CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting
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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
Teresa C. Horan, MPH, Mary Andrus, RN, BA, CIC, and Margaret A. Dudeck, MPH
Atlanta, Georgia
BACKGROUND population for which clinical sepsis is used has been re
stricted to patients #1 year old. Another example is that
Since 1988, the Centers for Disease Control and incisional SSI descriptions have been expanded to spec
Prevention (CDC) has published 2 articles in which nos ify whether an SSI affects the primary or a secondary in
ocomial infection and criteria for specific types of nos cision following operative procedures in which more
ocomial infection for surveillance purposes for use in than 1 incision is made. For additional information about
acute care settings have been defined.1,2 This document how these criteria are used for NHSN surveillance, refer
replaces those articles, which are now considered obso to the NHSN Manual: Patient Safety Component Protocol
lete, and uses the generic term ‘‘health care–associated available at the NHSN Web site (www.cdc.gov/ncidod/
infection’’ or ‘‘HAI’’ instead of ‘‘nosocomial.’’ This doc dhqp/nhsn.html). Whenever revisions occur, they will
ument reflects the elimination of criterion 1 of clinical be published and made available at the NHSN Web site.
sepsis (effective in National Healthcare Safety Network
[NHSN] facilities since January 2005) and criteria for lab
oratory–confirmed bloodstream infection (LCBI). Spe CDC/NHSN SURVEILLANCE DEFINITION OF
cifically for LCBI, criterion 2c and 3c, and 2b and 3b, HEALTH CARE–ASSOCIATED INFECTION
were removed effective in NHSN facilities since January
For the purposes of NHSN surveillance in the acute
2005 and January 2008, respectively. The definition of
care setting, the CDC defines an HAI as a localized or
‘‘implant,’’ which is part of the surgical site infection
systemic condition resulting from an adverse reaction
(SSI) criteria, has been slightly modified. No other infec
to the presence of an infectious agent(s) or its toxin(s).
tion criteria have been added, removed, or changed.
There must be no evidence that the infection was pre
There are also notes throughout this document that
sent or incubating at the time of admission to the acute
reflect changes in the use of surveillance criteria since
care setting.
the implementation of NHSN. For example, the
HAIs may be caused by infectious agents from
endogenous or exogenous sources.
From the National Healthcare Safety Network, Division of Healthcare d Endogenous sources are body sites, such as the skin,
Quality Promotion, Centers for Disease Control and Prevention, nose, mouth, gastrointestinal (GI) tract, or vagina
Atlanta, GA.
that are normally inhabited by microorganisms.
Address correspondence to Teresa C. Horan, MPH, Division of Health- d Exogenous sources are those external to the pa
care Quality Promotion, Centers for Disease Control and Prevention,
Mailstop A24, 1600 Clifton Road, NE, Atlanta, GA 30333. E-mail:
tient, such as patient care personnel, visitors, pa
thoran@cdc.gov. tient care equipment, medical devices, or the
Am J Infect Control 2008;36:309-32. health care environment.
0196-6553/$34.00 Other important considerations include the
Copyright ª 2008 by the Association for Professionals in Infection following:
Control and Epidemiology, Inc.
d Clinical evidence may be derived from direct ob
doi:10.1016/j.ajic.2008.03.002
servation of the infection site (eg, a wound) or
309310 Vol. 36 No. 5 Horan, Andrus, and Dudeck
review of information in the patient chart or other USE OF THESE CRITERIA FOR PUBLICLY
clinical records. REPORTED HAI DATA
d For certain types of infection, a physician or sur
geon diagnosis of infection derived from direct ob Not all infections or infection criteria may be appro
servation during a surgical operation, endoscopic priate for use in public reporting of HAIs. Guidance on
examination, or other diagnostic studies or from what infections and infection criteria are recommen
clinical judgment is an acceptable criterion for an ded is available from other sources (eg, HICPAC [http:
HAI, unless there is compelling evidence to the //www.cdc.gov/ncidod/dhqp/hicpac_pubs.html]; National
contrary. For example, one of the criteria for SSI Quality Forum [http://www.qualityforum.org/]; profes
is ‘‘surgeon or attending physician diagnosis.’’ Un sional organizations).
less stated explicitly, physician diagnosis alone is
not an acceptable criterion for any specific type UTI-URINARY TRACT INFECTION
of HAI.
d Infections occurring in infants that result from SUTI-Symptomatic urinary tract infection
passage through the birth canal are considered
A symptomatic urinary tract infection must meet
HAIs.
at least 1 of the following criteria:
d The following infections are not considered health
care associated: 1. Patient has at least 1 of the following signs or
s Infections associated with complications or ex symptoms with no other recognized cause: fever
tensions of infections already present on ad (.388C), urgency, frequency, dysuria, or suprapu
mission, unless a change in pathogen or bic tenderness
symptoms strongly suggests the acquisition of and
a new infection; patient has a positive urine culture, that is, $105
s infections in infants that have been acquired microorganisms per cc of urine with no more
transplacentally (eg, herpes simplex, toxoplas than 2 species of microorganisms.
mosis, rubella, cytomegalovirus, or syphilis) 2. Patient has at least 2 of the following signs or symp
and become evident #48 hours after birth; and toms with no other recognized cause: fever
s reactivation of a latent infection (eg, herpes zos (.388C), urgency, frequency, dysuria, or suprapu
ter [shingles], herpes simplex, syphilis, or bic tenderness
tuberculosis). and
d The following conditions are not infections: at least 1 of the following
s Colonization, which means the presence of mi a. positive dipstick for leukocyte esterase and/
croorganisms on skin, on mucous membranes, or nitrate
in open wounds, or in excretions or secretions b. pyuria (urine specimen with $10 white
but are not causing adverse clinical signs or blood cell [WBC]/mm3 or $3 WBC/high
symptoms; and power field of unspun urine)
s inflammation that results from tissue response c. organisms seen on Gram’s stain of unspun
to injury or stimulation by noninfectious urine
agents, such as chemicals. d. at least 2 urine cultures with repeated
isolation of the same uropathogen (gram
CRITERIA FOR SPECIFIC TYPES OF INFECTION negative bacteria or Staphylococcus sapro
phyticus) with $102 colonies/mL in non-
Once an infection is deemed to be health care associ voided specimens
ated according to the definition shown above, the spe e. #105 colonies/mL of a single uropathogen
cific type of infection should be determined based on (gram-negative bacteria or S saprophyticus)
the criteria detailed below. These have been grouped in a patient being treated with an effective
into 13 major type categories to facilitate data analysis. antimicrobial agent for a urinary tract
For example, there are 3 specific types of urinary tract infection
infections (symptomatic urinary tract infection, asymp f. physician diagnosis of a urinary tract
tomatic bacteriuria, and other infections of the urinary infection
tract) that are grouped under the major type of Urinary g. physician institutes appropriate therapy for
Tract Infection. The specific and major types of infec a urinary tract infection.
