Point Prevalence Survey (PPS)
on
Antimicrobial Use and HAI

Nb	Topic	Question	Answer
1	Data collection form A	Patient B is admitted. At 8h the day of the survey he is present on the ward and still admitted. The moment at which the PPS team comes to the ward to do data collection, patient B is not physically present on the ward. He is still admitted on the ward, but there are two possibilities for his absence: a) he is in surgery; his file is in the operating theatre, he is not back when the PPS team is done. Should the team go back later that day to look at the file? b) he is undergoing a test; his file is in with him, he is not back when the PPS team is done. Should the team go back later that day to look at the file?	This is complex and the team may not have the time to do this. a) ideally they should go back to look at the file b) ideally they should go back to look at the file, but they are not allowed to look at the last test result
2	Data collection form A	Blood culture: in the protocol there is a list of skin contaminants, is this list complete?	Yes, if the germ you are looking for is not in the list, and it is not a known pathogenic germ either, it can not give a positive Blood culture in the PPS.
3	Data collection form A	What age do I give to newborns that are less then one month old?	Simply fill in age 0
4	Data collection form A, AB	Our patient is taking AB “X” for several diseases. In the part “Antimicrobial use” we should code the diagnose belonging to the AB. But how do you do this for 2 diagnoses for 1 AB?	Enter the same AB twice for the same patient, but describe a different indication, route and diagnosis site each time.
5	Data collection form A, AB	I am not sure when I should count a AB. I understand the rules (0h-0h for everything except SP) but what should I do if the patient didn’t take the pill yet on the moment of survey?	If the patient has already received a dose on the day of the survey (0-0h or 8-8h for SP) then it should always be counted, even if the physician has stopped therapy the day of the survey. If the patient has not yet received a certain AB (or if it is unclear whether he has already received it) then there are two options: -therapy was not stopped before the moment of survey: count -therapy was stopped before the moment of survey: don’t count
6	Data collection form A, AB	Should the result “I” in antimicrobial testing be counted as “R” when coding the antimicrobial resistance?	Yes
7	Data collection form A, AB	A patient is being treated for the disease “Z” with AB “X”, but there is a change on the day of the survey that switches AB “X” to AB “Y” for the same disease. For which AB is the PPS completed?	If the switch has happened before the time of collection, only AB Y. If the switch happens after the collection is completed but you find out by coincidence, only X.
8	Data collection form A, AB	In our hospital it sometimes happens that an Enterobacteriaceae is sensitive to third generation cephalosporins, but resistant to carbapenems. How do we code this in the AB part?	Code 2
9	Data collection form A, AB	What to do if an Enterobacteriaceae is sensitive to certain carbapenems, but resistant to others.	Code 2, resistant
10	Data collection form A, AB	Where do I find the definitions of the AB part?	There are no case definitions or definitions of CI or HI in the Ab part. This is in contrast with the very strict definitions in the HAI part. Do not apply the HAI part definitions to the AB part. In the AB part the clinicians are meant to note what they “think they are treating”. This is valid for the case definitions, and the CI/HI/LI
11	Data collection form A, HAI	The ambulatory patient B has a device that is equivalent to a CVC. At home, this patient gets an BSI that is clinically related to the catheter (no microbiological evidence). Patient is therefore admitted. The PPS is taking place the next day, we plan to count this as BSI, with a relevant device in place 48h before, in other words counting it as an active HAI. But where is the infection "origin"?	Correct, choose “other”.
12	Data collection form A, HAI	In children, often only one blood cultures is taken, is there an exception for this in the definition of positive blood culture?	No
13	Data collection form A, HAI	Semi-quantitative technique for respiratory samples, should they be looked at as quantitative or qualitative?	Everything that is not defined in the protocol as “quantitative” is “qualitative”.
14	Data collection form A, risk factors	How recent is the list of McCabe examples? Is a more complete or recent version available? Can you advise certain literature?	We can not advise on literature because it is actually more important to ask the physician their opinion based on how likely the patient is to die in 1 year, 5 years, or longer. The current list was updated for this protocol (original one has indeed become useless), but they are only examples mean to help the clinician to estimate.
