INFECTION CONTROL TRACKING
Confidential – Quality Assurance/Improvement Information
Frequency: Monthly
Definition:
§ “Admitted” – means that within 3-days of admission or re-admission to the nursing facility, the resident demonstrated conditions meeting at least one of the “infection” definitions.
§ “Nosocomial” – means that the resident did not demonstrate conditions meeting at least one of the “infection” definitions.
§ “Infection” – See attached listing.
Population:
§ Any resident who meets the “infection” definition. See attached listing of definitions of infections and medical terms.
Special Instructions:
§ The Infection Control Tracking, detailed unit report is to be completed monthly for each nursing unit.
* Select the appropriate column that describes both the location/variable and the primary pathogen
* Identify the number of residents under each appropriate category
* Select A if the resident was admitted with the infection
* Select N if the infection was nosocomial [acquired within the nursing facility]
* Identify the residents according to pathogen in the comment section at the bottom of the page
* Identify “others” in the comment section to the right of the page
* The detailed unit report does not need to be submitted to the corporate office
§ The Infection Control Tracking, facility monthly report is to be completed monthly for the combined facility information.
* Total number of resident days for the month
* Number of nosocomial [acquired]: identify the total number of residents who acquired the specified pathogen in-house or within 3 days of admission
* Number of admitted: identify the total number of residents who were admitted with the specified pathogen or who acquired the pathogen within 3 days of admission
* Identify “others” on the bottom of the page
* Location: identify the total number of residents with infections by specific category; a resident may be counted in more than one category
* # of residents treated with antibiotics who had positive cultures:
¨ Obtain listing of antibiotic orders from the pharmacy and compare to positive culture reports
¨ Identify total number of residents; if resident had more than one infection or course of antibiotic treatment, count one time
§ # of residents treated with antibiotics who displayed symptoms and did not have positive culture report
* Obtain listing of antibiotic orders from the pharmacy and compare to positive culture reports;
* Identify total number of residents treated without positive culture; if resident had more than one treatment, count one time
* If resident had both treatment with and without positive culture report, count in both categories
Infection rate: Determine rate by the following formulas:
The Admitted Rate is calculated by using the total number of infections that were identified within 3-days of admission or re-admission. [Total Facility Rate minus Nosocomial Rate]
· This month’s total ______This month’s infections per 1000 resident days ______
NEW CASES ADMITTED OF INFECTIONS FOR THE MONTH
The Nosocomial Rate is calculated by using the total number of infections that were identified for in-house residents. [Total Facility Rate minus Admitted Rate].
· This month’s total ______This month’s infections per 1000 resident days ______
NEW CASES ACQUIRED OF INFECTIONS FOR THE MONTH
The Total Facility Rate is calculated using the total number of infections [nosocomial plus admitted with].
· This month’s total ______This month’s infections per 1000 resident days ______
NEW CASES OF INFECTIONS FOR THE MONTH
Definitions for Surveillance
A Summary of McGeer’s Definitions of Infection
Guidelines for Use
· These definitions are not all inclusive.
· All symptoms must be new or acutely worse than previously observed.
· Noninfectious causes of infection should always be considered before a diagnosis of infection is made.
· Identification of infection should not be based on a single piece of evidence.
Upper Respiratory Tract Infections (URI)Common cold syndromes/pharyngitis: Must have at least two of the following:
• Runny nose or sneezing
• Stuffy nose/congestion
• Sore throat/hoarseness/difficulty swallowing
• Dry cough
• Swollen or tender glands in the neck
(cervical lymphadenopathy) / Influenza-like illness: Must have fever and meet three of the following:
(During months of Nov-April only).
• Chills
• New headache or eye pain
• Myalgias
• Malaise or loss of appetite
• Sore throat
• New or increased dry cough
Lower Respiratory Tract Infections (LRI)
Pneumonia: Must meet both of the following:
• Chest x-ray that demonstrates pneumonia, probable pneumonia, or presence of an infiltrate
• Resident must have two of the S/S described under LRI / Other LRIs (bronchitis, tracheobronchitis): must have three of the following:
• New or increased cough
• New or increased sputum production
• Fever ≥100.4°F
• Pleuritic pain
• New or findings on chest exam (rales, rhonchi, wheezes, or bronchial breathing)
• One of these changes in breathing: new or SOB, respiratory rate ≥25/min or worsening mental or functional status
Urinary Tract Infections (UTI)
Includes only symptomatic UTI. Must meet one of the following. *
No indwelling catheter. Must have three of the following:
• Fever ≥100.4°F
• New or increased burning on urination, frequency, or urgency
• New flank or suprapubic pain or tenderness
• Change in character of urine
• Worsening of mental or functional status / With indwelling catheter. Must have two of the following:
• Fever ≥100.4°F
• New flank or suprapubic pain or tenderness
• Change in character of urine
• Worsening of mental or functional status
*Note that culture results are not included. Pyuria may be considered change in character of urine, if
previously reported as negative (other changes include bloody urine, foul odor, or sediment).
