Infection Prevention Manual

EXPOSURE CONTROL PLAN (microbiology and serology findings) alone are not used to define infection, but may be used adjunctively as supportive evidence to confirm infection. The idea of using a designated temperature for fever is controversial, especially as many elderly persons have minimal or no temperature increase. However, for surveillance purposes, fever needs to be specified. Therefore, fever is present when the patient's temperature is 2.4 F degrees greater than the baseline temperature. This is important to note since normal temperature in the elderly is usually lower than 98.6 F. An elderly patient can be running a fever at 99.0. Defining infection in a patient receiving home health and/or hospice care depends upon a new sign(s) or symptom(s) identified by a clinician or other healthcare personnel. Supportive evidence from laboratory or other diagnostic testing can be used to confirm support criteria for a possible HAI. The following definitions by anatomical site are provided as criteria to identify HAIs in our patient populations and are fundamental to establishing a surveillance program. Surveillance programs are geared toward prevention of these adverse outcomes in the patient population. Bloodstream Infections (BSI) Primary Bloodstream Infection (BSI) Primary bloodstream infection (BSI) includes laboratory-confirmed bloodstream infection (LCBSI) and clinical sepsis (CSEP). A positive blood culture alone may be used to define bacteremia. Laboratory-confirmed bloodstream infection (LCBSI) Laboratory-confirmed bloodstream infection (LCBSI) must meet one of the following three criteria: 1. Patient has a recognized pathogen cultured from one or more blood cultures AND organism cultured from blood is not related to an infection at another site. 2. Patient has at least one of the following three signs or symptoms: a. Fever b. Chills c. Hypotension AND signs and symptoms and positive laboratory results are not related to an infection at another site AND common skin contaminant (e.g., diphtheroids, Bacillus spp., Propionibacterium spp., coagulase-negative staphylococci, or micrococci) cultured from two or more blood cultures drawn on separate occasions 3. Patient aged <1 year has at least one of the following four signs or symptoms: a. Fever b. Hypothermia c. Apnea d. Bradycardia AND signs and symptoms and positive laboratory results are not related to an infection at another site AND common skin contaminant (e.g., diphtheroids, Bacillus spp., Propionibacterium spp., coagulase-negative staphylococci, or micrococci) cultured from two or more blood cultures drawn on separate occasions NOTE: When an organism that is isolated from a blood culture is compatible with a related infection at another site, the bloodstream infection is classified as a secondary bloodstream infection NOTE: Infections related to intravascular access devices are classified as primary, even if localized signs of infection are present at the access site. The surveillance definition for CLABSI includes all bloodstream infections (BSIs) that occur in patients 48 hours after admission to home care with a CVC in place, when other sites of infection have been excluded. When an organism that is isolated from a blood culture is compatible with a related infection at another site, the bloodstream infection is classified as a secondary bloodstream infection. As such, the rate of CLABSI may overestimate the true incidence of CLABSI because not all BSIs originate from CVCs (i.e., infections may be secondary from undocumented sources such as postoperative surgical sites, intra-abdominal infections, and pneumonia or urinary tract infections) Our Agency requires that the Nursing Department monitor our compliance with best practices or evidence-based guidelines in preventing CLABSIs.