Criteria to Define CLABSI and SSI - TSICP – TSICP

1 Criteria to Define CLABSI and SSIT eresa C. Horan, MPHD ivision of Healthcare Quality PromotionNational Center for Emerging and Zoonotic Infectious DiseasesObjectives Review BSI and SSI Criteria Review definition of central line Review secondary BSI definition Identify resources needed accurately identify CLABSI and SSI A localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s) that Occurs in a patient in a healthcare setting and Was not present or incubating at the time of Healthcare-associated Infection (HAI) Was not present or incubating at the time of admission, unless the infection was related to a previous admission When the setting is a hospital, meets the Criteria for a specific infection (body) site as defined by CDC (Chapter 17 of NHSN Manual) Major Event Type: BSI Specific Event Central Line-associated Bloodstream Infection ( CLABSI ) Specific Event Type: Laboratory Confirmed Bloodstream Infection (LCBI)Central Line-associated Bloodstream Infection ( CLABSI ) CLABSI = Primary BSI that develops in a patient that had a central line within the 48 hours prior to the infection onsethours prior to the infection onset Primary BSI = BSI that is not secondary to an infection at another siteNOTE: There is no minimumtime period that the central linemust be in place in order for the BSI to be consideredcentral Line Definition Central line: An intravascular catheter that terminates at or close to the heart or in one of the great vessels which is used for infusion, withdrawal of blood, or hemodynamic monitoring.

2 The following are considered great vessels for the purpose of reporting central line-associated BSI and purpose of reporting central line-associated BSI and counting central line days in the NHSN system: Aorta Pulmonary artery Superior vena cava Inferior vena cava Brachiocephalic veins Internal jugular veins Subclavian veins External iliac veins Common iliac veins Femoral veins In neonates, umbilical artery/veinCentral Line DefinitionIncludes: Continuous infusions such as nutritious fluids or medications Infusion: The introduction of a solution through a catheter lumen into a blood vessel Continuous infusions such as nutritious fluids or medications Intermittent infusions such as flushes or IV antimicrobial administration Administration of blood or blood products in the case of transfusion or hemodialysis An introducer is considered an intravascular catheter, and depending on the location of its tip, may be a central line.

3 Pacemaker wires and other non-lumened devices inserted into central blood vessels or the heart are notconsidered central lines, because fluids are not infused, Central Line Definitionconsidered central lines, because fluids are not infused, pushed, nor withdrawn through such devices. The following devices are notconsidered central lines: extracorporeal membrane oxygenation (ECMO), femoral arterial catheters, and Intraaortic balloon pump (IABP) devices. If you have a question about whether a device qualifies as a central line, please email us at Secondary to Infection at Another Site A culture-confirmed BSI associated with a documented HAI at another site Primary infection site must meet one of Criteria found in the CDC/NHSN definitions (Chapter 17) BSI If the criterion met for the primary infection site requires a culture, then at least one organism from that site must match an organism in the blood culture (antibiograms of the isolates do not have to match)not have to match) Example: Patient grows E.

4 Coli in her deep incision and in her blood. The SSI is reported with a secondary , App 1 Secondary BSI (cont.) If criterion met for the primary infection site does notrequire a culture and the blood isolate is a logical pathogen for the site, report as secondary BSIE xample: 6 days postoperatively, Example: 6 days postoperatively, patient had fever, vomiting, and an abdominal abscess confirmed by CT scan. On the same day, his blood was drawn and grew Bacteroides fragilis. The infection was reported as an SSI-IAB with a secondary BSI. The organism was reported asB. , App 1 Secondary BSI , App 1 LCBI Criterion 1 Patient has a recognized pathogen cultured from one or more blood culturesandorganism cultured from blood is notrelated to an infection at another : Mr. Smith had a PICC line inserted on admission (June 1). On hospital day 4, he became confused and experienced chills.

5 Blood cultures were drawn which grew E. Smith meets the Criteria for LCBI Criterion at another siteMore details for LCBI Criterion 1 One or more blood culturesmeans that at least one bottle from a blood draw is reported by the laboratory as having grown organisms ( , is a positive blood culture). Recognized pathogen does not Recognized pathogen does not include organisms considered common commensals. A few of the recognized pathogensare Staphylococcus aureus, Enterococcus spp., E. coli, Pseudomonasspp., Klebsiellaspp., Candidaspp., Criterion 2 Patient has at least oneof the following signs or symptoms: fever (>38 C), chills or hypotension andsigns and symptoms and positive laboratory results are notrelated to an infection at another site andcommon commensal* is cultured from twoor more blood cultures common commensal* is cultured from twoor more blood cultures drawn on separate occasions.

