SSI SSI

(Surgical Site Infections) (SurgicalSiteInfections)

Jan2013NHSNDefinitionUpdates AdaptedfromNHSNUpdates Oct2012

BrookeBailey,BSN,RN ManagerofInfectionPrevention/EmployeeHealth EastAlabamaMedicalCenter Opelika,AL

SSI ActiveSurveillance Methods

Determinewhichsurgicalpatientsyouwill monitor
Reviewadmission,readmissionandORlogs g Reviewpatientchartsforsignsandsymptomsof SSI,riskfactors Reviewlab,Xray,otherdiagnostictestreports Reviewnursesandphysiciannotes VisittheICUandwards talktoprimarycarestaff

PostdischargeSSI SurveillanceMethods
Surgeonand/orpatientsurveysbymailorphone DevelopatoolthatincludestheSSIandmost commonspecificinfectionsitecriteriaforthe operativeproceduresbeingmonitored Trainsurgeonsandtheirofficestaff Reviewofpostoperativeclinicrecords Criteriamustbemet regardlessofwheretheSSIisdetected!

ChangestoPlanin2013for ProcedureAssociatedModule
NoPostprocedurePneumonia(PPP) ForSSI,nochoiceforBothbutwillbeabletoindicatethatbothin and outpatientsarebeingmonitoredforSSI

NHSNandCMS
COLOandHYSTmustbeincludedinyourMonthlyReportingPlans everymonthfordatatobereportedonyourbehalftoCMS MustfollowtheNHSNSSIprotocolexactlyandreportcompleteand accuratedatainatimelymanner ReporteachSSIdetectedorindicatethatnoSSIoccurred ReporteachCOLOandHYSTperformedoninpatients

OperationalGuidanceforReportingSurgicalSiteInfection(SSI)DatatoCDCsNHSNforthe PurposeofFulfillingCMSsHospitalInpatientQualityReporting(IQR)ProgramRequirements

http://www cdc gov/nhsn/PDFs/FINALACHSSIGuidance.pdf http://www.cdc.gov/nhsn/PDFs/FINAL Guidance pdf

NHSNandCMS
AsubsetofSSIfollowing ginPlan, ,inpatient p COLOand HYSTproceduresareusedtofulfillCMSreporting requirements: 18yearold ldpatient ti tat ttime ti of fsurgery Deepincisionalprimaryororgan/spaceSSI Detectedbyallsurveillancemethods (A,P,RF,RO)within30daysofdateofprocedure Theriskmodelsusedtocalculatetheexpectednumber ofSSIfortheSIRarebasedonlyonthepatientsageand ASAscore

COLOandHYST

HYSTReportingDetail
Whichstructuresandhowthey yaredetached( (the surgicaltechniqueorapproach),notthelocationof wherethestructureswerephysicallyremoved, determineshowtheICD9CMcodeisassigned 68.41 Laparoscopic p p totalabdominalhysterectomy y y( (HYST), ), evenifuterusisremovedthroughthevagina.REPORT 68.51 Laparoscopically assistedvaginalhysterectomy (VHYS);vaginalincision.DONOTREPORT

RememberifyouhavenoSSItoreport
Clickon EventIncomplete MissingPAEventstab Ch kReport Check R tNo N Events E t next t t toSSIand dS Save

Denominatordata arecollected usingthisform

SSIdataare collected usingthis form

KeyTerm: NHSNOperativeProcedure
Aprocedurethat
isperformedonapatientwhoisan NHSNinpatientoranNHSN outpatient takesplaceduringanoperation whereasurgeonmakesaskinor mucousmembraneincision (includingthelaparoscopic approach)andprimarilyclosesthe incisionbeforethep patientleaves theoperatingroom,and SkintoSkin isrepresentedbyan NHSNOperative p ProcedureCode.