Gastrointestinal Tract Infection (GI)
Must have one of the following: (Rule out noninfectious causes, for example medication changes.)
Two or more loose or watery
stools above what is normal
for the resident in a 24-hour
period. / OR: Two or more episodes of vomiting in a 24-hour period. / OR: Must have both of these:
• Positive stool culture for a pathogen
• One GI S/S (n/v/d or abd. pain)
Eye Infections
Must not be due to allergy or trauma to the conjunctiva.
Conjunctivitis must have one of the following:
• Pus from one or both eyes for at least 24 hours
• New or increased conjunctival redness, with or without itching or pain, for at least 24 hours
Ear Infection
Must meet one of the following:
• Diagnosis of ear infection by an MD
• New drainage from one or both ears (nonpurulent drainage must be accompanied by symptoms, such as pain or redness)
Mouth and Peri-oral Infections
A physician or a dentist must diagnose oral candidiasis or sinusitis.
Skin Infections
Cellulitis/soft tissue/wounds must meet one of the following:
1. Must have four of the following.
• Fever ≥100.4°F and/or
• Heat
• Redness
• Swelling
• Pain or tenderness
• Serous drainage
2. OR, pus present at the site / Fungal skin infections must have both:
• Maculopapular rash
• MD diagnosis or laboratory confirmation
Herpes simplex and zoster must have both:
• Vesicular rash
• MD diagnosis or laboratory confirmation / Scabies must have both:
• Maculopapular and/or itching rash
• MD diagnosis or laboratory confirmation
Systemic Infections
Must have one of the following:
1. Two or more blood cultures positive with the same organism
2. Single blood culture (not a contaminant) in the presence of:
• Fever ≥100.4°F or hypothermia <34.5°C
• Drop in systolic blood pressure of 30 mm Hg from baseline
• Worsening of mental or functional status
Fever of Unknown Origin (FUO)
Must have documented fever ≥100.4°F on two occasions at least 12 hours apart in any 3-day period, with no known infectious or noninfectious cause.
References
McGeer A, Campbell B, Emori TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991;19:1–7.
GLOSSARY
CHANGE IN CHARACTER OF URINE: Any significant change in the gross (e.g., new bloody urine, foul smell or amount of sediment) or microscopic (new pyuria or microscopic hematuria) character of the urine. For microscopic changes, this means that the results of a previous urinalysis must be on the chart. There is no time limit on when the previous urinalysis may have been done.
CHANGE IN FUNCTIONAL STATUS: A significant change in the resident's ability or willingness to carry out activities of daily living. For instance, new incontinence, new inability to walk to the dining room or increased difficulty in transfers would all be recorded as change in functional status.
CHANGE IN MENTAL STATUS: A significant change in the resident's cognitive function: for most residents, this will mean an increased level of confusion (e.g., new non-recognition of nurses).
COMPATIBLE CLINICAL SYNDROME: An acute illness with symptoms related to the relevant system (respiratory or gastrointestinal). In general, the symptoms will be some of those included in the definitions for either lower respiratory infection or gastroenteritis, but the criteria for the infection need not be met.
DIAGNOSIS BY A PHYSICIAN: Requires one of: a written note by a physician specifying diagnosis, a nursing note specifying that a diagnosis was made by a physician or a verbal report from either a physician or nurse that a specific diagnosis has been made.
EAR INFECTION: Includes infections of the external ear (otitis externa), middle ear (otitis media) or internal ear (otitis internal, labyrinthitis, vestibular neuronitis).
FEVER: A single temperature, taken by any route, of > 100.4 degrees Fahrenheit or 380 Celsius.
HYPOTHERMIA: A temperature which is below 94 degrees Fahrenheit or 34.50 Celsius or which does not register on the thermometer being used.
LABORATORY CONFIRMATION: With respect to skin infections, acceptable lab confirmation consists of:
§ Candida: positive culture from swab
§ Other fungi: positive culture from scraping
§ Herpes zoster or shingles: positive electron microscopic (EM) findings from scraping or positive culture of scraping or swab (note that EM cannot distinguish different species of Herpes)
§ Scabies: positive microscopic exam of scrapings
NEW PHYSICAL FINDINGS ON CHEST EXAM: New findings on examination of the chest with a stethoscope which suggest pneumonia: i.e., rales (crackles), rhonchi (wheezes) or bronchial breathing.
