2008 Surveillance Definitions and Reporting

2008 Surveillance Definitions and Reporting

2008 Surveillance Definitions and Reporting

Methicillin Resistant Staph Aureus

In 2008, new MRSA cultures processed in our laboratory will be classified by one of three definitions:

  1. Hospital Acquired MRSA (HA) – previously known as nosocomial
  2. Healthcare-associated MRSA (HCA)
  3. Community-associated MRSA (CA)

Hospital Acquired MRSA (HA) – Previously known as nosocomial

  1. Infection/colonization that was not present or incubating on admission in a patient hospitalized >48 hours
  2. Infection/colonization identified in a patient < 48 hours after hospital discharge
  3. Infection meeting other established criteria for hospital-acquired infections (i.e. NHSN definitions for surgical site infections)

When possible, attempt will be made to track MRSA infections vs. MRSA colonization.

NOTE: An MRSA infection in a patient previously identified as colonized with MRSA should not be counted as Hospital Acquired.

Healthcare-associated MRSA (HCA) – does not meet definition for Hospital Acquired

  1. Infection/colonization that was present or incubating on admission to the hospital in a patient with a history of healthcare exposure as defined below

OR

  1. Infection/colonization in a patient hospitalized < 48 hours in a patient with a history of healthcare exposureas defined below

Healthcare exposure – hospitalization (inpatient or OPO), surgery, dialysis, or residence in a chronic or acute care facility in the year prior to culture date or presence of a percutaneous indwelling medical device or catheter at the time of culture collection (i.e. trach, gastrostomy, foley, central/PICC line, excluding internal devices like pacemakers)

Community-associated MRSA (CA)

  1. Infection/colonization that was present or incubating on admission to the hospital in a patient with no Healthcare exposure as defined above

OR

  1. Infection/colonization presenting in a patient hospitalized < 48 hours in a patient with no history of Healthcare exposure as defined above

MRSA Definition Reference – page 51

2008 Surveillance Measurements –HA MRSA/1000 patient days

CA MRSA/100,000 population

HCA as % of total new MRSA

Risk Factors

Advanced age > 65y/oRecent Hospitalization (<30 days)

LTC patientsDialysis

DiabeticRecent incarceration

Chronic skin lesionsRecent Abx Tx (<30 days)

COPD

C Difficile Definitions

Case Defintitons –

  1. C.difficile associated disease (CDAD)

A CDAD case is defined as a case of diarrhea(unformed stool that conforms to the shape of a specimen collection container) or toxic megacolon without other known etiology that meet 1 or more of the following criteria:

  • + lab test for c. diff toxin A and/or B, or c. diff culture +
  • Pseudomembranous colitis seen during endoscopic exam or surgery
  • Pseudomembranous colitis is seen during histopathological exam
  1. Recurrent C. diff

Episode of c. diff that occurs 8 wks or < after onset of a previous episode provided that CDAD symptoms from earlier episode resolved with or without therapy

CDAD Exposure Defintions

  1. Hospital Acquired CDAD (HA) – previously known as nosocomial
  • A patient with CDAD symptom onset more than 48 hours after admission to HCF that does not meet any of the definitions below
  1. Community Onset – Healthcare Facility Associated CDAD (CO-HCFA)
  • Symptom onset in the community or < 48 hrs after admission to healthcare facility, provided that the onset was < 4 weeks after the last discharge from a healthcare facility
  1. Indeterminate CDAD (I)
  • CDAD symptom onset in the community but discharged from the same or another HCF 4 – 12 weeks before symptom onset
  1. Community Onset CDAD (CO)
  • Symptom onset in the community or < 48 hours after admission to a HCF, provided that the symptom onset was > 12 weeks after the last discharge from any HCF

Definition:

Healthcare Facility (HCF) – any acute care, LTC, LTAC or other facility in which skilled nursing care is provided and patients are admitted at least overnight.

2008 Surveillance Measures

Hospital Acquired (HA) - CDAD cases/10,000 patient days

Community Onset (CO) – CDAD cases per 100,000

CDAD Risk Factors

  • Antibiotic/Chemotherapy exposure in past 2 months
  • GI surgery or manipulation
  • LOS > 48 hours in HCF
  • Serious underlying disease – diabetes, COPD, Cancer, acute/chronic renal failure
  • Immunocompromised – HIV, transplant, neutropenic
  • Advanced age - > 65 y/o

Reference – Recommendations for Surveillance of Clostridium difficile – Associated Disease, “InfectionControl and Hospital Epidemiology, Feb. 2007, Vol. 28, No. 2

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