Con
firm
ed
Cas
es, 2
015
Bra
zil=
141
Can
ada=
195
Chi
le=5
Mex
ico=
1
USA
=173
Tota
l= 5
15 c
ases
Th
e C
ompr
ehen
sive
Fam
ily Im
mun
izat
ion
Uni
t (FG
L/IM
) –Pa
n A
mer
ican
Hea
lth O
rgan
izat
ion,
as
of e
pide
mio
logi
cal w
eek
21, 2
015
by s
econ
d ad
min
istra
tive
leve
l
N=1
,896
ca
ses
N=1
,369
ca
ses
Sum
mar
y •
Ove
r 70%
of H
AI c
an b
e pr
even
ted
•U
nder
stan
d ho
w H
AI a
ffect
s you
r pat
ient
s firs
t but
also
you
r fac
ility
•
Accu
rate
mea
sure
men
t is a
key
skill
in d
ecre
asin
g HA
I and
dev
elop
ing
EBP
for
prev
entio
n •
Base
prio
ritie
s on
annu
al ri
sk a
sses
smen
t, su
rvei
llanc
e an
d em
ergi
ng is
sues
•
Area
s to
cons
ider
Ac
cura
cy o
f sur
veill
ance
Pr
even
tion
stra
tegi
es: h
orizo
ntal
vs v
ertic
al
Impl
emen
tatio
n of
stra
tegi
es
Mea
sure
men
t of o
utco
mes
•In
volv
e al
l sta
ff, le
ader
ship
and
pat
ient
s in
prev
entio
n
•Sh
are
your
resu
lts a
nd c
eleb
rate
you
r suc
cess
!
Cont
act I
nfor
mat
ion
Gre
at P
lain
s Q
IN-Q
IO
1200
Lib
ra D
rive,
Sui
te 1
02
Linc
oln,
Neb
rask
a 68
512
Peg
Gilb
ert
Peg
.Gilb
ert@
area
-a.h
cqis
.org
P: 4
02.8
02.7
997
F: 4
02.4
76.1
335
ww
w.g
reat
plai
nsqi
n.or
g
This
mat
eria
l was
pre
pare
d th
e G
reat
Pla
ins
Qua
lity
Inno
vatio
n N
etw
ork,
the
Med
icar
e Q
ualit
y Im
prov
emen
t Org
aniz
atio
n fo
r Kan
sas,
Neb
rask
a, N
orth
Dak
ota
and
Sou
th D
akot
a, u
nder
con
tract
with
the
Cen
ters
for M
edic
are
& M
edic
aid
Ser
vice
s (C
MS
), an
age
ncy
of th
e U
.S. D
epar
tmen
t of H
ealth
and
Hum
an S
ervi
ces.
Th
e co
nten
ts p
rese
nted
do
not n
eces
saril
y re
flect
CM
S p
olic
y. 1
1SO
W-G
PQ
CC
-NE
-C1-
27/0
615
