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Appendix 1 Glossary
- Central line. A vascular infusion device that terminates at or close to the heart or in one of the great vessels. In the National Healthcare Safety Network (NHSN), the system replacing NNIS, the following are considered great vessels for the purpose of reporting central line infections and counting central line days: aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, and common femoral veins. Note. In neonates, the umbilical artery/vein is considered a great vessel. Note. Neither the location of the insertion site nor the type of device may be used to determine if a line qualifies as a central line. The device must terminate in one of these vessels or in or near the heart to qualify as a central line. Note: Pacemaker wires and other noninfusion devices inserted into central blood vessels or the heart are not considered central lines.
- CLA-LCBI. See laboratory-confirmed primary bloodstream infection.
- Confounding. The distortion of the apparent effect of an exposure on risk brought about by the association with other factors that can influence the outcome.33 Risk adjustment is performed to minimize the effects of patient co-morbidities and use of invasive devices (the confounding factors) on the estimate of risk for a unit or facility (the exposure).
- Device-associated infection. An infection in a patient with a device (eg, ventilator or central line) that was used within the 48-hour period before the infection's onset. If the time interval was longer than 48 hours, compelling evidence must be present to indicate that the infection was associated with use of the device. For catheter-associated urinary tract infection (UTI), the indwelling urinary catheter must have been in place within the 7-day period before positive laboratory results or signs and symptoms meeting the criteria for UTI were evident.23 d Health care–associated infection. A localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s) that 1) occurs in a patient in a health care setting (eg, a hospital or outpatient clinic), 2) was not found to be present or incubating at the time of admission unless the infection was related to a previous admission to the same setting, and 3) if the setting is a hospital, meets the criteria for a specific infection site as defined by CDC.23 (See also Nosocomial.)
- Intensive-care unit (ICU). A hospital unit that provides intensive observation, diagnostic, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes bone marrow transplant units and nursing areas that provide step-down, intermediate care or telemetry only. The type of ICU is determined by the service designation of the majority of patients cared for by the unit (ie, if 80% of the patients are on a certain service [eg, general surgery], then the ICU is designated as that type of unit [eg, surgical ICU]). An ICU with approximately equal numbers of medical and surgical patients is designated as a combined medical/surgical ICU.23
- Laboratory-confirmed primary bloodstream infection (LCBI). A primary bloodstream infection identified by laboratory tests with or without clinical signs or symptoms; most often associated with the use of catheters or other invasive medical devices. For the CDC surveillance definition of LCBIs, please see reference 14 or www.cdc.gov/ncidod/hip/surveill/ nnis.htm.
- NNIS SSI risk index. A score used to predict a surgical patient's risk of acquiring a surgical-site infection. The risk index score, ranging from 0 to 3, is the number of risk factors present among the following: 1) a patient with an American Society of Anesthesiologists' physical status classification score of 3, 4, or 5,34 b) an operation classified as contaminated or dirty infected, 35,36 and c) an operation lasting over T hours, where T depends upon the operation being performed. 25 Current T values can be found in the NNIS Report at www.cdc.gov/ncidod/hip/surveill/nnis.htm.
- Nosocomial. Originating or taking place in a hospital.
- Outcomes. All the possible results that maystem from exposure to a causal factor or from preventive or therapeutic interventions33 (eg, mortality, cost, and development of a health care–associated infection).
- Predictive value positive. The proportion of infections reported by a surveillance or reporting system that are true infections.14,15 d Private reporting system. A system that provides information about the quality of health services or systems for the purposes of improving the quality of the services or systems. By definition, the general public is not given access to the data; instead, the data are typically provided to the organization or health care workers whose performance is being assessed. The provision of these data is intended as an intervention to improve the performance of that entity or person.
- Process measure. A measure of recommended infection control or other practices (eg, adherence with hand hygiene recommendations).
- Public reporting system. A system that provides the public with information about the performance or quality of health services or systems for the purpose of improving the performance or quality of the services or systems.