tion used in NHSN and their abbreviated codes are listed 3. Patient #1 year of age has at least 1 of the fol
in Table 1, and the criteria for each of the specific types lowing signs or symptoms with no other recog
of infection follow it. nized cause: fever (.388C rectal), hypothermiaHoran, Andrus, and Dudeck June 2008 311
Table 1. CDC/NHSN major and specific types of health Table 1. Continued
care–associated infections EENT Eye, ear, nose, throat, or mouth infection
UTI Urinary tract infection CONJ Conjunctivitis
SUTI Symptomatic urinary EYE Eye, other
tract infection than conjunctivitis
ASB Asymptomatic bacteriuria EAR Ear, mastoid
OUTI Other infections ORAL Oral cavity
of the urinary tract (mouth, tongue, or gums)
SSI Surgical site infection SINU Sinusitis
SIP Superficial incisional UR Upper respiratory
primary SSI tract, pharyngitis,
SIS Superficial incisional laryngitis, epiglottitis
secondary SSI
DIP Deep incisional GI Gastrointestinal system infection
primary SSI GE Gastroenteritis
DIS Deep incisional GIT Gastrointestinal (GI) tract
secondary SSI HEP Hepatitis
Organ/space Organ/space SSI. Indicate IAB Intraabdominal, not specified
specific type: elsewhere
NEC Necrotizing enterocolitis
d BONE d LUNG
d BRST d MED LRI Lower respiratory tract infection, other
d CARD d MEN than pneumonia
BRON Bronchitis, tracheobronchitis,
d DISC d ORAL
tracheitis, without
d EAR d OREP evidence of pneumonia
d EMET d OUTI LUNG Other infections
d ENDO d SA of the lower
respiratory tract
d EYE d SINU
d GIT d UR REPR Reproductive tract infection
d IAB d VASC EMET Endometritis
EPIS Episiotomy
d IC d VCUF
VCUF Vaginal cuff
d JNT OREP Other infections
BSI Bloodstream infection of the male
LCBI Laboratory-confirmed or female reproductive
bloodstream infection tract
CSEP Clinical sepsis
SST Skin and soft tissue infection
PNEU Pneumonia SKIN Skin
PNU1 Clinically defined pneumonia ST Soft tissue
PNU2 Pneumonia with DECU Decubitus ulcer
specific laboratory findings BURN Burn
PNU3 Pneumonia in BRST Breast abscess
immunocompromised or mastitis
patient UMB Omphalitis
PUST Pustulosis
BJ Bone and joint infection CIRC Newborn circumcision
BONE Osteomyelitis
JNT Joint or bursa SYS Systemic Infection
DISC Disc space DI Disseminated infection
CNS Central nervous system
IC Intracranial infection
(,378C rectal), apnea, bradycardia, dysuria, leth
MEN Meningitis or ventriculitis argy, or vomiting
SA Spinal abscess and
without meningitis patient has a positive urine culture, that is, $105
microorganisms per cc of urine with no more
CVS Cardiovascular system infection
VASC Arterial or venous infection
than two species of microorganisms.
ENDO Endocarditis 4. Patient #1 year of age has at least 1 of the follow
CARD Myocarditis or pericarditis ing signs or symptoms with no other recognized
MED Mediastinitis cause: fever (.388C), hypothermia (,378C), ap
Continued nea, bradycardia, dysuria, lethargy, or vomiting312 Vol. 36 No. 5 Horan, Andrus, and Dudeck
and d Urine cultures must be obtained using appropriate
at least 1 of the following: technique, such as clean catch collection or
a. positive dipstick for leukocyte esterase and/ catheterization.
or nitrate d In infants, a urine culture should be obtained by
b. pyuria (urine specimen with $10 WBC/mm3 bladder catheterization or suprapubic aspiration;
or $3 WBC/high-power field of unspun a positive urine culture from a bag specimen is un
urine) reliable and should be confirmed by a specimen
c. organisms seen on Gram’s stain of unspun aseptically obtained by catheterization or supra
urine pubic aspiration.
d. at least 2 urine cultures with repeated
isolation of the same uropathogen (gram
negative bacteria or S saprophyticus) OUTI-Other infections of the urinary tract
with $102 colonies/mL in nonvoided (kidney, ureter, bladder, urethra, or tissue
specimens surrounding the retroperitoneal or perinephric
e. #105 colonies/mL of a single uropathogen space)
(gram-negative bacteria or S saprophyticus)
Other infections of the urinary tract must meet at
in a patient being treated with an effective
least 1 of the following criteria:
antimicrobial agent for a urinary tract
infection 1. Patient has organisms isolated from culture of
f. physician diagnosis of a urinary tract fluid (other than urine) or tissue from affected site.
infection 2. Patient has an abscess or other evidence of infec
g. physician institutes appropriate therapy for tion seen on direct examination, during a surgical
a urinary tract infection. operation, or during a histopathologic
examination.
3. Patient has at least 2 of the following signs or
ASB-Asymptomatic bacteriuria symptoms with no other recognized cause: fever
An asymptomatic bacteriuria must meet at least 1 of (.388C), localized pain, or localized tenderness at
the following criteria: the involved site
and
1. Patient has had an indwelling urinary catheter at least 1 of the following:
within 7 days before the culture a. purulent drainage from affected site
and b. organisms cultured from blood that are
patient has a positive urine culture, that is, $105 compatible with suspected site of infection
microorganisms per cc of urine with no more c. radiographic evidence of infection (eg, ab
than 2 species of microorganisms normal ultrasound, computerized tomogra
and phy [CT] scan, magnetic resonance imaging
patient has no fever (.388C), urgency, frequency, [MRI], or radiolabel scan [gallium, techne
dysuria, or suprapubic tenderness. tium], etc)
2. Patient has not had an indwelling urinary cathe d. physician diagnosis of infection of the
ter within 7 days before the first positive culture kidney, ureter, bladder, urethra, or tissues
and surrounding the retroperitoneal or peri
patient has had at least 2 positive urine cultures, nephric space
that is, $105 microorganisms per cc of urine e. physician institutes appropriate therapy for
with repeated isolation of the same micro an infection of the kidney, ureter, bladder,
organism and no more than 2 species of urethra, or tissues surrounding the retroper
microorganisms itoneal or perinephric space.
and 4. Patient #1 year of age has at least 1 of the follow
patient has no fever (.388C), urgency, frequency, ing signs or symptoms with no other recognized
dysuria, or suprapubic tenderness. cause: fever (.388C rectal), hypothermia (,378C
rectal), apnea, bradycardia, lethargy, or vomiting
and
Comments
at least 1 of the following:
d A positive culture of a urinary catheter tip is not an a. purulent drainage from affected site
acceptable laboratory test to diagnose a urinary b. organisms cultured from blood that are
tract infection. compatible with suspected site of infectionHoran, Andrus, and Dudeck June 2008 313
c. radiographic evidence of infection (eg, ab Reporting instructions
normal ultrasound, CT scan, MRI, or radiola
d Do not report a stitch abscess (minimal inflamma
bel scan [gallium, technetium])
tion and discharge confined to the points of suture
d. physician diagnosis of infection of the kid
penetration) as an infection.
ney, ureter, bladder, urethra, or tissues sur
d Do not report a localized stab wound infection as
rounding the retroperitoneal or
SSI, instead report as skin (SKIN), or soft tissue
perinephric space
(ST), infection, depending on its depth.
e. physician institutes appropriate therapy for
d Report infection of the circumcision site in new
an infection of the kidney, ureter, bladder,
borns as CIRC. Circumcision is not an NHSN oper
urethra, or tissues surrounding the retroper
ative procedure.
itoneal or perinephric space.
d Report infected burn wound as BURN.
d If the incisional site infection involves or extends
Reporting instruction into the fascial and muscle layers, report as a
deep incisional SSI.
d Report infections following circumcision in new
d Classify infection that involves both superficial
borns as CIRC.
and deep incision sites as deep incisional SSI.
