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CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting

https://doi.org/10.1016/j.ajic.2008.03.002Get rights and content

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Background

Since 1988, the Centers for Disease Control and Prevention (CDC) has published 2 articles in which nosocomial infection and criteria for specific types of nosocomial infection for surveillance purposes for use in acute care settings have been defined.1, 2 This document replaces those articles, which are now considered obsolete, and uses the generic term “health care–associated infection” or “HAI” instead of “nosocomial.” This document reflects the elimination of criterion 1 of clinical sepsis

CDC/NHSN surveillance definition of health care–associated infection

For the purposes of NHSN surveillance in the acute care setting, the CDC defines an HAI as a localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s). There must be no evidence that the infection was present or incubating at the time of admission to the acute care setting.

HAIs may be caused by infectious agents from endogenous or exogenous sources.

  • Endogenous sources are body sites, such as the skin, nose, mouth,

Criteria for specific types of infection

Once an infection is deemed to be health care associated according to the definition shown above, the specific type of infection should be determined based on the criteria detailed below. These have been grouped into 13 major type categories to facilitate data analysis. For example, there are 3 specific types of urinary tract infections (symptomatic urinary tract infection, asymptomatic bacteriuria, and other infections of the urinary tract) that are grouped under the major type of Urinary

Use of these criteria for publicly reported HAI data

Not all infections or infection criteria may be appropriate for use in public reporting of HAIs. Guidance on what infections and infection criteria are recommended is available from other sources (eg, HICPAC [http://www.cdc.gov/ncidod/dhqp/hicpac_pubs.html]; National Quality Forum [http://www.qualityforum.org/]; professional organizations).

SUTI-Symptomatic urinary tract infection

A symptomatic urinary tract infection must meet at least 1 of the following criteria:

  • 1.

    Patient has at least 1 of the following signs or symptoms with no other recognized cause: fever (>38°C), urgency, frequency, dysuria, or suprapubic tenderness

  • and

  • patient has a positive urine culture, that is, ≥105 microorganisms per cc of urine with no more than 2 species of microorganisms.

  • 2.

    Patient has at least 2 of the following signs or symptoms with no other recognized cause: fever (>38°C), urgency, frequency,

SIP/SIS-Superficial incisional surgical site infection

  • A superficial incisional SSI (SIP or SIS) must meet the following criterion:

  • Infection occurs within 30 days after the operative procedure

  • and

  • involves only skin and subcutaneous tissue of the incision

  • and

  • patient has at least 1 of the following:

    • a.

      purulent drainage from the superficial incision

    • b.

      organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision

    • c.

      at least 1 of the following signs or symptoms of infection: pain or tenderness, localized swelling,

LCBI-Laboratory-confirmed bloodstream infection

LCBI criteria 1 and 2 may be used for patients of any age, including patients ≤1 year of age.

LCBI must meet at least 1 of the following criteria:

  • 1.

    Patient has a recognized pathogen cultured from 1 or more blood cultures

  • and

  • organism cultured from blood is not related to an infection at another site. (See Notes 1 and 2.)

  • 2.

    Patient has at least 1 of the following signs or symptoms: fever (>38°C), chills, or hypotension

  • and

  • signs and symptoms and positive laboratory results are not related to an infection

CSEP-Clinical sepsis

CSEP may be used only to report primary BSI in neonates and infants. It is not used to report BSI in adults and children.

Clinical sepsis must meet the following criterion:

Patient ≤1 year of age has at least 1 of the following clinical signs or symptoms with no other recognized cause: fever (>38°C rectal), hypothermia (<37°C rectal), apnea, or bradycardia

  • and

  • blood culture not done or no organisms detected in blood

  • and

  • no apparent infection at another site

  • and

  • physician institutes treatment for sepsis.

PNEU-Pneumonia

See Appendix.

BONE-Osteomyelitis

Osteomyelitis must meet at least 1 of the following criteria:

  • 1.

    Patient has organisms cultured from bone.

  • 2.

    Patient has evidence of osteomyelitis on direct examination of the bone during a surgical operation or histopathologic examination.

  • 3.

    Patient has at least 2 of the following signs or symptoms with no other recognized cause: fever (>38°C), localized swelling, tenderness, heat, or drainage at suspected site of bone infection

  • and

  • at least 1 of the following:

    • a.

      organisms cultured from blood

    • b.

      positive blood

IC-Intracranial infection (brain abscess, subdural or epidural infection, encephalitis)

Intracranial infection must meet at least 1 of the following criteria:

  • 1.