- Risk adjustment. A summarizing procedure for a statistical measure in which the effects of differences in composition (eg, confounding factors) of the populations being compared have been minimized by statistical methods (eg, standardization and logistic regression).33
- Sensitivity. The proportion of true infections that are reported by a surveillance or reporting system. May also refer to the ability of the reporting system to detect outbreaks or unusual clusters of the adverse event (in time or place).14,15
- SSI Risk Index. See NNIS SSI Risk Index.
- Standardized infection ratio. The standardized infection ratio as used in this document is an example of indirect standardization in which the observed number of surgical site infections (SSIs) is divided by the expected number of SSIs. The expected number of SSIs is calculated by using NNIS SSI risk index category-specific data from a standard population (eg, the NNIS system data published in the NNIS Report) and the number of operations in each risk index category performed by a surgeon, a surgical subspecialty service, or a hospital. (Detailed explanation and examples can be found in Horan TC, Culver DH. Comparing surgical site infection rates. In: Pfeiffer JA, editor. APIC text of infection control and epidemiology. Washington, DC: Association for Professionals in Infection Control, 2000. p. 1-7.) d Surgical site infection (SSI). An infection of the incision or organ/space operated on during a surgical procedure. For the CDC surveillance definition of an SSI, see reference 14 or www.cdc.gov/ncidod/hip/ surveill/nnis.htm.
- Surveillance. The ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.14
Healthcare Infection Control Practices Advisory Committee
Chair: Patrick J. Brennan, MD, University of Pennsylvania School of Medicine, Philadelphia, PA
Executive Secretary: Michele L. Pearson, MD, CDC, Atlanta, GA
Members: Vicki L. Brinsko, RN, BA, Vanderbilt University Medical Center, Nashville, TN; Raymond Y. W. Chinn, MD, Sharp Memorial Hospital, San Diego, CA; E. Patchen Dellinger, MD, University of Washington School of Medicine, Seattle, WA; Nancy E. Foster, BA, American Hospital Association, Washington, DC; Steven M. Gordon, MD, Cleveland Clinic Foundation, Cleveland, OH; Lizzie J. Harrell, PhD, Duke University Medical Center, Durham, NC; Carol O'Boyle, PhD, RN, University of Minnesota, Minneapolis, MN; Dennis M. Perrotta, PhD, CIC, Texas Department of Health, Austin, TX; Harriett M. Pitt, MS, CIC, RN, Long Beach Memorial Medical Center, Long Beach, CA; Robert J. Sherertz, MD, Wake Forest University School of Medicine, Wake Forest, NC; Nalini Singh, MD, MPH, Children's National Medical Center, Washington, DC; Kurt B. Stevenson, MD, MPH, Qualis Health, Boise, ID; Philip W. Smith, MD, University of Nebraska Medical Center, Omaha, NE.
Liaison Representatives: William Baine, MD, Agency for Healthcare Research and Quality; Joan Blanchard, RN, BSN, MSS, CNOR, CIC., Association of periOperative Registered Nurses, Denver, CO; Georgia Dash, RN, MS, CIC, Association for Professionals of Infection Control and Epidemiology, Inc., Washington, DC; Sandra L. Fitzler, RN, American Healthcare Association, Washington, DC; David Henderson, MD, National Institutes of Health; Lorine Jay, RN, Health Services Resources Administration; Stephen F. Jencks, MD, MPH, Center for Medicare and Medicaid Services, Baltimore, MD; Chiu S. Lin, PhD, Food and Drug Administration, Rockville, MD; Mark Russi, MD, MPH, American College of Occupational and Environmental Medicine, Arlington Heights, IL; Rachel Stricof, MPH, Advisory Committee for the Elimination of Tuberculosis, CDC, Atlanta, GA; Michael Tapper, MD, Society for Healthcare Epidemiology of America, Inc, Washington, DC; Robert Wise, MD, Joint Commisssion on the Accreditation of Healthcare Organizations, Oakbrooke, IL.