PrimaryClosure

NEW

Primaryclosureisdefinedasclosureofalltissuelevels,regardless ofthepresenceofwires,wicks,drains,orotherdevicesorobjects extrudingthroughtheincision. However,regardlessofwhetheranythingisextrudingfromthe incision,iftheskinedgesarenotfullyapproximatedfortheentire l thof length fth thei incision i i (e.g., ( areloosely l l closed l dwith ithgapsbetween b t suture/staplepoints),theincisionisnotconsideredprimarilyclosed andthereforetheprocedurewouldnotbeconsideredanoperation. I such In hcases,anysubsequent b tinfection i f ti would ldnot tb beconsidered id dan SSI,althoughitmaybeanHAIifitmeetscriteriaforanother specificinfectionsite(e.g.,skinorsofttissueinfection).

KeyTerm:NHSNInpatient
Apatientwhosedateofadmissiontothe healthcarefacilityandthedateofdischargeare different ff calendardays. y

KeyTerm:NHSNOutpatient
Apatientwhosedateofadmissiontothe healthcarefacilityandthedateofdischargeare thesameday

KeyTerm:OperatingRoom
Ap patientcareareathatmettheFacilitiesGuidelines InstituteorAmericanInstituteofArchitectscriteriafor anoperatingroomwhenitwasconstructedor renovated. renovated May yinclude: Traditionaloperatingroom Csectionroom Interventionalradiologyroom Cardiaccatheterizationlab

Definitionsof SurgicalSiteInfection
SurgicalSiteInfection(SSI)Event http://www cdc gov/nhsn/PDFs/pscManual/9pscSSIcurrent pdf http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf

CDC/NHSNSurveillanceDefinitionofHealthcareAssociatedInfection andCriteriaforSpecificTypesofInfectionsintheAcuteCareSetting http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf

SSIDefinitions

SuperficialIncisionalSSI
Infectionoccurswithin30daysafteranyNHSNoperativeprocedure,includingthose codedasOTH and d involvesonlyskinandsubcutaneoustissuesoftheincision and patienthasatleastoneofthefollowing: p g a.purulentdrainagefromthesuperficialincision b.organismsisolatedfromanasepticallyobtainedcultureoffluidor tissue fromthesuperficialincision c superficialincisionthatisdeliberatelyopenedbyasurgeonandis c. culturepositiveornotcultured and patienthasatleastoneofthefollowingsignsorsymptoms: pain i ortenderness; t d localized l li dswelling; lli redness; d orh heat. t Aculturenegativefindingdoesnotmeetthiscriterion. Rearran nged d.diagnosisofasuperficialincisionalSSIbyasurgeonorattending physician.

SuperficialIncisionalSSI

ICD9Codes C d
http://www.cdc.gov/nhsn/XLS/ICD9cmCODEScurrent.xlsx

SIPandSIS
Superficialincisionalprimary (SIP) Superficialincisionalsecondary (SIS)

AsuperficialincisionalSSI thatisidentifiedinthe primaryincisionina patientthathashadan operationwithoneor moreincisions. incisions Examples: Csectionincision Chest Ch i incision i i for f coronaryartery bypassgraftwitha donorsite[CBGB]

Asuperficialincisional SSIthatisidentifiedin the h secondary d incision i i i in i apatientthathashadan operationwithmore than h oneincision. Example: Donorsiteincision forcoronaryartery bypassgraftwitha donorsite[CBGB]

Example
PatientdeliversababybyCSectiononAugust23. Onherfirstpostpartumvisittohersurgeonon September20,shenotesyellowpurulentdrainage inthesuperficialincision. DoesGretchenhaveasurgicalsiteinfection?

YES
IsitasuperficialSSI?

YES
IsitanSIPoranSIS?

SIP

DeepIncisionalSSI
Infection I f ti occurswithin ithi 30or90d daysafter ft th theNHSNoperative ti procedure d accordingtothelistinTable3 and involvesdeepsofttissuesoftheincision(e (e.g., g fascial andmusclelayers) and patienthasatleastoneofthefollowing: a purulentdrainagefromthedeepincision a. b.adeepincisionthatspontaneouslydehiscesorisdeliberately opened byasurgeonandisculturepositiveornotcultured and patienthasatleastoneofthefollowingsignsorsymptoms:fever (>38C);localizedpainortenderness. Aculturenegativefindingdoesnotmeetthiscriterion. criterion c.anabscessorotherevidenceofinfectioninvolvingthe deepincisionis foundondirectexamination,duringan invasiveprocedure,orbyhistopathologic examinationor imagingtest d.diagnosisofadeepincisionalSSIbyasurgeonor attendingphysician.

