Surgical Site Infection Surgical Site Infection SurveillanceSurveillanceNHSN Procedure-Associated ModuleNHSN Procedure-Associated ModuleNovember 10, 2011

Eve Giannetta, RN BSN UVAHSEve Giannetta, RN BSN UVAHS

Kathy Bailey, RN CIC Centra Health Kathy Bailey, RN CIC Centra Health SystemSystem

Janis Ober, RN BSN CIC VCUHSJanis Ober, RN BSN CIC VCUHS

CMS RequirementsCMS Requirements

SettingsSettings

Surveillance will occur with surgical Surveillance will occur with surgical patients in any patients in any inpatient/outpatient setting where inpatient/outpatient setting where the selected NHSN operative the selected NHSN operative procedure(s) are performed. procedure(s) are performed.

RequirementsRequirements

COLO Colon SurgeryCOLO Colon Surgery HYST Abdominal hysterectomy HYST Abdominal hysterectomy

Indicate these on the Indicate these on the Patient Patient Safety Monthly Reporting PlanSafety Monthly Reporting Plan

Collect numerator and Collect numerator and denominator data ondenominator data on all all selected selected procedure categories procedure categories

DefinitionsDefinitions

An NHSN operative procedure is a An NHSN operative procedure is a procedure procedure 1.1. That is performed on a patient who is That is performed on a patient who is

an NHSN inpatient or an NHSN an NHSN inpatient or an NHSN outpatient; outpatient;

NHSN InpatientNHSN Inpatient: A patient whose date of : A patient whose date of admission to the healthcare facility and the admission to the healthcare facility and the date of discharge are different calendar days. date of discharge are different calendar days.

NHSN OutpatientNHSN Outpatient: A patient whose date of : A patient whose date of admission to the healthcare facility and date admission to the healthcare facility and date of discharge are the same calendar day. of discharge are the same calendar day.

DefinitionsDefinitions

An NHSN operative procedure is a An NHSN operative procedure is a procedure procedure 2.2. Takes place during an operation Takes place during an operation

Defined as a single trip to the operating Defined as a single trip to the operating room (OR) where a surgeon room (OR) where a surgeon

– makes at least one incision through the skin makes at least one incision through the skin or mucous membrane, including or mucous membrane, including laparoscopic approachlaparoscopic approach

andand– closes the incision before the patient closes the incision before the patient

leaves the ORleaves the OR

DefinitionsDefinitions

NOTE: NOTE: – If the skin incision edges do not meet If the skin incision edges do not meet

because of wires or devices or other because of wires or devices or other objects extruding through the incision, objects extruding through the incision, the incision is not considered primarily the incision is not considered primarily closed and therefore closed and therefore the procedure is the procedure is not considered an operationnot considered an operation. .

– Further, any subsequent infection Further, any subsequent infection is is not considered a surgical site infectionnot considered a surgical site infection

DefinitionsDefinitions

Operating Room (OR): Operating Room (OR): A patient care area that met the A patient care area that met the

Facilities Guidelines Institute’s (FGI) or Facilities Guidelines Institute’s (FGI) or American Institute of Architects’ (AIA) American Institute of Architects’ (AIA) criteria for an operating room when it criteria for an operating room when it was constructed or renovated.was constructed or renovated.

This may include an operating room, C-This may include an operating room, C-Section room, interventional radiology Section room, interventional radiology room, or a cardiac catheterization lab. room, or a cardiac catheterization lab.

DefinitionsDefinitions

An NHSN operative procedure is a An NHSN operative procedure is a procedure procedure 3.3. That is included in That is included in Table 1Table 1. .