SSI-SURGICAL SITE INFECTION DIP/DIS-Deep incisional surgical site infection
SIP/SIS-Superficial incisional surgical site
A deep incisional SSI (DIP or DIS) must meet the fol
infection
lowing criterion:
A superficial incisional SSI (SIP or SIS) must meet the Infection occurs within 30 days after the operative
following criterion: procedure if no implant1 is left in place or within
Infection occurs within 30 days after the operative 1 year if implant is in place and the infection appears
procedure to be related to the operative procedure
and and
involves only skin and subcutaneous tissue of the involves deep soft tissues (eg, fascial and muscle layers)
incision of the incision
and and
patient has at least 1 of the following: patient has at least 1 of the following:
a. purulent drainage from the superficial incision a. purulent drainage from the deep incision but not
b. organisms isolated from an aseptically obtained from the organ/space component of the surgical
culture of fluid or tissue from the superficial site
incision b. a deep incision spontaneously dehisces or is de
c. at least 1 of the following signs or symptoms of liberately opened by a surgeon and is culture-pos
infection: pain or tenderness, localized swelling, itive or not cultured when the patient has at least
redness, or heat, and superficial incision is delib 1 of the following signs or symptoms: fever
erately opened by surgeon and is culture positive (.388C), or localized pain or tenderness. A cul
or not cultured. A culture-negative finding does ture-negative finding does not meet this criterion.
not meet this criterion. c. an abscess or other evidence of infection involving
d. diagnosis of superficial incisional SSI by the sur the deep incision is found on direct examination,
geon or attending physician. during reoperation, or by histopathologic or radi
ologic examination
There are 2 specific types of superficial incisional SSI:
d. diagnosis of a deep incisional SSI by a surgeon or
d Superficial incisional primary (SIP): a superficial in
attending physician.
cisional SSI that is identified in the primary inci
sion in a patient who has had an operation with There are 2 specific types of deep incisional SSI:
1 or more incisions (eg, C-section incision or chest d Deep incisional primary (DIP): a deep incisional SSI
incision for coronary artery bypass graft with a do that is identified in a primary incision in a patient
nor site [CBGB]).
d Superficial incisional secondary (SIS): a superficial
incisional SSI that is identified in the secondary in 1
A nonhuman-derived object, material, or tissue (eg, prosthetic heart
cision in a patient who has had an operation with valve, nonhuman vascular graft, mechanical heart, or hip prosthesis)
more than 1 incision (eg, donor site [leg] incision that is permanently placed in a patient during an operative procedure
and is not routinely manipulated for diagnostic or therapeutic purposes.
for CBGB).314 Vol. 36 No. 5 Horan, Andrus, and Dudeck
who has had an operation with one or more inci s CARD s MEN
sions (eg, C-section incision or chest incision for s DISC s ORAL
CBGB); and s EAR s OREP
d Deep incisional secondary (DIS): a deep incisional s EMET s OUTI
s ENDO s SA
SSI that is identified in the secondary incision in
s EYE s SINU
a patient who has had an operation with more s GIT s UR
than 1 incision (eg, donor site [leg] incision for s IAB s VASC
CBGB). s IC s VCUF
s JNT
Reporting instruction d Occasionally an organ/space infection drains
d Classify infection that involves both superficial through the incision. Such infection generally
and deep incision sites as deep incisional SSI. does not involve reoperation and is considered a
complication of the incision; therefore, classify it
Organ/space-Organ/space surgical site infection as a deep incisional SSI.
An organ/space SSI involves any part of the body, BSI-BLOODSTREAM INFECTION
excluding the skin incision, fascia, or muscle layers, LCBI-Laboratory-confirmed bloodstream
that is opened or manipulated during the operative infection
procedure. Specific sites are assigned to organ/space
SSI to identify further the location of the infection. LCBI criteria 1 and 2 may be used for patients of any
Listed below in reporting instructions are the specific age, including patients #1 year of age.
sites that must be used to differentiate organ/space LCBI must meet at least 1 of the following criteria:
SSI. An example is appendectomy with subsequent 1. Patient has a recognized pathogen cultured from
subdiaphragmatic abscess, which would be reported 1 or more blood cultures
as an organ/space SSI at the intraabdominal specific and
site (SSI-IAB). organism cultured from blood is not related to an
An organ/space SSI must meet the following criterion: infection at another site. (See Notes 1 and 2.)
2. Patient has at least 1 of the following signs or
Infection occurs within 30 days after the operative symptoms: fever (.388C), chills, or hypotension
procedure if no implant1 is left in place or within and
1 year if implant is in place and the infection appears signs and symptoms and positive laboratory re
to be related to the operative procedure sults are not related to an infection at another site
and and
infection involves any part of the body, excluding the common skin contaminant (ie, diphtheroids
skin incision, fascia, or muscle layers, that is opened [Corynebacterium spp], Bacillus [not B anthracis]
or manipulated during the operative procedure spp, Propionibacterium spp, coagulase-negative
and staphylococci [including S epidermidis], viridans
patient has at least 1 of the following: group streptococci, Aerococcus spp, Micrococcus
a. purulent drainage from a drain that is placed spp) is cultured from 2 or more blood cultures
through a stab wound into the organ/space drawn on separate occasions. (See Notes 3
b. organisms isolated from an aseptically obtained and 4.)
culture of fluid or tissue in the organ/space 3. Patient #1 year of age has at least 1 of the follow
c. an abscess or other evidence of infection involv ing signs or symptoms: fever (.388C, rectal), hy
ing the organ/space that is found on direct exam pothermia (,378C, rectal), apnea, or bradycardia
ination, during reoperation, or by histopathologic and
or radiologic examination signs and symptoms and positive laboratory re
d. diagnosis of an organ/space SSI by a surgeon or sults are not related to an infection at another site
attending physician. and
Reporting instructions common skin contaminant (ie, diphtheroids [Cor
ynebacterium spp], Bacillus [not B
d Specific sites of organ/space SSI (see also criteria anthracis] spp, Propionibacterium spp, coagulase-
for these sites) negative staphylococci [including S epidermidis],
s BONE s LUNG viridans group streptococci, Aerococcus spp, Mi
s BRST s MED crococcus spp) is cultured from 2 or more bloodHoran, Andrus, and Dudeck June 2008 315
cultures drawn on separate occasions. (See Notes Table 2. Examples of ‘‘sameness’’ by organism speciation
3 and 4.)