Re earranged

DeepIncisionalSSI
or90daysaftertheNHSNoperativeprocedure

invasiveprocedure

imagingtest

DIPandDIS
Deepincisionalprimary (DIP) AdeepincisionalSSIthatis identifiedintheprimary incisioninapatientthathas hadanoperationwithoneor moreincisions. Examples: Csectionincision Chestincisionfor coronary y artery ybypass yp graftwithadonorsite [CBGB]

Deepincisionalsecondary (DIS) AdeepincisionalSSIthatis identifiedinthesecondary incisioninapatientthathas hadanoperationwithmore thanoneincision. Example: Donorsiteincisionfor coronary yartery ybypass yp graftwithadonorsite [CBGB]

ReportingInstructions
Classify Cl if i infection f ti th that ti involves l both b thsuperficial fi i l anddeepincisionalsitesasdeepincisionalSSI Classifyinfectionthatinvolvesdeepincisional andorgan/spacesitesasdeepincisionalSSI Thismaychangein2014

Organ/SpaceSSI

NEW

Infectionoccurswithin30or90daysaftertheNHSNoperativeprocedure accordingtothelistinTable3 and involvesanypartofthebody,excludingtheskinincision,fascia,ormuscle layers,thatisopenedormanipulatedduringtheoperativeprocedure and patienthasatleastoneofthefollowing:

a.purulentdrainagefromadrainthatisplacedintotheorgan/space b organismsisolatedfromanasepticallyobtainedcultureoffluidortissueinthe b. organ/space c.anabscessorotherevidenceofinfectioninvolvingtheorgan/spacethatis foundondirectexamination,invasiveprocedure,orbyhistopathologic examinationorimagingtest d.diagnosisofanorgan/spaceSSIbyasurgeonorattendingphysician.

and meetsatleastonecriterionofaspecificorgan/spaceinfectionsitelisted inTable4. 4

OrganSpaceSSI check

or90daysaftertheNHSNoperativeprocedure accordingtothelistinTable3

invasiveprocedure

imagingtest

and meetsatleastonecriterionofaspecificorgan/spaceinfectionsitelistedinTable4.

Updated Slide

90 daySurveillance
Code
BRST CARD CBGB CBGC

OperativeProcedure
Breast surgery Cardiacsurgery Coronary ArteryBypassGraftwithbothchestanddonorsiteincisions CoronaryArteryBypass Graftwithchestincisiononly Craniotomy SpinalFusion Open reductionoffracture Hemiorrhaphy HipProsthesis KneeProsthesis Pacemakersurgery Peripheral vascularbypasssurgery Refusion ofspine Ventricular shunt

OnlyforDI andO/SSSI

CRAN FUSN FX HER HPRO KPRO PACE PVBY RFUSN VSHN

Recap
Forany yNHSNoperative p p procedure, ,monitorfor superficialSSIfor30daysonly ForselectedNHSNoperativeprocedures,monitorfor deepincisionalororgan/spaceSSIforeither30daysor 90days y

NEW

ExceptiontoHAIRuleforCertain Organ/SpaceSSIs
Ifapatient i h hasani infection f i i inthe h organ/space / being b i operated donin i thefirst2dayperiodofhospitalizationandthesurgicalincisionwas closedprimarily,subsequentcontinuationofthisinfectiontype duringtheremainderofthathospitalizationisconsideredan organ/spaceSSI,iforgan/spaceSSIandsitespecificinfection criteriaaremet. Rationale:Riskofcontinuingornewinfectionconsideredto beminimalwhensurgeonelectstocloseawoundprimarily
Updated Slide

Example
On8/1,patientpresentstoEDwithacuteabdomenandis admittedtotheORonthesamedayforcolonresection (COLO).Peritonealabscessnotedattimeofsurgery.Incisionis closedp primarily ywithaJPdraininanadjacent j stabwound. Evenonantibiotics,patientcontinuestohavelowgrade f fevers, abdominal bd i lpain, i and dpurulent l tdrainage d i via i JPd drain. i PatientreturnedtoORon8/6forexplorationandnew abscesseswerefound. ThisisreportedasanSSIIAB

ReportingInstructions
InChapter9,theReportingInstructionsintheSSIcriteria table,theNumeratorDatasectionandtheTableof Instructionsprovideimportantguidanceonthemanynuances ofhowtoreport p SSIdetailsinavariety yofsituations. Theexamplesshowninthispresentationareonlysomeofthem. Pleasereadandfollowalloftheinstructionscarefully!