COLO Colon SurgeryCOLO Colon Surgery– Incision, resection, or anastomosis of the large Incision, resection, or anastomosis of the large

intestine; includes large-to-small and small-to-large intestine; includes large-to-small and small-to-large bowel anastomosis; bowel anastomosis;

Does not include rectal operations Does not include rectal operations – ICD-9 codes: 17.31-17.36, 17.39, 45.03, 45.26, ICD-9 codes: 17.31-17.36, 17.39, 45.03, 45.26,

45.41, 45.49, 45.52, 45.71-45.76, 45.79, 45.81-45.83, 45.41, 45.49, 45.52, 45.71-45.76, 45.79, 45.81-45.83, 45.92-45.95, 46.03, 46.04, 46.10, 46.11, 46.13, 45.92-45.95, 46.03, 46.04, 46.10, 46.11, 46.13, 46.14, 46.43, 46.52, 46.75, 46.76, 46.94 46.14, 46.43, 46.52, 46.75, 46.76, 46.94

HYST Abdominal hysterectomy HYST Abdominal hysterectomy – Abdominal approach with uterine removal Abdominal approach with uterine removal – ICD-9 codes 68.31, 68.39, 68.41, 68.49, 68.61, 68.69 ICD-9 codes 68.31, 68.39, 68.41, 68.49, 68.61, 68.69

Case Finding - Case Finding - NumeratorNumeratorNumerator Data: Numerator Data: All patients having the All patients having the

selected operative procedure are selected operative procedure are monitored for signs of SSI. The monitored for signs of SSI. The Surgical Site Surgical Site Infection (SSI) form (CDC 57.120) is Infection (SSI) form (CDC 57.120) is completed for each such patient found to completed for each such patient found to have an SSI. have an SSI.

NOTES: NOTES: If a patient has several NHSN operative If a patient has several NHSN operative

procedures prior to an infection, report the procedures prior to an infection, report the operative procedure code of the operation that operative procedure code of the operation that was performed most closely in time prior to the was performed most closely in time prior to the infection date, unless there is evidence that the infection date, unless there is evidence that the infection is associated with a different operation. infection is associated with a different operation.

Case Finding - Case Finding - NumeratorNumerator If a procedure from more than one NHSN If a procedure from more than one NHSN

operative procedure category was done operative procedure category was done through a single incision, attempt to through a single incision, attempt to determine the procedure that is thought to determine the procedure that is thought to be associated with the infection. be associated with the infection.

If it is not clear (as is often the case when If it is not clear (as is often the case when the infection is a superficial incisional SSI), the infection is a superficial incisional SSI), or if the infection site being reported is not or if the infection site being reported is not an SSI, use the an SSI, use the NHSN Principal Operative NHSN Principal Operative Procedure Category SelectionProcedure Category Selection Lists (Table 3)Lists (Table 3) to select which operative procedure to to select which operative procedure to report. report.

Case Finding - Case Finding - NumeratorNumerator

• If small bowel and colon surgery done through same incision, report as a SB infection, not a COLO

• If ovarian surgery and hysterectomy performed, would be considered a HYST

• If CSEC and HYST are performed, would be considered a CSEC

Case Finding - Case Finding - DenominatorDenominatorDenominator Data: For Denominator Data: For allall patients having a patients having a

procedure selected for surveillance during procedure selected for surveillance during the month, complete the the month, complete the Denominator for Denominator for Procedure form (CDC 57.121). Procedure form (CDC 57.121).

The data are collected individually for each The data are collected individually for each operative procedure performed during the operative procedure performed during the month specified on the Patient Safety month specified on the Patient Safety Monthly Surveillance Plan . Monthly Surveillance Plan .

The Instructions for Completion of The Instructions for Completion of Denominator for Procedure form (Tables of Denominator for Procedure form (Tables of Instructions, Table 13) includes brief Instructions, Table 13) includes brief instructions for collection and entry of instructions for collection and entry of each data element on the form. each data element on the form.

