review of 2015 bsi, uti, vap, and vae criteria changes · 2015-06-04 · review of 2015 bsi, uti,...

Review of 2015 BSI, UTI, VAP, and VAE Criteria changes

APIC Indiana Webinar

April 20th, 2015 1pm to 2:30pm Facilitator: Kari Kuebler RN, BSN

Surveillance Infection Preventionist at Indiana University Health APIC Indiana NHSN Liaison and Board member

Objectives:

• Review pre-webinar survey results, summarizing attendees primary education needs concerning the 2015 criteria changes.

• Briefly review summary of 2015 changes to the BSI, UTI, VAP, and VAE criteria.

• Case study • Question and Answer • Where to find NHSN Links on the APIC Indiana

website • Link to Survey to assess for need for future NHSN

webinars.

Survey results Question: Please list any questions you have concerning the BSI, UTI, VAP, and VAE criteria you

would like answered during the webinar.

Answers: – Does the specialist ID physician determination trump the NHSN guidelines? – IF there is a CAUTI that is within the POA timeframe, and then there is a positive blood

culture collected during the RIT (14-17 days)with a matching organism. Is the blood culture a secondary BSI or is this a CLABSI if the patient has a central line?

– RIT – Infection Window – Secondary Attribution

Additional questions not related to BSI, UTI, VAP, or VAE

• How other facilities are able to track if HCWs physically work at different campuses that are miles apart but share the same CCN. Most payroll systems do not track if employees go to meetings at another campus. Our payroll system only can pull by home department for the employee category of influenza reporting.

• I don`t understand the AST part, which is included in the MDRO section. • Would like to hear how facilities know how to accurately map their locations. CMS will only be including the locations

mapped as med/surg for 2015 and curious if others have any concerns and how they ensure locations are mapped correctly looking at the previous years data.

• C-Diff window

Purposes of 2015 Definitional Modifications

□ Improve patient care* □ Decrease subjectivity* □ Optimize data consistency* □ Reflect current diagnostic methods* □ Respond to user input*

*While avoiding additional surveillance burden

PRINT and keep near you: Identifying Healthcare-associated Infection (HAIs) in

NHSN

http://www.cdc.gov/nhsn/PDFs/pscManual/2PSC_IdentifyingHAIs_NHSNcurrent.pdf




Review of 2015 changes

• Change: How to determine the date the infection occurred has been changed.

• Possible effect on data: Allows more accurate identification of infections that are present on admission. Could possibly decrease in number of cases.

• Change: Time frame in which all elements of site specific infection criterion must be met has been increased.

• Possible effect on data: Allows symptom to be separated from culture by two full calendar days. Could increase number of Catheter-Associated Urinary Tract Infections (CAUTI) and Common Commensal Central-Line Associated Bloodstream Infections (CLABSI) as increased time frame might allow for fevers and other symptoms not associated with culture to be linked together to meet criteria requirements.

Review of 2015 changes (continued)

• Change: Use of clinical judgment for identifying repeat infections and associating a CLABSI secondary to another infection site has been removed and replaced with black and white guidance and time frames.

• Possible effect on data: Assured accurate benchmarking with clear standard guidelines not depended on varying clinical judgment between practitioners.

• Change: Fungi removed from CAUTI criterion. Urine cultures with <100,000cfu/ml microorganisms removed from criterion.

• Possible effect on data: AHC number of cases are predicted to decrease by 30-50%. Insert your own prediction here


• Change: Site specific culture added to many of the CLABSI criterion are attributed as being secondary too. Example: SKIN infection criterion could be met in 2014 without a skin culture; however, in 2015 a skin culture would be required to meet.

• Possible effect on data: Numbers of CLABSIs could increase if site cultures are not preformed.


• Change: Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection (MBI-LCBI)

• Effect on data: Reporting required in 2015, as it will be a baseline

year for future SIR data. Will be removed from 2016 CLABSI metrics shared with CMS.


• Change: In addition to reporting CLABSI and CAUTI data from all adult, pediatric, and neonatal ICUs, CMS IPPS hospitals will also be required to report CLABSI and CAUTI data from adult and pediatric medical, surgical, and medical/surgical wards

• Possible effect on data: Depending on performance of the additional units, CMS data will improve or worsen. See reporting units by hospital: insert your own data below


• Please note: The criterion changes will affect all hospitals nationwide, where we will see increases and decreases, as will like hospitals. It is impossible to predict the affect the changes will have on our financial reimbursement and penalty programs as performance is based on comparison hospitals throughout the country.