WhenapatientwithanSSIhas hadmorethanoneoperation
Apatienthasseveral NHSNoperationspriorto anSSI,reportthe h operationthatwas performedmostcloselyin timepriortotheinfection d . date

Example: xample:PatientunderwentaCO COLO Oon1/12/13. / / 3.Threedayslater,on1/15/13, / 5/ 3, hewentbacktosurgerytorepairaleakinganastomosis(OTH).Hedeveloped anintraabdominal abscesson1/28/13. ThisSSIisattributedtothesecondprocedure(OTH), (OTH) nottheCOLO. COLO

Ifmorethanoneoperationis donethroughasingleincision
First First,attempttodeterminetheprocedurethatisthoughttobe associatedwiththeinfection
Example:IfthepatienthadaCBGCandCARDdoneatthesametimeand developsaninfectedvalve,thentheSSIwillbelinkedtotheCARD.

Ifitsnotclear(asinthecaseofasuperficial incisionalSSI),use theNHSNPrincipalOperativeProcedureSelectionListsto selectwhichoperativeproceduretoreport.

Table5.NHSNPrincipalOperative ProcedureCategorySelectionLists

NHSNPrincipalOperative ProcedureCategorySelectionLists
FivelistsinTable5 Abdominaloperations Thoracicoperations Neurosurgical(spine)operations Neurosurgical(brain)operations Neckoperations CategorieswiththehighestriskofSSIarelistedbeforethosewith lowerrisks In2013,orderisCOLO,SB,REC; Updated p previousorderisSB, SB REC, REC COLO In Slide In2013,HYSTisstillbeforeVHYS

SSIafterLaparoscopic Procedure
Ifmorethanoneofthelaparoscopic/robotic incisionsbecomesinfected,reportonlyoneSSI IfoneisasuperficialincisionalSSIandanotherisa deepincisionalSSI,reportasadeepincisionalSSI

CompletingtheSSIEventForm (Numerator)

CompleteaSurgical SiteInfection(SSI) formforeachpatient foundtohaveanSSI usingthedefinitions

SSIForm BasicSSIInformation

CHANGE
Dateof Event: Required. Required Thedate when thelast element usedtomeet the SSIcriterion occurred occurred.

Updated Slide

ReportingSSIforPatientswho areReadmitted
UsetheadmissiondateoftheoriginalsurgicaladmissionastheDate AdmittedtoFacility,notthereadmissiondate ThentheDateofProcedureandDateofEventwillbeinthecorrect sequence

DateAdmittedtoFacilityDateofProcedure<DateofEvent

SSIForm BasicSSI Information

Enterthedatethep patientwasadmittedtothehospital p whentheoperation p was performed(notthedateofreadmission)andthelocationwherethepatientwas housedafterleavingtheOR/PACU.

Note: Location isan Note Note: Location isan optional field forfor SSI! optional field SSI!

Note:Thisisneveralocationoradmission place dateassociatedwithareadmissionorap wherethepatientmaybeafterdischarge (e.g.,nursinghome).

SSIForm EventDetails

SpecificEvent Required Checktheboxtoindicate thedefinitionthatwas usedtoidentifytheSSI

SSI EventDetails

Selectthespecificelementsofthe criterionthatwereusedtoidentify thisinfection.