6 *Diphtheroids [Corynebacterium spp.]Bacillus [not B. anthracis] staphylococci [including S. epidermidis]Viridans group Criterion 3 Patient <1 year of age has at least oneof the following signs or symptoms: fever (>38 C core), hypothermia (<36 C core), apnea, or bradycardia andsigns and symptoms and positive laboratory results are notrelated to an infection at another site andandcommon commensal* is cultured from twoor more blood cultures drawn on separate occasions.*Diphtheroids [Corynebacterium spp.]Bacillus [not B. anthracis] staphylococci [including S. epidermidis]Viridans group Commensal List Resource Library NHSN Codes and Variables Common Skin Contaminant List (June 2011)Contaminant List (June 2011) 62 choices!Note LCBI Criteria 1 and 2 may be used for patients of ANY age, including those 1 year old or ANY age, including those 1 year old or less.

7 LCBI criterion 3 only applies to patients who are 1 year old or Blood Culture SpecimensIdeally, blood specimens for culture should be obtained from two to four blood draws from separate venipuncture sites ( , right and left antecubital veins), not through a vascular blood draws should be performed simultaneously or over a short period of time ( , within a few hours).If your facility does not currently obtain specimens using this technique, you may still report BSIs using the NHSN Criteria , but you should work with appropriate personnel to facilitate better specimen collection practices for blood phrase two or more blood cultures (BC) drawn on separate occasions blood from at least two blood draws were More details for Criteria 2 and blood from at least two blood draws were collected within two days of each other,And2. That at least one bottle from each blood draw is reported by the laboratory as having grown the same common commensal(s) ( , is a positive BC)Determining sameness of two organismsAssume that the organisms are the sameif the organism from one blood cultureis identified to both genus and species level and the companion cultureidentifies only the genuswith or without other attributes.

8 More details for Criteria 2 and 3 Example: Culture 1: S. epidermidisCulture 2: Coagulase-negative staphylococci Report the genus/species as S. epidermidis to NHSND etermining sameness of two organisms (cont.) Antibiograms are no longer utilized to determine the sameness of two organisms. Report the more resistant details for Criteria 2 and 3 Examples: Criteria forSurgical Site TypesHoran TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13(10) Incisional SSISIP and SISS uperficial incisional primary (SIP)A superficial incisional SSI that is identified in the primary incision in a patient that has had an operation Superficial incisional secondary (SIS)A superficial incisional SSI that is identified in the secondary incision in a patient that has had an a patient that has had an operation with one or more incisions.

9 Examples: C-section incision Chest incision for coronary artery bypass graft with a donor site [CBGB]in a patient that has had an operation with more than one incision. Example: Donor site incision for coronary artery bypass graft with a donor site [CBGB]ExamplePatient delivers a baby by C-Section on August 23. On her first postpartum visit to her surgeon on September 20, she notes yellow purulent drainage in the superficial delivers a baby by C-Section on August 23. On her first postpartum visit to her surgeon on September 20, she notes yellow purulent drainage in the superficial Gretchen have a surgical site infection?ExamplePatient underwent a coronary artery bypass graft (CBGB) in which the surgeon obtained a donor vessel from a site in the patient s left days postoperatively, patient had pain and edema in the leg incision. The surgeon opened the superficial incision, drained the pus, and irrigated the , drained the pus, and irrigated the the patient have a superficial incisional SSI?

10 Deep Incisional SSIDIP and DISDeep incisional primary(DIP)A deep incisional SSI that is identified in the primary incision in a patient that has had an operation Deep incisional secondary (DIS)A deep incisional SSI that is identified in the secondary incision in a patient that has had an a patient that has had an operation with one or more incisions. Examples: C-section incision Chest incision for coronary artery bypass graft with a donor site [CBGB]in a patient that has had an operation with more than one incision. Example: Donor site incision for coronary artery bypass graft with a donor site [CBGB]Endoscope If more than one of the endoscopic/robotic incisions becomes infected, report only one SSISSI If one is a superficial incisional SSI and another is a deep incisional SSI, report as a deep incisional SSIO rgan/Space SSIO rgan/Space SSIBONEO steomyelitisJNTJ oint or bursaBRSTB reast abscess/mastitisLUNGO ther infections of respiratory tractCARDM yocarditis/pericarditisMEDM ediastinitisDISCDisc spaceORALOral cavityEAREar, mastoidOREPO ther respiratory EMETE ndometritisOUTIO ther urinaryENDOE ndocarditisSASpinal abscessEYEEye, other than conjunctivitisSINUS inusitisGITGI tractURUpper respiratoryIABI ntraabdominal, NOSVASCA rterial or venousICIntracranialVCUFV aginal cuffChapter 17 17 Pay attention to the notes in the table at the beginning of the chapter and any reporting instructions for a specific infection site!