Case Finding - Case Finding - DenominatorDenominator If procedures in more than one NHSN If procedures in more than one NHSN

operative procedure category are performed operative procedure category are performed during the same trip to the OR even if during the same trip to the OR even if performed through the same incision, a performed through the same incision, a Denominator for Procedure record is reported Denominator for Procedure record is reported for each operative procedure being for each operative procedure being monitored. For example, if a CARD and CBGC monitored. For example, if a CARD and CBGC are done through the same incision, a are done through the same incision, a Denominator for Procedure record is reported Denominator for Procedure record is reported for each. for each.

If procedures of different ICD-9-CM codes from If procedures of different ICD-9-CM codes from the same NHSN Operative Procedure the same NHSN Operative Procedure Category are performed through the same Category are performed through the same incision, record only one procedure for that incision, record only one procedure for that category. category.

Case FindingCase Finding

Must review your OR procedure list to Must review your OR procedure list to determine which procedures map to determine which procedures map to ICD-9 procedure codes included in ICD-9 procedure codes included in HYST and COLO procedure categories HYST and COLO procedure categories (and any others you choose to follow)(and any others you choose to follow)

There is an ICD-9/CPT code crosswalk There is an ICD-9/CPT code crosswalk to assistto assist

NHSN has a NHSN has a complete list of ICD-9 codes complete list of ICD-9 codes with their mappingwith their mapping

OR Procedure ListOR Procedure List

OR_Procedure_Nme NHSN_Cde Actv_Cde COLON, COLECTOMY-LEFT (44140)+ COLO A COLON, COLECTOMY-RIGHT (44140,44160)+ COLO A COLON, DA VINCI PARTIAL COLECTOMY (44204,44205,44206,44207,44208,44227,44238)+ COLO A COLON, HEMICOLECTOMY (44140)+ COLO A COLON, LAPAROSCOPIC DIVERTING COLOSTOMY (44188) COLO A COLON, LAPAROSCOPIC LEFT COLECTOMY (44204,44206,44207,44208,44227)+ COLO A COLON, LAPAROSCOPIC PARTIAL COLECTOMY W/OSTOMY (44205,44206,44207,44208)+ COLO A COLON, LAPAROSCOPIC RIGHT COLECTOMY (44204,44207,44208,44227)+ COLO A COLON, LAPAROSCOPIC SIGMOID COLECTOMY (44204,44206,44207,44208,44227)+ COLO A COLON, LAPAROSCOPIC TOTAL COLECTOMY W/OSTOMY (44210,44211,44212)+ COLO A COLON, LAPAROSCOPIC TRANSVERSE COLECTOMY (44204,44207,44208,44227)+ COLO A COLON, LOW ANTERIOR RESECTION (44145,44146)+ COLO A COLON, PARTIAL RESECTION W/ANASTOMOSIS (44140)+ COLO A COLON, PARTIAL RESECTION W/COLOSTOMY (44141,44143,44144)+ COLO A COLON, SIGMOID RESECTION (44140)+ COLO A COLON, TOTAL COLECTOMY W/ILEOSTOMY (44150,44151)+ COLO A COLON/RECTUM, APR/PROCTOCOLECTOMY W/ILEOANAL PULL THROUGH (45112,45119,45120,45121)+ NA A COLON/RECTUM, TOTAL PROCTOCOLECTOMY (44155,44156,44157,44158)+ NA A COLONOSCOPY/FLEX SIGMOIDOSCOPY, 45378, 45380, 45385, G0105, G0121, 45381, G0105, 91500 NA A COLOSTOMY(44320) COLO A COLOSTOMY, REVISION (44340) COLO A COLOSTOMY, TAKEDOWN (44620,44625,44626) COLO A COLOSTOMY, TRANSVERSE(44320) COLO A COLPOCLEISIS, 57120 NA A

Data Entry/UploadData Entry/Upload

Denominator Data for all procedures Denominator Data for all procedures may be entered manually or imported may be entered manually or imported electronically electronically

All required fields must be populated All required fields must be populated in order to successfully upload in order to successfully upload electronic data fileelectronic data file