SSI EventDetails
A SSIwasidentifiedbeforethe patientwasdischargedfromthe facilityfollowingtheoperation PSSIwasidentifiedonlyaspartof postdischarge surveillance,including EDvisitwithoutreadmission.If readmitted,useRForROas appropriate. DetectedRequired. Checktheboxtoindicate when/howtheSSIwas identified identified. RFSSIwasidentifiedduetopatient readmissiontothefacilitywherethe operationwasperformed. ROSSIwasidentifiedduetopatient admissiontoafacilityotherthan wheretheoperationwasperformed.

SSI EventDetails

SecondaryBSIRequired. Ifthepatienthadacultureconfirmed BloodstreaminfectionwithadocumentedSSI, checkYes.

SecondaryBSI

Updated Slide

Ifth thecriterion it i met t f forth theprimary i i infection f ti site it requires i aculture, lt thenatleastoneorganismfromthatsitemustmatchanorganismin thebloodculture(antibiograms oftheisolatesdonothaveto match). match) Example:PatientgrowsE.coliinherdeepincisionandinherblood. TheSSIisreportedwithasecondaryBSIandthepathogenasE. E coli.

CentralLineAssociatedBloodstreamInfection(CLABSI)Event
http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

SecondaryBSI(cont.)
Ifthecriterionmetfortheprimaryinfectionsitedoesnot requireacultureandthebloodisolateisalogicalpathogenfor thesite,reportassecondaryBSI.

Example:Postoperativepatienthadabscessin smallbowelnotedduring greoperation. p No specimensexceptbloodculturestaken;blood grewBacteroides fragilis.Theinfectionwas reportedasanSSIGITmeetingcriterion1 (surgicallyidentifiedabscess), abscess) witha secondaryBSI.Theorganismwasreportedas B.fragilis

Updated Slide Slid

SecondaryBSIGuide
Besidesthe2examplesjustgiven,thereareotherscenariosinthisguide thatyou o will illfindhelpful helpf l Exampleswhenbloodandsitespecificculturesdonotmatch Exampleswhenbloodispositivebutsitespecificcultureisnegative Definitionofmatchingorganism Additi Additional lnotes t and dreporting ti i instructions t ti

CentralLineAssociatedBloodstreamInfection(CLABSI)Event http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

SSI EventDetails

DiedRequiredforcompletion Ifthepatientdiedduringthishospitalization, hospitalization checkYes. **Therecordmaybesavedwithout completing l i this hi fi field, ld but b it i will illbe b considered id d incomplete

SSIContributedtoDeath Requiredonlyifthepatientdied. IftheSSIcausedthedeathor exacerbatedanexistingcondition whichledtodeath,checkYes.

SSI EventDetails

DischargeDate:Optional Thedatethepatientwasdischargedfromthe hospital hospital. Thisisthehospitalizationduringwhichthe operationwasperformed.

PathogensIdentifiedRequired CircleYesifoneormorepathogens wasidentified. identified Specificinformationaboutthe pathogenisenteredonthebackof theform

Foreachantimicrobialagent g identified,checkthepathogens susceptibilityresult.

S=Susceptible I=Intermediate R=Resistant NS=Nonsusceptible SDD=Susceptibledose dependent N=Nottested

Summary
Completeandenteror i import tSurgical S i lSite Sit Infectionrecordsfor theproceduresthat areselectedfor surveillance. UsetheSSIProtocol, TablesofInstructions, InfectionSite Definitionschaptersof thePatientSafety Manualforguidance.

NHSNOperativeProcedureCodes EachNHSNoperative p procedure p category g yisdefinedby y agroupofICD9CMprocedurecodes

CPTcodesdonottakeprecedenceover ICD9codeswhencategorizingNHSN operativeprocedures.

NHSNOperativeProcedures

DenominatorData
Thesurveillanceperiodisone month. th CompleteaDenominatorfor Procedurerecordforevery operationmeetingtheNHSN operativeprocedure definitionthatwasdone duringthatmonthifitisin yourMonthlyReportingPlan. Submitdatawithinamonth oftheendofthis period

DenominatorforProcedure
Forexample, p ,ifyour y Monthly yReporting p gPlanindicates thatyouwillmonitorCOLOproceduresinJanuary,and 43COLOweredonethatmonth,thenyoushould enter/import43separateCOLOprocedurerecordsinto NHSNbytheendofFebruary

DenominatorforProcedure
PatientInformation: PatientID=MR# G d Gender DateofBirth DateofProcedure NHSNProcedureCode areallrequired

DenominatorforProcedure

TheNHSNProcedureCodeandtheDate ofProceduremustbeentered. TheICD9CMcodeisoptional

ProcedureDetails OutpatientandDuration

DurationRequired Recordthehoursandminutes betweentheskinincisionand skinclosure. Donot recordanesthesiatime!

