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