Requires collaboration with your OR Requires collaboration with your OR Information Technology DepartmentInformation Technology Department

May require additional data collection May require additional data collection by OR staffby OR staff

Resources on NHSN websiteResources on NHSN website

Identifying and Identifying and Recording Surgical Site Recording Surgical Site InfectionsInfections Examples of SSI data sources include Examples of SSI data sources include

but are not limited to: microbiology but are not limited to: microbiology reports, OR schedules, return to OR reports, OR schedules, return to OR reports, readmission lists, chart reports, readmission lists, chart review of patients with selected review of patients with selected surgical procedures, surgeon queries.surgical procedures, surgeon queries.

Consistently adhere to the NHSN Consistently adhere to the NHSN surveillance definitions for SSIs.surveillance definitions for SSIs.

Superficial SSI DefinedSuperficial SSI Defined

A superficial incisional SSI (SIP or SIS) must meet the followingA superficial incisional SSI (SIP or SIS) must meet the following criterion: criterion:     Infection occurs within 30 days after the operative procedure Infection occurs within 30 days after the operative procedure andand involves only skin and subcutaneous tissue of the incision involves only skin and subcutaneous tissue of the incision and and patient has at least 1 of the following: patient has at least 1 of the following: a. purulent drainage from the superficial incision. a. purulent drainage from the superficial incision. b. organisms isolated from an aseptically obtained culture of fluidb. organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision. or tissue from the superficial incision. c. at least 1 of the following signs or symptoms of infection: pain c. at least 1 of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat, and or tenderness, localized swelling, redness, or heat, and superficial incision is deliberately opened by surgeon and is superficial incision is deliberately opened by surgeon and is culture positive or not cultured. A culture-negative finding does culture positive or not cultured. A culture-negative finding does not meet this criterion. not meet this criterion. d. diagnosis of superficial incisional SSI by the surgeon/attending.d. diagnosis of superficial incisional SSI by the surgeon/attending.   

Types of Superficial Types of Superficial SSIsSSIs Superficial incisional primary (SIP): a Superficial incisional primary (SIP): a

superficial incisional SSI that is superficial incisional SSI that is identified in the primary incision in a identified in the primary incision in a patient who has had an operation with 1 patient who has had an operation with 1 or more incisions (eg, C-section incision or more incisions (eg, C-section incision or chest incision for coronary artery or chest incision for coronary artery bypass graft with a donor site [CBGB]). bypass graft with a donor site [CBGB]).

Superficial incisional secondary (SIS): a Superficial incisional secondary (SIS): a superficial incisional SSI that is superficial incisional SSI that is identified in the secondary incision in a identified in the secondary incision in a patient who has had an operation with patient who has had an operation with more than 1 incision (eg, donor site more than 1 incision (eg, donor site [leg] incision for CBGB). [leg] incision for CBGB).

Reporting Instructions Reporting Instructions for Superficial SSIsfor Superficial SSIs

Do not report a stitch abscess (minimal inflammation Do not report a stitch abscess (minimal inflammation and discharge confined to the points of suture and discharge confined to the points of suture penetration) as an infection.penetration) as an infection.

Do not report a localized stab wound infection as SSI. Do not report a localized stab wound infection as SSI. While it would be considered either a skin (SKIN) or While it would be considered either a skin (SKIN) or soft tissue (ST) infection, depending on its depth, it is soft tissue (ST) infection, depending on its depth, it is not reportable under this module. not reportable under this module.

““Cellulitis”, by itself, does not meet the criteria for Cellulitis”, by itself, does not meet the criteria for Superficial Incisional SSI. If the incisional site infection Superficial Incisional SSI. If the incisional site infection involves or extends into the fascial and muscle layers, involves or extends into the fascial and muscle layers, report as a deep incisional SSI.report as a deep incisional SSI.