OutpatientRequired Ifadmissionanddischargedates arethesamecalendardate, selectYes;otherwise,selectNo.

ProcedureDetails Implant
Nolongerrequired!

NEW

Insteadcertainoperativeprocedureswillrequiremonitoring fordeepincisionalororgan/spaceSSIforeither30daysor90 days Implant p definitiontoobroadwhichlimiteditsusefulnessasan SSIstratifier Alsotoodifficulttocollect

Reporting p gInstructions
IfproceduresinmorethanoneNHSNoperativeprocedurecategory aredonethroughthesameincisionduringthesametriptotheOR, createarecordforeachprocedurethatyouaremonitoringinthe MonthlyReportingPlan,andusethetotaltimeforthedurationfor eachrecord.

Example:Patienthadacoronaryarterybypassgraftwithachest incisiononly(CBGC)andalsoamitralvalvereplacement(CARD). Thetimefromskinincisiontoskinclosurewas5hours.A DenominatorforProcedureformiscompletedfortheCBGCand another th for f the th CARD, CARD i indicating di ti the th duration d ti as5h hoursand d0 minutesoneachform.

ReportingInstructions
EXCEPTION:IfapatienthasbothaCBGCandaCBGBduring thesametriptotheOR,reportonlyasaCBGB.

Example:Patientwasscheduledtohaveacoronaryarterybypassgraft withachestincisiononly(CBGC),howeverduringtheprocedureit becamenecessarytoharvestavesselfromtheleg.Eventhoughan ICD9CMprocedurecodeforaCBGCandaCBGBwillbeassignedby coders,onlycompleteaCBGBDenominatorforProcedureform.The timefromchestskinincisiontochestprimaryclosureisreportedfor thedurationoftheprocedure

ReportingInstructions
IfthepatientgoestotheORmorethanonceduringthesame admissionandanotherprocedureofthesameordifferent NHSNoperativeprocedurecategoryisperformedthroughthe sameincisionwithin24hoursoftheendoftheoriginal g incision,reportonlyoneDenominatorforProcedureformfor theoriginalprocedurecombiningthedurationsforboth procedures.
Example:Patienthadcolonsurgery(COLO)performedonTuesdaymorningwhichhada durationof3hoursand10minutes.OnTuesdayevening,hewasreturnedtotheORwhere theCOLOincisionwasopenedtorepairableedingvessel(OTH).Thedurationofthesecond procedurewas1hourand10minutes. ReportonlyoneCOLOwithacombineddurationof4hoursand20minutes.Donotreport anOTHrecord.

ReportingInstruction: BilateralProcedures
Forproceduresthatcanbe performedbilaterallyduringthe sametriptotheOR(e.g.,KPRO), twoseparateDenominatorfor Procedureformsarecompleted. Todocumentthedurationofthe procedure,indicatetheincision timetoclosureforeach procedureseparatelyor, alternatively,takethetotaltime forbothproceduresandsplitit evenlybetweenthetwo.

ProcedureDetails WoundClass
Woundclassisan assessmentofthe likelihoodanddegreeof contaminationofa surgicalwoundatthe timeoftheoperation. Itshouldbeassignedby apersondirectly involvedinperforming theoperation; p rarely yby y theIP.