ORGANISM THOUGHT TO BE A CONTAMINANT (in blood culture): Organisms which are common skin flora may contaminate blood cultures and a single blood culture positive for one of these may be non-significant.
MEDICAL TERMS
CONJUNCTIVA: Mucous membrane covering the eyeball.
FLANK: Side of the body, below the rib cage and above the hip (the area in which pain is usually felt in upper urinary tract infections, referred to as the "costovertebral angle", is a relatively posterior area of the flank just below the ribs and extending from the side nearly to the backbone).
LYMPHADENO-PATHY: Enlargement of lymph glands.
MACULOPA- PULAR: Applied to a rash characterized by abnormally colored (usually red) areas of skin, of varying size, which may be either flat or slightly raised.
MALAISE: A feeling of generalized discomfort or uneasiness or being "out-of sorts".
PATHOGEN: A microorganism capable of causing disease.
PLEURITIC CHEST PAIN: Pain caused by inflammation of the pleura (lung lining), a sharp pain felt at any site over the rib-cage, which is brought on or made much worse by deep breathing.
PURULENT: Containing the by-products of inflammation (pus).
SEROUS: With watery consistency (as opposed to purulent).
SUPRAPUBIC: Above the pubic arch (i.e., the area of the bladder, in the central lower area of the abdomen).
VESICULAR: Applied to a rash characterized by blister-like lesions (i.e., localized areas of elevated skin, usually only a few mm in size, containing a watery substance).
INFECTION CONTROL TRACKING – Detailed UNIT Report Facility______Unit ______
PATHOGEN / S. Aureus / Pneumo / Strep Group / Entercocci / E. Coli / Kiebsielia / Enterbacteria / Prot. Vulgaris / Prot. Mirabilis / Pseudo / MRSA / VRE / ORSA / ScabiesAcquired/Nonsocomial
/ A / N / A / N / A / N / A / N / A / N / A / N / A / N / A / N / A / N / A / N / A / N / A / N / A / N / A / NLocation/Variables
UTI with catheterUTI w/o catheter
Resp with trach
Resp w/o trach
Pressure Area
Stasis Ulcer
Skin
Surgical Wound
Wound, other
GI Tract
Eye
PEG/NG site
Other
TOTAL
COMMENTS
“Confidential – Privileged Under Virginia Code §8.01-581.16 and 17 – For Quality Assurance Use Only”
INFECTION CONTROL TRACKING, Facility Monthly Report Facility ______
Total number of resident days/month
Total # of residents with positive cultures
# with nosocomial MRSA
# with nosocomial Staph
# with nosocomial E. Coli
# with nosocomial Scabies
# with nosocomial Other
LOCATION OF INFECTION
UTI, with catheter, admitted
UTI, with catheter, nosocomial
UTI without catheter, admitted
UTI without catheter, nosocomial
Resp, with trach, admitted
Resp, with trach, nosocomial
Resp without trach, admitted
Resp, without trach, nosocomial
Pressure Area, admitted
Pressure Area, nosocomial
Stasis Ulcer, admitted
Stasis Ulcer, nosocomial
Skin, admitted
Skin, nosocomial
Surgical Wound, admitted
Surgical Wound, nosocomial
Wound, other, admitted
Wound, other, nosocomial
GI Tract, admitted
GI Tract, nosocomial
Eye, admitted
Eye, nosocomial
PEG/NG site, admitted
PEG/NG site, nosocomial
Other, admitted
Other, nosocomial
“Confidential – Privileged Under Virginia Code §8.01-581.16 and 17 – For Quality Assurance Use Only”
INFECTION CONTROL TRACKING, Facility Monthly Report Facility ______
Page 2
Variable / Jan / Feb / Mar / April / May / June / July / Aug / Sept / Oct / Nov / Dec / TotalDEMOGRAPHIC ANALYSIS
# of residents treated with Antibiotics who displayed symptoms & did not have positive cultures
# of residents treated with Antibiotics prophalatically
# of residents treated for Scabies who displayed symptoms & did not have positive scraping
# of residents treated for Scabies prophalatically
INFECTION RATE – ADMITTED
INFECTION RATE – NOSOCOMIAL
TOTAL INFECTION RATE
COMMENTS
“Confidential – Privileged Under Virginia Code §8.01-581.16 and 17 – For Quality Assurance Use Only”