Classify infection that involves both superficial and Classify infection that involves both superficial and deep incision sites as deep incisional SSI. deep incision sites as deep incisional SSI.

  

Deep SSI DefinedDeep SSI Defined

A deep incisional SSI must meet the following criterion: A deep incisional SSI must meet the following criterion: Infection occurs within 30 days after the operative procedure if no Infection occurs within 30 days after the operative procedure if no implant*implant* is left in place or within 1 year if implant* is in place and the is left in place or within 1 year if implant* is in place and the infection appears to be related to the operative procedure infection appears to be related to the operative procedure and and involves deep soft tissues (eg, fascial and muscle layers) of theinvolves deep soft tissues (eg, fascial and muscle layers) of the incision incision and and patient has at least 1 of the following: patient has at least 1 of the following: a. purulent drainage from the deep incision but not from a. purulent drainage from the deep incision but not from organ/space component of the surgical site. organ/space component of the surgical site. b. a deep incision spontaneously dehisces or is deliberately opened b. a deep incision spontaneously dehisces or is deliberately opened

by aby a surgeon and is culture-positive or not cultured when the patient has surgeon and is culture-positive or not cultured when the patient has at least 1 of the following signs or symptoms: fever (38at least 1 of the following signs or symptoms: fever (38ooC), or C), or localized pain or tenderness. A culture-negative finding does not localized pain or tenderness. A culture-negative finding does not meet this criterion. meet this criterion. c. an abscess or other evidence of infection involving the deep c. an abscess or other evidence of infection involving the deep

incision incision is found on direct examination, during reoperation, or by is found on direct examination, during reoperation, or by histopathologic or radiologic examination. histopathologic or radiologic examination. d. diagnosis of a deep incisional SSI by a surgeon or attending MD. d. diagnosis of a deep incisional SSI by a surgeon or attending MD.   

ImplantImplant

Porcine or Porcine or synthetic heart synthetic heart valvesvalves

Mechanical heartMechanical heart Metal rodsMetal rods MeshMesh

Sternal wiresSternal wires ScrewsScrews CementsCements Internal staplesInternal staples HemoclipsHemoclips

A nonhuman-derived object, material or tissue that is permanently placed in a patient during an operative procedure and is not routinely manipulated for diagnostic or therapeutic purposes.

Non-absorbable sutures are excluded because Infection Preventionists may not easily identify and/or differentiate the soluble nature of suture material used.

Types of Deep SSIsTypes of Deep SSIs

Deep incisional primary (DIP): a deep Deep incisional primary (DIP): a deep incisional SSI that is identified in a incisional SSI that is identified in a primary incision in a patient who has had primary incision in a patient who has had an operation with one or more incisions an operation with one or more incisions (eg, C-section incision or chest incision (eg, C-section incision or chest incision for CBGB)for CBGB)

Deep incisional secondary (DIS): a deep Deep incisional secondary (DIS): a deep incisional SSI that is identified in the incisional SSI that is identified in the secondary incision in a patient who has secondary incision in a patient who has had an operation with more than 1 had an operation with more than 1 incision (eg, donor site [leg] incision for incision (eg, donor site [leg] incision for CBGB). CBGB).

  

Reporting Instructions Reporting Instructions for Deep SSIsfor Deep SSIs

Classify infection that involves Classify infection that involves both superficial and deep incision both superficial and deep incision sites as deep incisional SSI.sites as deep incisional SSI.

Organ/Space SSI DefinedOrgan/Space SSI Defined

An organ/space SSI involves any part of the An organ/space SSI involves any part of the body, excluding the skin incision, fascia, body, excluding the skin incision, fascia, or muscle layers, that is opened or or muscle layers, that is opened or manipulated during the operative manipulated during the operative procedure. Specific sites are assigned to procedure. Specific sites are assigned to organ/space SSI to identify further the organ/space SSI to identify further the location of the infection. location of the infection.