Culture Companion Culture Report as.
S epidermidis Coagulase-negative S epidermidis
Notes staphylococci
1. In criterion 1, the phrase ‘‘1 or more blood cul Bacillus spp (not anthracis) B cereus B cereus
S salivarius Strep viridans S salivarius
tures’’ means that at least 1 bottle from a blood
draw is reported by the laboratory as having
grown organisms (ie, is a positive blood culture). Table 3. Examples of ‘‘sameness’’ by organism
2. In criterion 1, the term ‘‘recognized pathogen’’ antibiogram
does not include organisms considered common
skin contaminants (see criteria 2 and 3 for a list of Organism Name Isolate A Isolate B Interpret as.
common skin contaminants). A few of the recog S epidermidis All drugs S All drugs S Same
nized pathogens are S aureus, Enterococcus spp, E S epidermidis OX R OX S Different
coli, Pseudomonas spp, Klebsiella spp, Candida CEFAZ R CEFAZ S
spp, and others. Corynebacterium spp PENG R PENG S Different
CIPRO S CIPRO R
3. In criteria 2 and 3, the phrase ‘‘2 or more blood cul
Strep viridans All drugs S All drugs S Same
tures drawn on separate occasions’’ means (1) that except
blood from at least 2 blood draws were collected ERYTH R
within 2 days of each other (eg, blood draws on
S, sensitive; R, resistant.
Monday and Tuesday or Monday and Wednesday
would be acceptable for blood cultures drawn on
and a companion culture is identified with
separate occasions, but blood draws on Monday
only a descriptive name (ie, to the genus
and Thursday would be too far apart in time to
level), then it is assumed that the organisms
meet this criterion) and (2) that at least 1 bottle
are the same. The speciated organism
from each blood draw is reported by the labora
should be reported as the infecting patho
tory as having grown the same common skin con
gen (see examples in Table 2).
taminant organism (ie, is a positive blood culture).
b. If common skin contaminant organisms
(See Note 4 for determining sameness of
from the cultures are speciated but no anti
organisms.)
biograms are done or they are done for only
a. For example, an adult patient has blood
1 of the isolates, it is assumed that the orga
drawn at 8 AM and again at 8:15 AM of the
nisms are the same.
same day. Blood from each blood draw is in
c. If the common skin contaminants from the
oculated into 2 bottles and incubated (4 bot
cultures have antibiograms that are differ
tles total). If 1 bottle from each blood draw
ent for 2 or more antimicrobial agents, it is
set is positive for coagulase-negative staph
assumed that the organisms are not the
ylococci, this part of the criterion is met.
same (see examples in Table 3).
b. For example, a neonate has blood drawn
d. For the purpose of NHSN antibiogram re
for culture on Tuesday and again on Satur
porting, the category interpretation of inter
day, and both grow the same common
mediate (I) should not be used to distinguish
skin contaminant. Because the time be
whether 2 organisms are the same.
tween these blood cultures exceeds the
2-day period for blood draws stipulated Specimen collection considerations
in criteria 2 and 3, this part of the criteria
is not met. Ideally, blood specimens for culture should be ob
c. A blood culture may consist of a single bot tained from 2 to 4 blood draws from separate veni
tle for a pediatric blood draw because of vol puncture sites (eg, right and left antecubital veins),
ume constraints. Therefore, to meet this not through a vascular catheter. These blood draws
part of the criterion, each bottle from 2 or should be performed simultaneously or over a short
more draws would have to be culture posi period of time (ie, within a few hours).3,4 If your facility
tive for the same skin contaminant. does not currently obtain specimens using this tech
4. There are several issues to consider when deter nique, you may still report BSIs using the criteria and
mining sameness of organisms. notes above, but you should work with appropriate
a. If the common skin contaminant is identi personnel to facilitate better specimen collection prac
fied to the species level from 1 culture, tices for blood cultures.316 Vol. 36 No. 5 Horan, Andrus, and Dudeck
Reporting instructions c. radiographic evidence of infection (eg, ab
normal findings on x-ray, CT scan, MRI, ra
d Purulent phlebitis confirmed with a positive semi-
diolabel scan [gallium, technetium, etc]).
quantitative culture of a catheter tip, but with ei
ther negative or no blood culture is considered a
CVS-VASC, not a BSI. Reporting instruction
d Report organisms cultured from blood as BSI–LCBI
when no other site of infection is evident. d Report mediastinitis following cardiac surgery
that is accompanied by osteomyelitis as SSI-MED
rather than SSI-BONE.
CSEP-CLINICAL SEPSIS
CSEP may be used only to report primary BSI in ne JNT-Joint or bursa
onates and infants. It is not used to report BSI in adults
and children. Joint or bursa infections must meet at least 1 of the
Clinical sepsis must meet the following criterion: following criteria:
Patient #1 year of age has at least 1 of the following 1. Patient has organisms cultured from joint fluid or
clinical signs or symptoms with no other recognized synovial biopsy.
cause: fever (.388C rectal), hypothermia (,378C rec 2. Patient has evidence of joint or bursa infection
tal), apnea, or bradycardia seen during a surgical operation or histopatho
and logic examination.
blood culture not done or no organisms detected in 3. Patient has at least 2 of the following signs or
blood symptoms with no other recognized cause: joint
and pain, swelling, tenderness, heat, evidence of effu
no apparent infection at another site sion or limitation of motion
and and
physician institutes treatment for sepsis. at least 1 of the following:
a. organisms and white blood cells seen on
Reporting instruction Gram’s stain of joint fluid
b. positive antigen test on blood, urine, or joint
d Report culture-positive infections of the blood
fluid
stream as BSI-LCBI.
c. cellular profile and chemistries of joint fluid
compatible with infection and not ex
PNEU-PNEUMONIA plained by an underlying rheumatologic
disorder
See Appendix. d. radiographic evidence of infection (eg, ab
normal findings on x-ray, CT scan, MRI, ra
BJ–BONE AND JOINT INFECTION diolabel scan [gallium, technetium, etc]).
BONE-Osteomyelitis
DISC-Disc space infection
Osteomyelitis must meet at least 1 of the following
criteria: Vertebral disc space infection must meet at least 1 of
the following criteria:
1. Patient has organisms cultured from bone.
2. Patient has evidence of osteomyelitis on direct 1. Patient has organisms cultured from vertebral
examination of the bone during a surgical opera disc space tissue obtained during a surgical oper
tion or histopathologic examination. ation or needle aspiration.