15	Data collection form A, risk factors	I am doing the PPS at 14h today, the catheter was removed at 12h. Do I note “yes” there is a catheter?	There are two moments at which you can check if the risk factors PVC, CVC, UC and intubation were present: 8h the day of the survey, and the moment of survey. If at either moment the risk factor was present, you mark “yes”. In the example question, because the risk factor was present at 8h, you mark “yes”, even if it was removed at the moment of survey. If the catheter / intubation or UC was present before 8h, but not present at 8h, and not present at time of survey, don’t count it.
16	Data collection form A, risk factors	How do you define a urinary catheter?	The definition for Urinary tract catheter in the PPS was changed after the pilot and most training sessions were completed, it is now the same as the CDC definition: A urinary catheter in the PPS is an “indwelling urinary catheter”, which is a drainage tube that is inserted into the urinary bladder through the urethra, is left in place, and is connected to a closed collection system. It should not only have been used to empty the bladder and then withdrawn. Exclusion examples: suprapubic, intermittent (including self-intermittent), external catheter (condom), urostomy, nephrostomy etc
17	Data collection form A, risk factors	How do you define a CVC? (as a risk factor and as a relevant device) I have some device and i wonder if it can be considered CVC.	A CVC is any device that has all of the following characteristics: -ends in the heart or one of the great vessels -is used for infusion, blood sampling and hemodynamic monitoring. The following are considered "great vessels": Aorta, pulmonary artery, vena cava sup and inf, vena brachiocephalica, vena jugularis interna, vena subclavia, vena iliaca externa, vena iliaca communis, vena femoralis communis and in neonates the umbilical arteries / veins. Taking into account the above definition of a CVC, example of CVC can be: -introducer -port-a-cath -permanent dialysis catheter Exclusion: Pacemaker
18	Data collection form A, risk factors	Are all endoscopic procedures in the group “non NHSN surgery”? Is PTCA in the group “non NHSN surgery”?	Purely diagnostic endoscopy (even if about every possible barrier is perforated) is not surgery (no non-NHSN either), and can therefore not give rise to an SSI. During a diagnostic endoscopy, very often a therapeutic act is performed, then it becomes surgery. These are non-NHSN surgery unless they specified in the NHSN list. PTCA is “non NHSN surgery”
19	Data collection form A, risk factors	Is all laparoscopy minimally invasive (non-NHSN) surgery?	Yes
20	Data collection form A: AB	Are the following counted as antimicrobial use ? -Colistine and Vancomycine for decontamination of the intestines. -J05 antivirals	ATC to be collected	explanation
			J01	antibacterials for systemic use
			J02	antimycotics for systemic use
			A07AA	intestinal anti-infective antibiotics (no resorbtion)
			P01AB	Nitroimidazole derivatives for antiprotozoa use
			D01BA	Antifungals for systemic use
			J04AB02	rifampicin for treatment of TBC
			Conclusion: The decontaminants belong in the A07AA category and should therefore be registered in the PPS The J05 antivirals should not be counted There is also a list of all to be collected molecules on our website http://www.nsih.be/pps/index.html
21	Data collection form A: risk factors	Is placing a Deep venous catheter, Swan Ganz, Dialysis catheter, tracheostomy or Hickman line surgery when it is done in the operating theatre?	Mark "no surgery". The purpose of surgery should be primarily therapeutic - such devices/lines are NOT included.
22	Data collection: Form H	The form “hospital data” has a field “Total Number of Patients included in PPS”. It is very difficult to know this in advance but it is required to save the form. How can this be fixed?	This number corresponds to the number of patient forms, it is known after the data collection. This form (hospital data) is therefore best filled in after PPS data collection is completed.
23	Data collection: Form H	I have heard that certain fields on Form H should be rounded UP, for anonymity reasons, which are they?	Variable	Round up to nearest
			Hospital size	25
			Number of acute care beds	25
			Number of ICU beds	5
			Total number of beds in included wards	150
			Number of discharges/admissions in year	150
			Number of patient days in year	150
			Alcoholic hand rub	150
			Number of patient rooms	50
			Number of single patient rooms	25
			Number of FTE infection control staff	1