C=Clean CC=CleanContaminated CO=Contaminated D=Dirty U=Unknown

WoundClass
Clean(I)
Uninfectedwoundwithnoinflammation Respiratory,alimentary,genital*oruninfectedurinarytractarenot entered Primarilyclosed Closeddrainage,ifneeded

CleanContaminated(II)
Respiratory,alimentary,genital*,orurinarytractsenteredunder controlledconditionsandwithoutunusualcontamination Includeoperationsonbiliarytract,appendix,vagina,oropharynx ifnoevidenceofinfectionormajorbreakintechnique
*Includesfemaleandmalereproductivetracts

WoundClass
Contaminated(III) ( )
Open,fresh,accidentalwounds MajorbreaksinsteriletechniqueorgrossspillagefromtheGItract Includesincisionsintoacute acute,nonpurulent inflamedtissues

DirtyorInfected(IV)
Oldtraumaticwoundswithretaineddevitalizedtissue Woundsinvolvingexistingclinicalinfectionorperforatedviscera

Note:NHSNallowsunknowntobereportedthrough2013 2013, however,theprocedurewillnotbeincludedintheaggregate pooloryourfacilitysriskadjustedmetrics.

WoundClassCases
Case
Susannehadanappendectomyfollowing1dayofacuteabdominalpain withreboundtenderness.Attheendofthecase,thesurgeonindicates thattheappendixwasinflamedandthesurgicalareawasirrigatedand cefoxitin wasorderedfor3dayspostoperatively. Fredhadacholecystectomyusingalaparoscopictechnique.The gallbladderwasremovedsuccessfullywithnobreaksinoperativeasepsis GeorgehadaKPROrevision. revision Whenthesurgeonmakestheincisioninto thesurgicalsite,shenotesthatthekneejointdemonstratespurulent materialandinflammation.Aspecimenisobtainedandsenttothe laboratorywhichgrowsS.aureus(MSSA).

Wound Class

Contaminated Clean Contaminated Dirty or Infected Clean Contaminated

Maryhadascheduled,uneventfulabdominalhysterectomy

ASAScore
Requiredonlyforinpatient procedures
1 Normallyhealthypatient 2 Patientwithmildsystemicdisease 3 Patientwithseveresystemicdiseasethatis
notincapacitated i i d

4 Patientwithanincapacitatingsystemic 5

diseasethatisaconstantthreattolife

Moribundpatientwhoisnotexpected tosurvivefor24hourswithor withoutoperation

Linking gandImporting p gRecords

DenominatorforProcedureandSSIrecordsmustbeLINKEDsothatthecorrect riskfactordataarematchedtotheSSIforagivenpatient.

LinkingProcedureandSSI Records
1. EntertheDenominatorforProcedure record d 2. EntertheSSIrecord 3. Linkthetworecords

WhenSSIisselectedfromtheEventTypefield, thelinkbuttonautomaticallyappearsonthe screenandmessageindicatesthattheeventis notlinked.Clickonthebutton.Dontneedto entertheproceduredata.

Anewscreenappears listingalltheoperative proceduresthispatient hashad

Checktheboxnextto theappropriate procedure,andclickon theLink/Unlink button

AfterlinkinganSSItoitscorrespondingprocedure procedure,the remainderoftheSSIformmuststillbecompletedandthe recordsavedforlinkingtooccur

AfterclickingSAVE

Alldata arelinked g together

ImportingProcedures

ImportingPatientSafetyProcedureData
http://www.cdc.gov/nhsn/PDFs/ImportingProcedureData_current.pdf

ImportingProcedures

Note:Ifyoucreate aheader headerrow row withfieldnamesat thetop,itmustbe deletedbeforethe fileisimportedto NHSN!

ResourcesforSSISurveillance
NHSN S Patient at e tSafety Sa etyComponent Co po e tManual, a ua ,Ja January ua y2013 0 3
Ch 1:NHSNOverview:SurveillanceTechniques Ch 3:MonthlyReportingPlan Ch 9:SSIProtocol,Forms,andTablesofInstructions Ch 16:KeyTerms Ch 17:InfectionSiteDefinitions

http://www.cdc.gov/nhsn/TOC_PSCManual.html

ResourcesforSSISurveillance
NHSNForms(January2013) 57.106:MonthlyReportingPlan 57.120:SurgicalSiteInfection 57.121: 57 121:DenominatorforProcedure

NHSNTrainingCourseResourceLinks

https://www.signup4.net/Public/ap.aspx?EID=TEST2089Ef