3. Patient has at least 2 of the following signs 2. Patient has evidence of vertebral disc space infec
or symptoms with no other recognized cause: tion seen during a surgical operation or histo
fever (.388C), localized swelling, tenderness, pathologic examination.
heat, or drainage at suspected site of bone 3. Patient has fever (.388C) with no other recog
infection nized cause or pain at the involved vertebral
and disc space
at least 1 of the following: and
a. organisms cultured from blood radiographic evidence of infection, (eg, abnormal
b. positive blood antigen test (eg, H influenzae, findings on x-ray, CT scan, MRI, radiolabel scan
S pneumoniae) [gallium, technetium, etc]).Horan, Andrus, and Dudeck June 2008 317
4. Patient has fever (.388C) with no other recog b. positive antigen test on blood or urine
nized cause and pain at the involved vertebral c. radiographic evidence of infection, (eg, ab
disc space normal findings on ultrasound, CT scan,
and MRI, radionuclide brain scan, or arteriogram)
positive antigen test on blood or urine (eg, H influ d. diagnostic single antibody titer (IgM) or 4
enzae, S pneumoniae, N meningitidis, or Group B fold increase in paired sera (IgG) for
Streptococcus). pathogen
and
if diagnosis is made antemortem, physician insti
CNS-CENTRAL NERVOUS SYSTEM INFECTION tutes appropriate antimicrobial therapy.
IC-Intracranial infection (brain abscess, Reporting instruction
subdural or epidural infection,
encephalitis) d If meningitis and a brain abscess are present to
gether, report the infection as IC.
Intracranial infection must meet at least 1 of the fol
lowing criteria:
MEN-Meningitis or ventriculitis
1. Patient has organisms cultured from brain tissue Meningitis or ventriculitis must meet at least 1 of the
or dura. following criteria:
2. Patient has an abscess or evidence of intracranial
infection seen during a surgical operation or his 1. Patient has organisms cultured from cerebrospi
topathologic examination. nal fluid (CSF).
3. Patient has at least 2 of the following signs or 2. Patient has at least 1 of the following signs or
symptoms with no other recognized cause: head symptoms with no other recognized cause: fever
ache, dizziness, fever (.388C), localizing neuro (.388C), headache, stiff neck, meningeal signs,
logic signs, changing level of consciousness, or cranial nerve signs, or irritability
confusion and
and at least 1 of the following:
at least 1 of the following: a. increased white cells, elevated protein, and/
or decreased glucose in CSF
a. organisms seen on microscopic examina b. organisms seen on Gram’s stain of CSF
tion of brain or abscess tissue obtained by c. organisms cultured from blood
needle aspiration or by biopsy during a sur d. positive antigen test of CSF, blood, or urine
gical operation or autopsy e. diagnostic single antibody titer (IgM) or 4-fold
b. positive antigen test on blood or urine increase in paired sera (IgG) for pathogen
c. radiographic evidence of infection, (eg, ab and
normal findings on ultrasound, CT scan, if diagnosis is made antemortem, physician insti
MRI, radionuclide brain scan, or arteriogram) tutes appropriate antimicrobial therapy.
d. diagnostic single antibody titer (IgM) or 4 3. Patient #1 year of age has at least 1 of the
fold increase in paired sera (IgG) for pathogen following signs or symptoms with no other rec
and ognized cause: fever (.388C rectal), hypother
if diagnosis is made antemortem, physician insti mia (,378C rectal), apnea, bradycardia, stiff
tutes appropriate antimicrobial therapy. neck, meningeal signs, cranial nerve signs, or
4. Patient #1 year of age has at least 2 of the follow irritability
ing signs or symptoms with no other recognized and
cause: fever (.388C rectal), hypothermia (,378C at least 1 of the following:
rectal), apnea, bradycardia, localizing neurologic a. positive CSF examination with increased
signs, or changing level of consciousness white cells, elevated protein, and/or de
and creased glucose
at least 1 of the following: b. positive Gram’s stain of CSF
c. organisms cultured from blood
a. organisms seen on microscopic examina d. positive antigen test of CSF, blood, or urine
tion of brain or abscess tissue obtained by e. diagnostic single antibody titer (IgM) or 4
needle aspiration or by biopsy during a sur fold increase in paired sera (IgG) for
gical operation or autopsy pathogen318 Vol. 36 No. 5 Horan, Andrus, and Dudeck
and and
if diagnosis is made antemortem, physician insti blood culture not done or no organisms cultured
tutes appropriate antimicrobial therapy. from blood.
2. Patient has evidence of arterial or venous infec
Reporting instructions tion seen during a surgical operation or histo
pathologic examination.
d Report meningitis in the newborn as health care- 3. Patient has at least 1 of the following signs or
associated unless there is compelling evidence symptoms with no other recognized cause: fever
indicating the meningitis was acquired (.388C), pain, erythema, or heat at involved vas
transplacentally. cular site
d Report CSF shunt infection as SSI-MEN if it occurs and
#1 year of placement; if later or after manipula more than 15 colonies cultured from intravascu
tion/access of the shunt, report as CNS-MEN. lar cannula tip using semiquantitative culture
d Report meningoencephalitis as MEN. method
d Report spinal abscess with meningitis as MEN. and
blood culture not done or no organisms cultured
SA-Spinal abscess without meningitis from blood.
4. Patient has purulent drainage at involved vascu
An abscess of the spinal epidural or subdural space, lar site
without involvement of the cerebrospinal fluid or adja and
cent bone structures, must meet at least 1 of the follow blood culture not done or no organisms cultured
ing criteria: from blood.
1. Patient has organisms cultured from abscess in 5. Patient #1 year of age has at least 1 of the follow
the spinal epidural or subdural space. ing signs or symptoms with no other recognized
2. Patient has an abscess in the spinal epidural or cause: fever (.388C rectal), hypothermia (,378C
subdural space seen during a surgical operation rectal), apnea, bradycardia, lethargy, or pain, ery
or at autopsy or evidence of an abscess seen dur thema, or heat at involved vascular site
ing a histopathologic examination. and
3. Patient has at least 1 of the following signs or more than 15 colonies cultured from intravascu
symptoms with no other recognized cause: fever lar cannula tip using semiquantitative culture
(.388C), back pain, focal tenderness, radiculitis, method
paraparesis, or paraplegia and
and blood culture not done or no organisms cultured
at least 1 of the following: from blood.
a. organisms cultured from blood
b. radiographic evidence of a spinal abscess Reporting instructions
(eg, abnormal findings on myelography, ul
trasound, CT scan, MRI, or other scans [gal d Report infections of an arteriovenous graft, shunt,
lium, technetium, etc]). or fistula or intravascular cannulation site without
and organisms cultured from blood as CVS-VASC.
if diagnosis is made antemortem, physician insti d Report intravascular infections with organisms
tutes appropriate antimicrobial therapy. cultured from the blood as BSI-LCBI.
Reporting instruction ENDO-Endocarditis
d Report spinal abscess with meningitis as MEN.
Endocarditis of a natural or prosthetic heart valve
must meet at least 1 of the following criteria:
CVS-CARDIOVASCULAR SYSTEM INFECTION
1. Patient has organisms cultured from valve or
VASC-Arterial or venous infection vegetation.