• The only way to ensure optimum patient safety and provider payment is to focus on evidence based improvement measures.

From NHSN training on NHSN

website:

Infection Window for LCBI:

CASE Study:

• Pt transferred to facility on 1/17 with chronic lymphedema

• Admitted to the ICU with respiratory failure (intubated) from influenza, bilateral PE, and shock.

• Transferring facilities ED records report “MRSA UTI in last month”

• Pt has had two episodes of cardiac arrest since transfer.

• Upon arrival pt did not have central access, PICC line was placed on 1/17.

• Indwelling ureteral catheter was present on admission.

• ID notes from OSH report “1/16/2015 blood culture with GPC’s”

• Pt is not noted to have s/s of PNU. Viral panel upon transfer is negative and no sputum culture is not obtained.

• First blood culture taken is on 1/20 and ID is consulted.

• Pt has DVT of R common femoral vein, and diagnosis of non Q-wave MI vs stress change from PE.

• Pt’s wife reports he has been having sweats and chills prior to admission.

• Pt has chronic lymphedema, no s/s of cellulitis at this time.

• No vegetations seen on TEE.

• PICC is changed again on 12/20 due to possibility that the pt has had bacteremia for extended duration of time.

Case Study continued:

• Does Patient have any HAI’s that are POA per NHSN criteria?

Blood CX Urine CX

19-Feb

>100,000 cfu/ml Proteus mirabilis

>100,000 cfu/ml Klebsiella pneumoniae

18-Feb Proteus mirabilis


13-Feb

35,000 cfu/ml Klebsiella pneumoniae

<10,000 cfu/ml Gram Negative Rods Not

identified

11-Feb NEG

11-Feb NEG

7-Feb Staphylococcus aureus

(MRSA)


(MRSA)

4-Feb NEG


(MRSA)

22-Jan NEG

20-Jan Staphylococcus aureus

(MRSA)


(MRSA)

Case Study Continued:

• YES


• What is the RIT for the POA LCBI?

• DOE is on 1/17 • RIT is 14 days

starting on 1/17 – 1/17-1/31 – Therefore culture

on 1/20 is not reported as it is a continuation (within RIT of a POA LCBI)

Blood CX Urine CX

19-Feb





13-Feb



identified

11-Feb NEG

11-Feb NEG


(MRSA)


(MRSA)

4-Feb NEG


(MRSA)

22-Jan NEG


(MRSA)


(MRSA)


– Next blood culture is on 2/1, and grows MRSA again.

– Would you review this to assess for a primary LCBI?

Blood CX Urine CX

19-Feb





13-Feb



identified

11-Feb NEG

11-Feb NEG


(MRSA)


(MRSA)

4-Feb NEG


(MRSA)

22-Jan NEG


(MRSA)


(MRSA)


• YES

• It is outside of the RIT and has to be reviewed as a NEW infection, cannot be called a continuation despite the fact the patient is still on q72 hr vanc for the bacteremia that was POA.

• The patient does not grows MRSA at any other site and does not meet any chapter 17 site specific infection criteria. This is a primary LCBI- the patient’s PICC from 1/20 is still in place, therefore it is reported as a CLABSI.


• Do you need to report the MRSA blood cultures on 2/4 or 2/7?

• NO- this is within the RIT

• What action would you take of the organisms on 2/7 was VRE?

• Answer: Add the new organism from 2/7 to the CLABSI reported in NHSN on 2/1.


• Pt spikes a temp on 2/13 urine culture is done- grows <35,000 Klebsiella.

• Is this a UTI?

• NO- <100,000cfu’s

• Pt spikes a temp of 101.6 on 2/18.

• Blood culture is done on 2/18 and grows Proteus.

• On 2/19, Urine culture is done and grows >100,000 Klebsiella and >100,000 Proteus.

• Pt continues to have an indwelling catheter and PICC line

• What HAI would you identify?


• CAUTI with event date of 2/18.

• Blood culture is within the secondary attribution period therefore it is not reported as a primary LCBI.

• The secondary attribution period is the infection window for the CAUTI + the RIT for the CAUTI = 2/17-3/3

Questions?

review of 2015 bsi, uti, vap, and vae criteria changes · 2015-06-04 · review of 2015 bsi, uti,...

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