An organ/space SSI must meet the following criterion: Infection occurs within 30 days after the operative procedure if no implant* is left in place or within 1 year if implant* is in place and the infection appears to be related to the operative procedure and infection involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure and patient has at least 1 of the following:  a. purulent drainage from a drain that is placed through a stab wound into the organ/space. b. organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space. c. an abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination. d. diagnosis of an organ/space SSI by a surgeon or attending physician.

Organ/Space SSI Defined

Organ/Space SSI Specific Organ/Space SSI Specific SitesSites

Specific sites are assigned to Specific sites are assigned to organ/space SSIs to further identify organ/space SSIs to further identify the location of the infection. the location of the infection.

Example: Report colon procedure Example: Report colon procedure with subsequent abdominal abscess with subsequent abdominal abscess as an organ/space SSI at the as an organ/space SSI at the intraabdominal specific site (SSI-IAB). intraabdominal specific site (SSI-IAB).

BONEBONE OsteomyelitisOsteomyelitis JNTJNT Joint or bursaJoint or bursa

BRSTBRSTBreast abscess or Breast abscess or mastitismastitis LUNGLUNG

Other infections of the Other infections of the respiratory tractrespiratory tract

CARDCARDMyocarditis or Myocarditis or pericarditispericarditis MEDMED MediastinitisMediastinitis

DISCDISC Disc-spaceDisc-space ORALORAL Oral cavityOral cavity

EAREAR Ear, mastoidEar, mastoid OREPOREP Other reproductive tractOther reproductive tract

EMETEMET EndometritisEndometritis OUTIOUTI Other urinary tractOther urinary tract

ENDOENDO EndocarditisEndocarditis SASASpinal abscess without Spinal abscess without meningitismeningitis

EYEEYEEye, other than Eye, other than conjunctivitisconjunctivitis SINUSINU SinusitisSinusitis

GITGIT GI tractGI tract URUR Upper respiratory tractUpper respiratory tract

IABIAB Intraabdominal, NOSIntraabdominal, NOS VASCVASC Arterial or venousArterial or venous

ICICIntracranial, brain Intracranial, brain abscess or duraabscess or dura VCUFFVCUFF Vaginal cuffVaginal cuff

Specific Sites of an Organ/Space SSISpecific Sites of an Organ/Space SSI

Reporting Instructions Reporting Instructions for Organ/Space SSIsfor Organ/Space SSIs

Occasionally an organ/space Occasionally an organ/space infection drains through the infection drains through the incision. Such infection generally incision. Such infection generally does not involve reoperation and does not involve reoperation and is considered a complication of is considered a complication of the incision. Therefore, classify it the incision. Therefore, classify it as a deep incisional SSI. as a deep incisional SSI.

Related NHSN Published Related NHSN Published FAQsFAQsQ: Q: If an abdominal hysterectomy is performed If an abdominal hysterectomy is performed

but the uterus is removed through the but the uterus is removed through the vagina, is this still reported as an vagina, is this still reported as an abdominal hysterectomy (HYST) for surgical abdominal hysterectomy (HYST) for surgical site infection (SSI) reporting in the NHSN, site infection (SSI) reporting in the NHSN, or should it be recorded as a vaginal or should it be recorded as a vaginal hysterectomy (VHYS)?hysterectomy (VHYS)?

A: This surgery should be reported as an abdominal A: This surgery should be reported as an abdominal hysterectomy. The updated manual which will be hysterectomy. The updated manual which will be released as part of the v6.4 release of NHSN has released as part of the v6.4 release of NHSN has new descriptions for both of these procedures. new descriptions for both of these procedures. The categorization is based on the approach of The categorization is based on the approach of the surgery, not how the uterus is removed. A the surgery, not how the uterus is removed. A hysterectomy with an abdominal approach is hysterectomy with an abdominal approach is reported as a HYST, and a hysterectomy with a reported as a HYST, and a hysterectomy with a vaginal approach is reported as a VHYS. vaginal approach is reported as a VHYS.