2. Patient has 2 or more of the following signs or
Arterial or venous infection must meet at least 1 of
symptoms with no other recognized cause: fever
the following criteria:
(.388C), new or changing murmur, embolic phe
1. Patient has organisms cultured from arteries or nomena, skin manifestations (ie, petechiae, splin
veins removed during a surgical operation ter hemorrhages, painful subcutaneous nodules),Horan, Andrus, and Dudeck June 2008 319
congestive heart failure, or cardiac conduction and
abnormality at least 1 of the following:
and a. abnormal EKG consistent with myocarditis
at least 1 of the following: or pericarditis
a. organisms cultured from 2 or more blood b. positive antigen test on blood (eg, H influen
cultures zae, S pneumoniae)
b. organisms seen on Gram’s stain of valve c. evidence of myocarditis or pericarditis on
when culture is negative or not done histologic examination of heart tissue
c. valvular vegetation seen during a surgical d. 4-fold rise in type-specific antibody with or
operation or autopsy without isolation of virus from pharynx or
d. positive antigen test on blood or urine (eg, H feces
influenzae, S pneumoniae, N meningitidis, or e. pericardial effusion identified by echocardi
Group B Streptococcus) ogram, CT scan, MRI, or angiography.
e. evidence of new vegetation seen on 3. Patient #1 year of age has at least 2 of the follow
echocardiogram ing signs or symptoms with no other recognized
and cause: fever (.388C rectal), hypothermia (,378C
if diagnosis is made antemortem, physician insti rectal), apnea, bradycardia, paradoxical pulse, or
tutes appropriate antimicrobial therapy. increased heart size
3. Patient #1 year of age has 2 or more of the follow and
ing signs or symptoms with no other recognized at least 1 of the following:
cause: fever (.388C rectal), hypothermia (,378C a. abnormal EKG consistent with myocarditis
rectal), apnea, bradycardia, new or changing mur or pericarditis
mur, embolic phenomena, skin manifestations b. positive antigen test on blood (eg, H influen
(ie, petechiae, splinter hemorrhages, painful sub zae, S pneumoniae)
cutaneous nodules), congestive heart failure, or c. histologic examination of heart tissue shows
cardiac conduction abnormality evidence of myocarditis or pericarditis
and d. 4-fold rise in type-specific antibody with or
at least 1 of the following: without isolation of virus from pharynx or
a. organisms cultured from 2 or more blood feces
cultures e. pericardial effusion identified by echocardi
b. organisms seen on Gram’s stain of valve ogram, CT scan, MRI, or angiography.
when culture is negative or not done
c. valvular vegetation seen during a surgical
operation or autopsy Comment
d. positive antigen test on blood or urine (eg, H d Most cases of postcardiac surgery or postmyocar
influenzae, S pneumoniae, N meningitidis, or dial infarction pericarditis are not infectious.
Group B Streptococcus)
e. evidence of new vegetation seen on
echocardiogram MED-Mediastinitis
and
Mediastinitis must meet at least 1 of the following
if diagnosis is made antemortem, physician insti
criteria:
tutes appropriate antimicrobial therapy.
1. Patient has organisms cultured from mediastinal
tissue or fluid obtained during a surgical opera
CARD-Myocarditis or pericarditis tion or needle aspiration.
2. Patient has evidence of mediastinitis seen during a
Myocarditis or pericarditis must meet at least 1 of
surgical operation or histopathologic examination.
the following criteria:
3. Patient has at least 1 of the following signs or
1. Patient has organisms cultured from pericardial symptoms with no other recognized cause: fever
tissue or fluid obtained by needle aspiration or (.388C), chest pain, or sternal instability
during a surgical operation. and
2. Patient has at least 2 of the following signs or at least 1 of the following:
symptoms with no other recognized cause: fever a. purulent discharge from mediastinal area
(.388C), chest pain, paradoxical pulse, or in b. organisms cultured from blood or discharge
creased heart size from mediastinal area320 Vol. 36 No. 5 Horan, Andrus, and Dudeck
c. mediastinal widening on x-ray. EYE-Eye, other than conjunctivitis
4. Patient #1 year of age has at least 1 of the follow
ing signs or symptoms with no other recognized An infection of the eye, other than conjunctivitis,
cause: fever (.388C rectal), hypothermia (,378C must meet at least 1 of the following criteria:
rectal), apnea, bradycardia, or sternal instability 1. Patient has organisms cultured from anterior or
and posterior chamber or vitreous fluid.
at least 1 of the following: 2. Patient has at least 2 of the following signs or
a. purulent discharge from mediastinal area symptoms with no other recognized cause: eye
b. organisms cultured from blood or discharge pain, visual disturbance, or hypopyon
from mediastinal area and
c. mediastinal widening on x-ray. at least 1 of the following:
a. physician diagnosis of an eye infection
Reporting instruction b. positive antigen test on blood (eg, H influen
zae, S pneumoniae)
d Report mediastinitis following cardiac surgery
c. organisms cultured from blood.
that is accompanied by osteomyelitis as SSI-MED
rather than SSI-BONE.
EAR-Ear mastoid
EENT-EYE, EAR, NOSE, THROAT, OR MOUTH Ear and mastoid infections must meet at least 1 of
INFECTION the following criteria:
CONJ-Conjunctivitis Otitis externa must meet at least 1 of the following
criteria:
Conjunctivitis must meet at least 1 of the following
criteria: 1. Patient has pathogens cultured from purulent
drainage from ear canal.
1. Patient has pathogens cultured from purulent ex 2. Patient has at least 1 of the following signs or
udate obtained from the conjunctiva or contigu symptoms with no other recognized cause: fever
ous tissues, such as eyelid, cornea, meibomian (.388C), pain, redness, or drainage from ear
glands, or lacrimal glands. canal
2. Patient has pain or redness of conjunctiva or and
around eye organisms seen on Gram’s stain of purulent
and drainage.
at least 1 of the following:
a. WBCs and organisms seen on Gram’s stain Otitis media must meet at least 1 of the following
of exudate criteria:
b. purulent exudate 1. Patient has organisms cultured from fluid from
c. positive antigen test (eg, ELISA or IF for Chla middle ear obtained by tympanocentesis or at
mydia trachomatis, herpes simplex virus, surgical operation.
adenovirus) on exudate or conjunctival 2. Patient has at least 2 of the following signs or
scraping symptoms with no other recognized cause: fever
d. multinucleated giant cells seen on micro (.388C), pain in the eardrum, inflammation, re
scopic examination of conjunctival exudate traction or decreased mobility of eardrum, or
or scrapings fluid behind eardrum.
e. positive viral culture
f. diagnostic single antibody titer (IgM) or 4-fold Otitis interna must meet at least 1 of the following
increase in paired sera (IgG) for pathogen. criteria:
1. Patient has organisms cultured from fluid from
Reporting instructions
inner ear obtained at surgical operation.
d Report other infections of the eye as EYE. 2. Patient has a physician diagnosis of inner ear
d Do not report chemical conjunctivitis caused by infection.