    Patient has organisms cultured from brain tissue or dura.

  • 2.

    Patient has an abscess or evidence of intracranial infection seen during a surgical operation or histopathologic examination.

  • 3.

    Patient has at least 2 of the following signs or symptoms with no other recognized cause: headache, dizziness, fever (>38°C), localizing neurologic signs, changing level of consciousness, or confusion

  • and

  • at least 1 of the following:

    • a.

      organisms seen

VASC-Arterial or venous infection

Arterial or venous infection must meet at least 1 of the following criteria:

  • 1.

    Patient has organisms cultured from arteries or veins removed during a surgical operation

  • and

  • blood culture not done or no organisms cultured from blood.

  • 2.

    Patient has evidence of arterial or venous infection seen during a surgical operation or histopathologic examination.

  • 3.

    Patient has at least 1 of the following signs or symptoms with no other recognized cause: fever (>38°C), pain, erythema, or heat at involved vascular site

CONJ-Conjunctivitis

Conjunctivitis must meet at least 1 of the following criteria:

  • 1.

    Patient has pathogens cultured from purulent exudate obtained from the conjunctiva or contiguous tissues, such as eyelid, cornea, meibomian glands, or lacrimal glands.

  • 2.

    Patient has pain or redness of conjunctiva or around eye

  • and

  • at least 1 of the following:

    • a.

      WBCs and organisms seen on Gram's stain of exudate

    • b.

      purulent exudate

    • c.

      positive antigen test (eg, ELISA or IF for Chlamydia trachomatis, herpes simplex virus, adenovirus) on exudate or

GE-Gastroenteritis

Gastroenteritis must meet at least 1 of the following criteria:

  • 1.

    Patient has an acute onset of diarrhea (liquid stools for more than 12 hours) with or without vomiting or fever (>38°C) and no likely noninfectious cause (eg, diagnostic tests, therapeutic regimen other than antimicrobial agents, acute exacerbation of a chronic condition, or psychologic stress).

  • 2.

    Patient has at least 2 of the following signs or symptoms with no other recognized cause: nausea, vomiting, abdominal pain, fever (>38°C),

BRON-Bronchitis, tracheobronchitis, bronchiolitis, tracheitis, without evidence of pneumonia

Tracheobronchial infections must meet at least 1 of the following criteria:

  • 1.

    Patient has no clinical or radiographic evidence of pneumonia

  • and

  • patient has at least 2 of the following signs or symptoms with no other recognized cause: fever (>38°C), cough, new or increased sputum production, rhonchi, wheezing

  • and

  • at least 1 of the following:

    • a.

      positive culture obtained by deep tracheal aspirate or bronchoscopy

    • b.

      positive antigen test on respiratory secretions.

  • 2.

    Patient ≤1 year of age has no clinical or

EMET-Endometritis

Endometritis must meet at least 1 of the following criteria:

  • 1.

    Patient has organisms cultured from fluid or tissue from endometrium obtained during surgical operation, by needle aspiration, or by brush biopsy.

  • 2.

    Patient has at least 2 of the following signs or symptoms with no other recognized cause: fever (>38°C), abdominal pain, uterine tenderness, or purulent drainage from uterus.

Reporting instruction

  • Report postpartum endometritis as a health care–associated infection unless the amniotic fluid is infected at the time

SKIN-Skin

Skin infections must meet at least 1 of the following criteria:

  • 1.

    Patient has purulent drainage, pustules, vesicles, or boils.

  • 2.

    Patient has at least 2 of the following signs or symptoms with no other recognized cause: pain or tenderness, localized swelling, redness, or heat

  • and

  • at least 1 of the following:

    • a.

      organisms cultured from aspirate or drainage from affected site; if organisms are normal skin flora (ie, diphtheroids [Corynebacterium spp], Bacillus [not B anthracis] spp, Propionibacterium spp,

DI-Disseminated infection

Disseminated infection is infection involving multiple organs or systems, without an apparent single site of infection, usually of viral origin, and with signs or symptoms with no other recognized cause and compatible with infectious involvement of multiple organs or systems.

Reporting instructions

  • Use this code for viral infections involving multiple organ systems (eg, measles, mumps, rubella, varicella, erythema infectiosum). These infections often can be identified by clinical criteria alone. Do not use this code

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