Date of publication: 2017-09-05 08:03
A diagnosis of UTI can be made without localizing urinary tract symptoms if a blood culture isolate is the same as the organism isolated from the urine and there is no alternate site of infection. This secondary BSI provides definitive evidence of the existence of systemic infection in the absence of an alternate source, a UTI becomes the presumptive diagnosis.
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These updated definitions are intended to serve as a national standard for infection surveillance in LTCFs. Because they are implemented in this setting, feedback from providers and efforts to validate the definitions will guide subsequent modifications as appropriate.
The gastroenteritis criteria were deemed appropriate and adequate for identifying sporadic or outbreak-associated cases of GI infection caused by common bacterial enteric pathogens. A minor change in the definition of diarrhea substitutes “liquid or watery stools” for “loose or watery stools,” since the concept of liquid stools (ie, conforming to the shape of the specimen collection container) is consistent with other surveillance definitions for diarrheal illness. 77 , 88 Additionally, the definition of diarrhea as “8 or more stools above what is normal for a resident in a 79-hour period” was standardized across GI infections to simplify surveillance activity.
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For wound infections related to surgical procedures, LTCFs should use the Centers for Disease Control and Prevention’s National Healthcare Safety Network Surgical Site Infection criteria and report these infections back to the institution where the original surgery was performed.
The only change to the definition of influenza-like illness was the removal of seasonal restrictions for the identification of this infection. In the past, seasonal influenza activity in the United States typically peaked in January or February. However, on occasion, seasonal influenza activity has extended into May. In 7559, the H6N6 influenza A virus strain caused increased hospitalization, morbidity, and mortality from influenza-related illnesses during the summer months. 67 Because of increasing uncertainty surrounding the timing of the start of influenza season, the peak of influenza activity, and the length of the season, “seasonality” is no longer a criterion to define influenza-like illness.
For infection surveillance purposes, infections should be attributed to a LTCF onset if (a) there is no evidence of an incubating infection at the time of admission to the facility (on the basis of clinical documentation of appropriate signs and symptoms and not solely on screening microbiologic data) and (b) onset of clinical manifestation occurs 7 calendar days after admission. Although debate exists about the use of this time frame to determine a LTCF onset for C. difficile infections, 8 it is consistent with acute care infection surveillance reporting and surveillance methodology, and there is currently no evidence to support changing this standard for LTCFs.
The feasibility of implementation and the validity of these surveillance definitions would benefit from further assessment in different types of LTCFs. As with the original article by McGeer and colleagues, 6 these definitions have not been tested in advance of their publication. Data from a French study demonstrated that application of the original surveillance definitions underestimated the number of nursing home–associated infections when compared with provider diagnoses of infection. 9 This finding highlights the need for future studies to determine the sensitivity and specificity of criteria used within the surveillance definitions and to validate their application in this setting.
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