silver nitrate (AgNO3) as a health care–associated
Mastoiditis must meet at least 1 of the following
infection.
criteria:
d Do not report conjunctivitis that occurs as a part of
a more widely disseminated viral illness (such as 1. Patient has organisms cultured from purulent
measles, chickenpox, or a URI). drainage from mastoid.Horan, Andrus, and Dudeck June 2008 321
2. Patient has at least 2 of the following signs or and
symptoms with no other recognized cause: fever at least 1 of the following:
(.388C), pain, tenderness, erythema, headache, a. positive transillumination
or facial paralysis b. positive radiographic examination (includ
and ing CT scan).
at least 1 of the following:
a. organisms seen on Gram’s stain of purulent
material from mastoid UR-Upper respiratory tract, pharyngitis,
b. positive antigen test on blood. laryngitis, epiglottitis
ORAL-Oral cavity (mouth, tongue, or gums) Upper respiratory tract infections must meet at least
1 of the following criteria:
Oral cavity infections must meet at least 1 of the fol
lowing criteria: 1. Patient has at least 2 of the following signs or
symptoms with no other recognized cause: fever
1. Patient has organisms cultured from purulent
(.388C), erythema of pharynx, sore throat,
material from tissues of oral cavity.
cough, hoarseness, or purulent exudate in throat
2. Patient has an abscess or other evidence of oral
and
cavity infection seen on direct examination, dur
at least 1 of the following:
ing a surgical operation, or during a histopatho
a. organisms cultured from the specific site
logic examination.
b. organisms cultured from blood
3. Patient has at least 1 of the following signs or
c. positive antigen test on blood or respiratory
symptoms with no other recognized cause: ab
secretions
scess, ulceration, or raised white patches on in
d. diagnostic single antibody titer (IgM) or 4
flamed mucosa, or plaques on oral mucosa
fold increase in paired sera (IgG) for
and
pathogen
at least 1 of the following:
e. physician diagnosis of an upper respiratory
a. organisms seen on Gram’s stain
infection.
b. positive KOH (potassium hydroxide) stain
2. Patient has an abscess seen on direct examina
c. multinucleated giant cells seen on micro
tion, during a surgical operation, or during a his
scopic examination of mucosal scrapings
topathologic examination.
d. positive antigen test on oral secretions
3. Patient #1 year of age has at least 2 of the follow
e. diagnostic single antibody titer (IgM) or 4
ing signs or symptoms with no other recognized
fold increase in paired sera (IgG) for
cause: fever (.388C rectal), hypothermia (,378C
pathogen
rectal), apnea, bradycardia, nasal discharge, or
f. physician diagnosis of infection and treat
purulent exudate in throat
ment with topical or oral antifungal therapy.
and
at least 1 of the following:
Reporting instruction a. organisms cultured from the specific site
d Report health care–associated primary herpes b. organisms cultured from blood
simplex infections of the oral cavity as ORAL; re c. positive antigen test on blood or respiratory
current herpes infections are not health care– secretions
associated. d. diagnostic single antibody titer (IgM) or 4
fold increase in paired sera (IgG) for
pathogen
SINU-Sinusitis e. physician diagnosis of an upper respiratory
Sinusitis must meet at least 1 of the following infection.
criteria:
GI-GASTROINTESTINAL SYSTEM INFECTION
1. Patient has organisms cultured from purulent
material obtained from sinus cavity. GE-Gastroenteritis
2. Patient has at least 1 of the following signs or
Gastroenteritis must meet at least 1 of the following
symptoms with no other recognized cause: fever
criteria:
(.388C), pain or tenderness over the involved si
nus, headache, purulent exudate, or nasal 1. Patient has an acute onset of diarrhea (liquid
obstruction stools for more than 12 hours) with or without322 Vol. 36 No. 5 Horan, Andrus, and Dudeck
vomiting or fever (.388C) and no likely noninfec HEP-Hepatitis
tious cause (eg, diagnostic tests, therapeutic regi
men other than antimicrobial agents, acute Hepatitis must meet the following criterion:
exacerbation of a chronic condition, or psycho Patient has at least 2 of the following signs or
logic stress). symptoms with no other recognized cause: fever
2. Patient has at least 2 of the following signs or (.388C), anorexia, nausea, vomiting, abdominal pain,
symptoms with no other recognized cause: nau jaundice, or history of transfusion within the previous
sea, vomiting, abdominal pain, fever (.388C), or 3 months
headache and
and at least 1 of the following:
at least 1 of the following: a. positive antigen or antibody test for hepatitis
a. an enteric pathogen is cultured from stool A, hepatitis B, hepatitis C, or delta hepatitis
or rectal swab b. abnormal liver function tests (eg, elevated ALT/
b. an enteric pathogen is detected by routine AST, bilirubin)
or electron microscopy c. cytomegalovirus (CMV) detected in urine or or
c. an enteric pathogen is detected by antigen opharyngeal secretions.
or antibody assay on blood or feces
d. evidence of an enteric pathogen is detected
Reporting instructions
by cytopathic changes in tissue culture
(toxin assay) d Do not report hepatitis or jaundice of noninfec
e. diagnostic single antibody titer (IgM) or 4 tious origin (alpha-1 antitrypsin deficiency, etc).
fold increase in paired sera (IgG) for d Do not report hepatitis or jaundice that results
pathogen. from exposure to hepatotoxins (alcoholic or acet
aminophen-induced hepatitis, etc).
GIT-Gastrointestinal tract (esophagus, stomach, d Do not report hepatitis or jaundice that results
small and large bowel, and rectum) excluding from biliary obstruction (cholecystitis).
gastroenteritis and appendicitis
Gastrointestinal tract infections, excluding gastroen IAB-Intraabdominal, not specified elsewhere
teritis and appendicitis, must meet at least 1 of the fol including gallbladder, bile ducts, liver
lowing criteria: (excluding viral hepatitis), spleen, pancreas,
1. Patient has an abscess or other evidence of infec peritoneum, subphrenic or subdiaphragmatic
tion seen during a surgical operation or histo space, or other intraabdominal tissue or area
pathologic examination. not specified elsewhere
2. Patient has at least 2 of the following signs or
Intraabdominal infections must meet at least 1 of the
symptoms with no other recognized cause and
following criteria:
compatible with infection of the organ or tissue
involved: fever (.388C), nausea, vomiting, ab 1. Patient has organisms cultured from purulent
dominal pain, or tenderness material from intraabdominal space obtained
and during a surgical operation or needle aspiration.
at least 1 of the following: 2. Patient has abscess or other evidence of intraab
a. organisms cultured from drainage or tissue dominal infection seen during a surgical opera
obtained during a surgical operation or en tion or histopathologic examination.
