How infection present at time of surgery (PATOS) data impacts your surgical site infection (SSI) standardized infection ratios (SIR), with focus on the complex 30-day SSI SIR model.

This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network's (NHSN) health care-associated infection (HAI) surveillance definitions. This is the first analytic case study published in AJIC since the CDC/ NHSN updated its HAI risk adjustment models and rebaselined the standardized infection ratios (SIRs) in 2015. This case describes a scenario that Infection Preventionists (IPs) have encountered during their analysis of surgical site infection (SSI) surveillance data. The case study is intended to illustrate how specific models can impact the SIR results by highlighting differences in the criteria for NHSN's older and newer risk models: the original versions and the updated models introduced in 2015. Understanding these differences provides insight into how SSI SIR calculations differ between the older and newer NHSN baseline models. NHSN plans to produce another set of HAI risk adjustment models in the future, using newer HAI incidence and risk factor data. While the timetable for these changes remains to be determined, the statistical methods used to produce future models and SIR calculations will continue the precedents that NHSN has established. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers, explanations, rationales, and summary of teaching points. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of the NHSN's HAI data analysis. There are 2 baselines available for SSI standardized infection ration (SIRs) in the National Healthcare Safety Network (NHSN); one based on the 2006-2008 national aggregate data and another based on the 2015 data. Each of the 2 baselines has a different set of inclusion criteria for the SSI data, which impact the calculation of the SIR. In this case study, we focused on the impact of the inclusion of PATOS in the calculation of the 2006-2008 baseline SSI SIR and the exclusion of PATOS from the calculation of the 2015 baseline SSI SIR. In the 2006-2008 baseline SSI SIRs, PATOS events and the procedures to which they are linked are included in the calculation of the SSI SIR whereas in the 2015 baseline SSI SIRs, PATOS events and the procedures to which they are linked are excluded from the calculation of the SSI SIR. Meaning, if we control for all other inclusion criteria other than PATOS data for both baselines, we will notice differences in the number of observed events as well as the number of predicted infections for the 2 baselines. For details of the 2015 baseline and risk adjustment calculation, please review the NHSN Guide to the SIR referenced below. For details of the 2006-2008 baseline4 and risk adjustment, please see the SHEA paper "Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safety Network" by author Yi Mu.

Epidemiología de las infecciones urinarias asociadas a catéter y no asociadas a catéter en un hospital universitario de tercer nivel / Nosocomial urinary tract infection: an analysis beyond urinary catheterization

Resumen Introducción: Las infecciones urinarias asociadas a la atención de la salud (ITU-AAS) representan un importante problema sanitario, siendo poco conocidas sus características cuando no están asociadas a cateterización urinaria u ocurren fuera de unidades de cuidados intensivos (UCI). Objetivos: Determinar las características de los pacientes con ITU-AAS, etiología y susceptibilidad antimicrobiana de las mismas, tanto asociadas a catéter (ITU-C) como no asociadas a catéter (ITU-noC), en UCI y en sala general. Materiales y Métodos: Se realizó un estudio analítico retrospectivo de corte transversal entre 2009 y 2013 en un hospital universitario de tercer nivel. Se identificaron todos los episodios de ITU-AAS, diferenciándolas en ITU-C e ITU-noC. Resultados: Se incluyeron 253 episodios de ITU-AAS, siendo más frecuentes las ITU-C (60,9%) respecto a ITU-noC. Un 37,4% de ITU-noC y 59,7% de ITU-C ocurrieron en UCI. Los microorganismos aislados más frecuentemente fueron Escherichia coli, Klebsiella pneumoniae y Enterococcus sp. El 19% de los bacilos gramnegativos fueron productores de β-lactamasa de espectro extendido, siendo su frecuencia similar en ambos grupos. Conclusión: Las co-morbilidades de los pacientes con ITU-AAS, los agentes etiológicos responsables y sus correspondientes espectros de sensibilidad, fueron similares en los grupos de ITU-C e ITU-noC, tanto en sala general como en UCI.

Introduction: Nosocomially acquired urinary tract infections (NAUTI) represent an important public health issue, but its characteristics when they are not catheter associated (CA-UTI) or when they take place outside intensive care units (ICU) are poorly understood. Objectives: To determine the patients' characteristics, etiology and antimicrobial susceptibility of NAUTI, both CA-UTI and no CA-UTI, in general ward and ICU. Methods: We conducted a retrospective analytic cross-sectional study, between 2009 and 2013, in a third level universitary hospital. All NAUTI episodes were identified, classifying them as CA-UTI and no CA-UTI. Results: We included 253 episodes of NAUTI, being CA-UTI (60,9%) more frequent than no CA-UTI. A 37,4% of no CA-UTI and 59,7% of CA-UTI were identified in ICU. The most frequently isolated microorganisms were Escherichia coli, Klebsiella pneumoniae and Enterococcus sp. A 19% of extended spectrum betalactamase producing gram negative bacilli were found, without differences between groups. Conclusion: Patients's comorbidities, microorganisms associated to NAUTI and its antimicrobial susceptibility were similar in CA-UTI and no CA-UTI, as in general ward and ICU.

An outbreak of Pseudomonas aeruginosa respiratory tract infections associated with intrinsically contaminated ultrasound transmission gel.

We describe an outbreak of Pseudomonas aeruginosa respiratory tract infections related to intrinsically contaminated ultrasound gel used for intraoperative transesophageal echocardiograms in cardiovascular surgery patients. This investigation led to a product safety alert by the Food and Drug Administration and the development of guidelines for appropriate use of ultrasound gel.