1672 Section XV: Organization and Implementation of Infection Control Programs insic risk-adjusted rates of adverse outcomes. Failure to do so will certainly make interhospital comparisons meaningless or From: Horan TC, Gaynes RP. Surveillance of nosocomial infections. In:Hospital Epidemiology and Infection Control, CVS Cardiovascular System Infection 3rd ed., Mayhall CG, editor. Philadelphia:Lippincott VASC Arterial or venous infection Williams & Wilkins, 2004:1659-1702. ven misleading (27). ENDO Endocarditis CARD Myocarditis or pericarditis MED Mediastinitis APPENDIX A-1. CDC DEFINITIONS OF EENT Eye, Ear, Nose, Throat, or Mouth Infection NOSOCOMIAL INFECTIONS [EXCLUDING CONJ Conjunctivitis PNEUMONIA (SEE APPENDIX A-2)] EYE Eye Other than conjunctivitis EAR Ear Mastoid Listing of Major and Specific Site Codes and ORAL Oral Cavity (mouth, tongue, or gums) Descriptions SINU Sinusitis UTI Urinary Tract Infection UR Upper respiratory tract, pharyngitis, SUTI Symptomatic urinary tract infection laryngitis, epiglottitis ASB Asymptomatic bacteriuria GI Gastrointestinal System Infection OUTI Other infections of the urinary tract GE Gastroenteritis GIT Gastrointestinal (GI) tract SSI Surgical Site Infection HEP Hepatitis SKIN Superficial incisional site, except after IAB Intraabdominal, not specified elsewhere CBGB1 NEC Necrotizing enterocolitis SKNC After CBGB, report SKNC for superficial LRI Lower Respiratory Tract Infection, Other Than incisional infection at chest incision site Pneumonia SKNL After CBGB, report SKNL for superficial BRON Bronchitis, tracheobronchitis, tracheitis, incisional infection at leg (donor) site without evidence of pneumonia ST Deep incisional surgical site infection, LUNG Other infections of the lower respiratory except after CBGB tract STC After CBGB, report STC for deep REPR Reproductive Tract Infection incisional surgical site infection at chest EMET Endometritis incision site EPIS Episiotomy STL After CBGB, report STL for deep VCUF Vaginal cuff incisional surgical site infection at leg OREP Other infections of the male or female (donor) site reproductive tract Organ/Space Surgical Site Infection SST Skin and Soft Tissue Infection Indicate specific site: SKIN Skin BONE, BRST, CARD, DISC, EAR, ST Soft tissue EMET, ENDO, EYE, GIT, IAB, IC, JNT, DECU Decubitus ulcer LUNG, MED, MEN, ORAL, OREP, BURN Burn OUTI, SA, SINU, UR, VASC, VCUP. BRST Breast abscess or mastitis UMB Omphalitis PNEU Pneumonia (See Appendix A:2) PUST Infant pustulosis PNU 1 CIRC Newborn circumcision PNU 2 SYS Systemic Infection PNU 3 DI Disseminated infection BSI Bloodstream Infection LCBI Laboratory-confirmed bloodstream infection Definitions of Infection Sites CSEP Clinical sepsis INFECTION SITE: Symptomatic urinary tract infection BJ Bone and Joint Infection CODE: UTI-SUTI BONE Osteomyelitis DEFINITION: A symptomatic urinary tract infection must JNT Joint or bursa meet at least one of the following criteria: DISC Disc space Criterion 1: Patient has at least one of the following signs or CNS Central Nervous System Infection symptoms with no other recognized cause: fever IC Intracranial infection (Ͼ38ЊC), urgency, frequency, dysuria, or su- MEN Meningitis or ventriculitis prapubic tenderness SA Spinal abscess without meningitis and patient has a positive urine culture, that is, Ն105 microorganisms per cm3 of urine with no more 1 CBGB, coronary artery bypass graft with both chest and donor site inci- than two species of microorganisms. sions. Criterion 2: Patient has at least two of the following signs or Chapter 94: Surveillance of Nosocomial Infections 1673 symptoms with no other recognized cause: fever ᭿ Urine cultures must be obtained using appropriate technique, (Ͼ38ЊC), urgency, frequency, dysuria, or su- such as clean catch collection or catheterization. prapubic tenderness ᭿ In infants, a urine culture should be obtained by bladder and catheterization or suprapubic aspiration; a positive urine cul- at least one of the following: ture from a bag specimen is unreliable and should be con- a. Positive dipstick for leukocyte esterase and/or firmed by a specimen aseptically obtained by catheterization nitrate or suprapubic aspiration. b. Pyuria (urine specimen with Ն10 WBC/mm3 or Ն3 WBC/high power field of unspun urine) INFECTION SITE: Asymptomatic bacteriuria c. Organisms seen on Gram stain of unspun urine CODE: UTI-ASB d. At least two urine cultures with repeated isola- DEFINITION: An asymptomatic bacteriuria must meet at least tion of the same uropathogen (gram-negative one of the following criteria: bacteria or S. saprophyticus) with Ն102 colo- Criterion 1: Patient has had an indwelling urinary catheter nies/mL in nonvoided specimens within 7 days before the culture e. Յ105 colonies/mL of a single uropathogen and