Related NHSN Published Related NHSN Published FAQsFAQs

Q: Is an intraabdominal infection that Q: Is an intraabdominal infection that develops secondary to an anastamotic leak develops secondary to an anastamotic leak a complication of surgery, or a Surgical Site a complication of surgery, or a Surgical Site Infection (SSI)?Infection (SSI)?

A: Both. Any infection that develops following an A: Both. Any infection that develops following an operative procedure and meets the SSI criteria is operative procedure and meets the SSI criteria is indeed an SSI. In the above instance, the indeed an SSI. In the above instance, the anastamotic leak may have been the reason that anastamotic leak may have been the reason that the infection developed, but if the patient had not the infection developed, but if the patient had not had the surgery, there would not have been an had the surgery, there would not have been an anastamotic leak. anastamotic leak.

Related NHSN Published Related NHSN Published FAQsFAQs

Q: Are Hemoclips considered implants in Q: Are Hemoclips considered implants in NHSN?NHSN?

A: We consider hemoclips to be implants because A: We consider hemoclips to be implants because they are non-human derived objects that are they are non-human derived objects that are permanently placed in patients during surgery permanently placed in patients during surgery and are not routinely manipulated. However, we and are not routinely manipulated. However, we recognize that identifying their use for recognize that identifying their use for surveillance purposes presents a unique surveillance purposes presents a unique challenge to most Infection Preventionists challenge to most Infection Preventionists because hemoclip use may not be routinely because hemoclip use may not be routinely documented in operative procedures records. We documented in operative procedures records. We believe this issue may be worth discussing with believe this issue may be worth discussing with your OR staff.your OR staff.

Related NHSN Published Related NHSN Published FAQsFAQs

Q: Is an “infected hematoma” in a Q: Is an “infected hematoma” in a postoperative wound an SSI?postoperative wound an SSI?

A: The fact that wounds can be labeled in A: The fact that wounds can be labeled in various ways by different physicians is the various ways by different physicians is the reason that criteria rather than labels are reason that criteria rather than labels are used for determination of healthcare-used for determination of healthcare-associated infections in NHSN. A wound associated infections in NHSN. A wound described as an infected hematoma, may described as an infected hematoma, may indeed meet the criteria for a superficial or indeed meet the criteria for a superficial or deep incisional SSI and should be identified deep incisional SSI and should be identified as such if appropriate.as such if appropriate.

  

In the case of a laparoscopic hysterectomy, the In the case of a laparoscopic hysterectomy, the uterus is removed with the help of a morcellator. uterus is removed with the help of a morcellator. This instrument allows the surgeon to remove a This instrument allows the surgeon to remove a large uterus through a small incision. ICD-9-CM large uterus through a small incision. ICD-9-CM codes for laparoscopic hysterectomy procedures codes for laparoscopic hysterectomy procedures are included within the NHSN operative procedure are included within the NHSN operative procedure categories of HYST (abdominal hysterectomy) and categories of HYST (abdominal hysterectomy) and VHYS (vaginal hysterectomy).VHYS (vaginal hysterectomy).

If the hysterectomy procedure was performed If the hysterectomy procedure was performed using a laparoscope and the uterus was removed using a laparoscope and the uterus was removed either through the small incision or through the either through the small incision or through the vagina, be sure to indicate “Yes” for the vagina, be sure to indicate “Yes” for the Endoscope field response. Check “No”, if the Endoscope field response. Check “No”, if the laparoscopic incision was extended to allow for the laparoscopic incision was extended to allow for the insertion of the surgeon’s handinsertion of the surgeon’s hand..

Related NHSN Published Clarification Use of Endoscopy (Laparoscopy) in Hysterectomy Use of Endoscopy (Laparoscopy) in Hysterectomy

ProceduresProcedures