doscopy or from a surgically placed drain 3. Patient has at least 2 of the following signs or
b. organisms seen on Gram’s or KOH stain or symptoms with no other recognized cause: fever
multinucleated giant cells seen on micro (.388C), nausea, vomiting, abdominal pain, or
scopic examination of drainage or tissue ob jaundice
tained during a surgical operation or and
endoscopy or from a surgically placed drain at least 1 of the following:
c. organisms cultured from blood a. organisms cultured from drainage from sur
d. evidence of pathologic findings on radio gically placed drain (eg, closed suction
graphic examination drainage system, open drain, T-tube drain)
e. evidence of pathologic findings on endo b. organisms seen on Gram’s stain of drainage
scopic examination (eg, Candida esophagitis or tissue obtained during surgical operation
or proctitis). or needle aspirationHoran, Andrus, and Dudeck June 2008 323
c. organisms cultured from blood and radio (.388C rectal), cough, new or increased sputum
graphic evidence of infection (eg, abnormal production, rhonchi, wheezing, respiratory dis
findings on ultrasound, CT scan, MRI, or ra tress, apnea, or bradycardia
diolabel scans [gallium, technetium, etc] or and
on abdominal x-ray). at least 1 of the following:
a. organisms cultured from material obtained
Reporting instruction by deep tracheal aspirate or bronchoscopy
d Do not report pancreatitis (an inflammatory syn b. positive antigen test on respiratory
drome characterized by abdominal pain, nausea, secretions
and vomiting associated with high serum levels c. diagnostic single antibody titer (IgM) or 4
of pancreatic enzymes) unless it is determined to fold increase in paired sera (IgG) for
be infectious in origin. pathogen.
NEC-Necrotizing enterocolitis
Reporting instruction
Necrotizing enterocolitis in infants must meet the
d Do not report chronic bronchitis in a patient with
following criterion:
chronic lung disease as an infection unless there is
Infant has at least 2 of the following signs or symp
evidence of an acute secondary infection, mani
toms with no other recognized cause: vomiting, ab
fested by change in organism.
dominal distention, or prefeeding residuals
and
persistent microscopic or gross blood in stools LUNG-Other infections of the lower respiratory
and tract
at least 1 of the following abdominal radiographic
abnormalities: Other infections of the lower respiratory tract must
a. pneumoperitoneum meet at least 1 of the following criteria:
b. pneumatosis intestinalis 1. Patient has organisms seen on smear or cul
c. unchanging ‘‘rigid’’ loops of small bowel. tured from lung tissue or fluid, including pleural
fluid.
LRI-LOWER RESPIRATORY TRACT INFECTION, 2. Patient has a lung abscess or empyema seen dur
OTHER THAN PNEUMONIA ing a surgical operation or histopathologic
BRON-Bronchitis, tracheobronchitis, examination.
bronchiolitis, tracheitis, without evidence of 3. Patient has an abscess cavity seen on radio
pneumonia graphic examination of lung.
Tracheobronchial infections must meet at least 1 of
the following criteria: Reporting instructions
1. Patient has no clinical or radiographic evidence of d Report concurrent lower respiratory tract infec
pneumonia tion and pneumonia with the same organism(s)
and as PNEU.
patient has at least 2 of the following signs or d Report lung abscess or empyema without pneu
symptoms with no other recognized cause: fever monia as LUNG.
(.388C), cough, new or increased sputum pro
duction, rhonchi, wheezing REPR-REPRODUCTIVE TRACT INFECTION
and
at least 1 of the following: EMET-Endometritis
a. positive culture obtained by deep tracheal
Endometritis must meet at least 1 of the following
aspirate or bronchoscopy
criteria:
b. positive antigen test on respiratory
secretions. 1. Patient has organisms cultured from fluid or tis
2. Patient #1 year of age has no clinical or radio sue from endometrium obtained during surgical
graphic evidence of pneumonia operation, by needle aspiration, or by brush
and biopsy.
patient has at least 2 of the following signs or 2. Patient has at least 2 of the following signs or
symptoms with no other recognized cause: fever symptoms with no other recognized cause: fever324 Vol. 36 No. 5 Horan, Andrus, and Dudeck
(.388C), abdominal pain, uterine tenderness, or 3. Patient has 2 of the following signs or symptoms
purulent drainage from uterus. with no other recognized cause: fever (.388C),
nausea, vomiting, pain, tenderness, or dysuria
and
Reporting instruction at least 1 of the following:
d Report postpartum endometritis as a health care– a. organisms cultured from blood
associated infection unless the amniotic fluid is b. physician diagnosis.
infected at the time of admission or the patient
was admitted 48 hours after rupture of the Reporting instructions
membrane. d Report endometritis as EMET.
d Report vaginal cuff infections as VCUF.
EPIS-Episiotomy
Episiotomy infections must meet at least 1 of the fol
SST-SKIN AND SOFT TISSUE INFECTION
lowing criteria: SKIN-Skin
1. Postvaginal delivery patient has purulent drain Skin infections must meet at least 1 of the following
age from the episiotomy. criteria:
2. Postvaginal delivery patient has an episiotomy
abscess. 1. Patient has purulent drainage, pustules, vesicles,
or boils.
2. Patient has at least 2 of the following signs or
Comment
symptoms with no other recognized cause: pain
d Episiotomy is not considered an operative proce or tenderness, localized swelling, redness, or
dure in NHSN. heat
and
VCUF-Vaginal cuff at least 1 of the following:
a. organisms cultured from aspirate or drain
Vaginal cuff infections must meet at least 1 of the age from affected site; if organisms are
following criteria: normal skin flora (ie, diphtheroids [Coryne
1. Posthysterectomy patient has purulent drainage bacterium spp], Bacillus [not B anthracis]
from the vaginal cuff. spp, Propionibacterium spp, coagulase-neg
2. Posthysterectomy patient has an abscess at the ative staphylococci [including S epidermi
vaginal cuff. dis], viridans group streptococci,
3. Posthysterectomy patient has pathogens cultured Aerococcus spp, Micrococcus spp), they
from fluid or tissue obtained from the vaginal must be a pure culture
cuff. b. organisms cultured from blood
c. positive antigen test performed on infected
Reporting instruction tissue or blood (eg, herpes simplex, varicella
zoster, H influenzae, N meningitidis)
d Report vaginal cuff infections as SSI-VCUF. d. multinucleated giant cells seen on micro
scopic examination of affected tissue
OREP-Other infections of the male or female e. diagnostic single antibody titer (IgM) or 4
reproductive tract (epididymis, testes, prostate, fold increase in paired sera (IgG) for
vagina, ovaries, uterus, or other deep pelvic pathogen.
tissues, excluding endometritis or vaginal cuff
infections)
Reporting instructions
Other infections of the male or female reproductive
d Report omphalitis in infants as UMB.
tract must meet at least 1 of the following criteria:
d Report infections of the circumcision site in new
1. Patient has organisms cultured from tissue or borns as CIRC.
fluid from affected site. d Report pustules in infants as PUST.
2. Patient has an abscess or other evidence of infec d Report infected decubitus ulcers as DECU.
tion of affected site seen during a surgical opera d Report infected burns as BURN.
tion or histopathologic examination. d Report breast abscesses or mastitis as BRST.You can also read