patient has a positive urine culture, that is, Ն105 (gram-negative bacteria or S. saprophyticus) in 3 a patient being treated with an effective antimi- microorganisms per cm of urine with no more crobial agent for a urinary tract infection than two species of microorganisms f. Physician diagnosis of a urinary tract infection and patient has no fever (Ͼ38ЊC), urgency, frequency, g. Physician institutes appropriate therapy for a dysuria, or suprapubic tenderness. urinary tract infection Criterion 2: Patient has not had an indwelling uri- Criterion 3: Patient Յ1 year of age has at least one of the fol- nary catheter within 7 days before the first positive lowing signs or symptoms with no other recog- culture nized cause: fever (Ͼ38ЊC), hypothermia and (Ͻ37ЊC), apnea, bradycardia, dysuria, lethargy, or patient has had at least two positive urine cultures, vomiting that is, Ն105 microorganisms per cm3 of urine and with repeated isolation of the same microorganism patient has a positive urine culture, that is, Ն105 and no more than two species of microorganisms microorganisms per cm3 of urine with no more and than two species of microorganisms. patient has no fever (Ͼ38ЊC), urgency, frequency, Criterion 4: Patient Յ1 year of age has at least one of the fol- dysuria, or suprapubic tenderness. lowing signs or symptoms with no other recog- nized cause: fever (Ͼ38ЊC), hypothermia COMMENTS: (Ͻ37ЊC), apnea, bradycardia, dysuria, lethargy, or vomiting ᭿ A positive culture of a urinary catheter tip is not an acceptable and laboratory test to diagnose bacteriuria. at least one of the following: ᭿ Urine cultures must be obtained using appropriate technique, a. Positive dipstick for leukocyte esterase and/or such as clean catch collection or catheterization. nitrate b. Pyuria (urine specimen with Ն10 WBC/mm3 INFECTION SITE: Other infections of the urinary tract (kid- or Ն3 WBC/high power field of unspun urine) ney, ureter, bladder, urethra, or tissues surrounding the retroper- c. Organisms seen on Gram stain of unspun urine itoneal or perinephric spaces) d. At least two urine cultures with repeated isola- CODE: SUTI-OUTI tion of the same uropathogen (gram-negative DEFINITION: Other infections of the urinary tract must meet bacteria or S. saprophyticus) with Ն102 colo- at least one of the following criteria: nies/mL in nonvoided specimens Criterion 1 Patient has organisms isolated from culture of e. Յ105 colonies/mL of a single uropathogen fluid (other than urine) or tissue from affected site. (gram-negative bacteria or S. saprophyticus) in Criterion 2: Patient has an abscess or other evi- a patient being treated with an effective antimi- dence of infection seen on direct examination, crobial agent for a urinary tract infection during a surgical operation, or during a histopath- f. Physician diagnosis of a urinary tract infection ologic examination. Criterion 3: Patient has at least of the following signs or g. Physician institutes appropriate therapy for a two symptoms with no other recognized cause: fever urinary tract infection (Ͼ38ЊC), localized pain, or localized tenderness COMMENTS: at the involved site and ᭿ A positive culture of a urinary catheter tip is not an acceptable at least one of the following: laboratory test to diagnose a urinary tract infection. a. Purulent drainage from affected site 1674 Section XV: Organization and Implementation of Infection Control Programs b. Organisms cultured from blood that are com- tained culture of fluid or tissue from the super- patible with suspected site of infection ficial incision c. Radiographic evidence of infection, for exam- c. At least one of the following signs or symptoms ple, abnormal ultrasound, computed tomogra- of infection: pain or tenderness, localized swell- phy (CT), magnetic resonance imaging (MRI), ing, redness, or heat, and superficial incision is or radiolabel scan (gallium, technetium) deliberately opened by surgeon, unless incision d. Physician diagnosis of infection of the kidney, is culture-negative ureter, bladder, urethra, or tissues surrounding d. Diagnosis of superficial incisional SSI by the the retroperitoneal or perinephric space surgeon or attending physician e. Physician institutes appropriate therapy for an infection of the kidney, ureter, bladder, ure- REPORTING INSTRUCTIONS: thra, or tissues surrounding the retroperitoneal ᭿ Do not report a stitch abscess (minimal inflammation and or perinephric space discharge confined to the points of suture penetration) as an Criterion 4: Patient Յ1 year of age has at least one of the infection. following signs or symptoms with no other recog- ᭿ Do not report a localized stab wound infection as SSI, instead nized cause: fever (Ͼ38ЊC), hypothermia report as skin or soft tissue infection, depending on its depth.