24	General	I have not finished data collection in 3 weeks, will my data be ignored in the analysis?	In the 2011 PPS, your data will be included. It will be analyzed and you will receive feedback. Please limit yourself to 3 weeks in the next PPS.
25	General	When is the last day I can send my data to the TTP?	20 dec 2011
26	Inclusion criteria	On my ward, they are 40 beds “geaggregeerd/agrée”. However, we have added to beds (there are 42 patients on this ward). Do these two extra patients participate in the PPS?	Yes
27	Inclusion criteria	A patient is admitted before 8 am the day of survey, but is not yet present on the ward because no bed is free. Is this patient included in the PPS?	No, he must be registered on the ward to be included in the PPS.
28	Inclusion criteria	Is the ward “palliative care” included?	No, this is considered chronic care
29	Inclusion criteria	What should I do if I have a ward that is partly chronic beds, and partly acute care beds?	If this is the permanent make up of this ward, you will have to exclude this ward if less then 80% of the beds is for acute care. If more then 80% of the beds is for acute care, then you include the ward in the PPS, but you pretend the chronic beds do not exist.? For instance: 20 acute beds + 2 chronic: you create a PPS ward that has 20 beds.
30	Inclusion criteria	Some of my beds on the ward are for “medium care”, what should I do?	Treat these beds as if they are just normal beds on the ward. You can specify a subspecialty at “consultant specialty” but medium care does not have a code, choose the most appropriate (possibly the code of the other beds on the ward)
31	Software	Is it possible to install HWN on a server and then access from multiple PCs?	Yes, The software can be installed on a network drive (server). This way, several pc can do data entry, but not at exactly the same time. It will not be possible to see who did what entry. If data from the same site are entered on different computers (different databases), it is a bit more complicated and should therefore be avoided.
32	Software	The export function of HWN does not work I think, is that correct?	Yes, the database must be sent by email. Please see the instruction video or ask us at mat.goossens@wiv-isp.be
33	Software	Installation does not work, what to do?	Watch http://www.youtube.com/watch?src_vid=_qBFkm33ffM&v= NghG1V9btYE&annotation_id=annotation_545743&feature=iv Please not that you need Win.rar to unzip the file, win.zip will not work.
34	TTP	When will we receive the TTP code?	In the last week of September, please contact mat.goossens@wiv-isp.be if you have not had yours
35	TTP	Because I am doing data entry for 4 or more sites as a fusion, the TTP code is to long for the field “hospital code”. What do I do?	Put as many numbers in the field as possible, and use that number as you hospital code on all the fields. On the form H, comments, write the full TTP code (just ones in other words)
36	Data collection form A, HAI	The newborn baby is in the room with the mother. How do i count the newborns, and with what specialty? What infections should i count as active HAI?	First, make sure that the newborn fullfills the PPS criteria (on the ward at 8 am the day of the survey). Then count them as a seperate patient (fill in a patient form) Under "ward specialty" fill in what you always do on this ward. Under "consultant/patient specialty" fill in GOOBS, unless there is a pediatrician that comes every day to look after the nexborn, in that case mark the code of that pediatric specialty (PEDNEO/PEDGEN/ICUNEO). For the newborn: In the HAI part: count all infections after their birth as active HAI. In the AB part, if the newborn is taking AB, the indication is "the opinion of the physician" (as it always is). For the mother: In the HAI part: count infections after giving birth as active HAI if the infection begins at day 3 or later (normal rules). Every small intervention (episiotomie) is non-NHSN surgery, which can lead to HAI before day 3. In the AB part, if the mother is taking AB, the indication is "the opinion of the physician" (as it always is).
37	Data collection form A, AB	I am filling in the "Diagnosis" in the AB part, but do not find the right code. I am doing profylaxis to prevent peritonitis.	The field "diagnosis" should only be recorded when the AB is given to treat an infection, not for prophylaxis or other indication. You can use code NA=not applicable.

Point Prevalence Survey (PPS) on Antimicrobial Use and HAI

October - November 2011

Protocol

Codebook

Forms to fill in

Software: HELICSwin.NET

Instruction Movies

Powerpoint Presentations of 08 september

Answers to case studies Limesurvey

Antimicrobials to be collected (list)

ICD-9 codes with explaination

Frequently Asked Questions

Point Prevalence Survey (PPS)
on
Antimicrobial Use and HAI