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>> Okay.
So I have about I guess 15 case studies that I want to go
through with you guys, and I hope that it helps
to solidify some of the definitions that we just went
through with some of the controversy and so forth.
And I do feel like we're at the debate from last night.
[Laughter] Okay.
Let's get started.
So I know that every presenter
who has done case studies read this to you, so I'm not going
to read it to you again.
Okay, case 1; we have a 56-year-old male admitted
to the ICU bed with pneumonia,
a central IV inserted for antibiotics.
On 2-2, the patient, Boyding,
without difficulty coughed
with moderate spewed in production.
Patient complains of lower abdominal cramps,
relieved with medication.
On 2-3, patient transfers to 2 East.
Later that day patient has fever of 38.2 and complains
of worsening lower abdominal pain; bowel movement
with loose unformed stool.
On 2-4, while on 2 East, the patient continues to complain
of lower abdominal pain and loose stools.
Over the course of 24 hours,
the patient had 3 loose stools, unformed.
Stool specimen collected and sent for testing.
On 2-5, lab results identified toxin positive C. difficile
stool sample.
[ Silence ]
So for facility-wide and patient lab ID reporting,
would you enter this as a lab ID event for this patient?
[ Silence ]
[ Background Talking ]
Okay. The timer is rolling.
Oh, okay, there it goes.
Okay, very good.
Okay; I have to get rid of my gum.
Okay. So 96% of you are correct.
>> Group: Yay.
[Laughter]
>> : Woo-hoo.
I don't know what's going on with the 4% of you, but so yes,
this is the first positive CDI isolate collected
in this inpatient location within 14 days.
Okay? What location would you attribute this lab ID a bit to:
ICU, 2 East, the lab, or FacWideIN?
[ Background Talking ]
The timer is rolling.
[ Background Talking ]
2 East; very good.
So remember, location attribution is based solely
on where the patient is assigned when the specimen is collected.
There is no thought process or subjective decisions allowed
for location attribution for lab ID event reporting.
And just remember, the NHSN transfer role does not apply
to lab ID event reporting.
Okay? Okay.
On 3-1, patient presents to the emergency department
with complaints of diarrhea
and lower abdominal pain for the past 3 days.
Patient states that he has been on antibiotics
for 10 days for a tooth abscess.
A stool specimen is collective on the patient
as in the emergency department,
and toxin assay is positive for C. Difficile.
On 3-1, patient is admitted to 2 South Medical Unit
for intravenous hydrations in medical management.
For facility-wide inpatient lab ID reporting,
can this result be entered as a lab ID event,
and if so what location would be entered?
So number 1, no, the ED is an outpatient location
and I am only monitoring inpatient locations.
Number 2, yes, location would be the ED
since specimen was collected there.
3, yes location would be 2 South, the admitting location.
Or 4, yes location would be back wide in.
[ Silence ]
Okay. The timer is rolling.
[ Silence ]
Interesting results.
Okay. So 76% of you were listening to my presentation.
[Laughter] Yes; the location would be 2 South,
the admitting location.
So remember, if a specimen is collected
in the emergency department and it's positive for C. diff,
and the patient is admitted to the facility
on the same calendar day into a location
that is monitoring lab ID events, which for back wide
in all inpatient locations would be monitoring,
then the specimen can be reported as the first specimen
for that patient in the admitting inpatient location.
What if you are reporting in both back wide in
and ED location specific reporting?
Number 1, you would report the positive CDI lab ID event
separately, once for ED and again for 2 South.
2, report only as back wide in.
3, report only as back wide out; or 4,
toss a coin to make a location selection.
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
We've got some troublemakers in the room.
[Laughter] Okay.
And I know who they are.
[Laughter] The correct answer is 1, you are going
to report the positive CDI lab ID separately, once for the ED,
and again for 2 South.
Okay; so both places, so just remember
if your monthly reporting plan includes both back wide in
and ED location specific reporting,
then you should report your event separately for each.
Okay. Case 3, on 2-15 we have a 55-year-old patient
with end-stage pancreatic cancer with liver
and bone meds admitted to inpatient unit 3 East
from hospice facility.
The patient has no previous history
of inpatient admission to this facility.
Upon admission to 3 East, the patient is noted
to have foul-smelling loose stools.
On 2-16 after 3 episodes of loose stool over the course
of 24 hours an unformed specimen was collected
and tested positive for C. difficile toxin.
For back wide in lab ID reporting should this be entered
into NHSN as a lab ID event?
Number 1, yes, the specimen was collected
from 3 East inpatient location, or 2,
this infection belongs to the
hospice. [ Background Talking ]
Okay; the timer is clicking.
[ Background Talking ]
Okay. So 92% of you are correct, yes, the specimen was collected
from 3 East inpatient location, so you should enter this.
So a toxin positive C. difficile stool specimen for a patient
and a location with no prior C. difficile specimen result
within 14 days for the patient and location.
Both community onset
and healthcare events should be reported.
So remember, regardless of what you think,
you should still report it, okay,
if it meets that lab ID event rule.
And then I just put a note at the bottom it is recommended
that you use optional fields or the comment section if you would
like to document -- in this case history of hospice admission
for internal tracking purposes.
How will NHSN categorize this CDI event:
[ Silence ]
community onset, number 2, healthcare facility onset,
number 3, community onset/healthcare facility
associated, or number 4, NHSN will not categorize the event.
The user will need to make a decision.
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
Okay, interesting; so community onset.
So this patient has no previous history of admission
to this facility, and the stool specimen was collected
as an inpatient less than 4 days after admission to the facility,
so it will be categorized as community onset.
And just as a note, community onset healthcare facility
associated is based on previous discharge
from the index facility; so that means your facility.
Okay. What if the stool specimen was collected 4 days
after admission to the hospital?
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
Good job. So healthcare facility onset
since the specimen was collected more than 3 days
after admission, okay, good job.
Case 4, a toxin positive C. difficile stool specimen
collected from an inpatient on day 4
of admission would be categorized as: number 1,
healthcare facility onset; number 2, community onset;
number 3, community onset/healthcare facility
associated; or number 4,
it depends on the patient's history.
This is a trick question.
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
Hmm, interesting results; hmm.
This is a good debate.
[Laughter] What do you think the answer is?
Hmm. So let me explain.
It is number 1, healthcare facility onset;
so remember NHSN categorizes the CDI lab ID events based
on the date admitted to the facility
and the specimen collection date.
So healthcare facility onset
since this lab ID event was collected more than 3 days
after admission to the facility.
Even if they had been in the hospital and they were --
this was collected greater than 3 days,
it would still be healthcare onset, okay;
so remember that community onset healthcare facility associated
is categorized under community onset events, okay?
[ Silence ]
Okay. We've got a question already; only on case 4.
Okay.
>> [Inaudible].
>> I think it's turned off.
[ Silence ]
[Laughter]
Okay. Let me just clarify something before you talk.
[Laughter] For those of you web-streaming this
and you can't see, but you can hear, that was not me.
[Laughter] Okay.
>> Okay...
[ Laughter ] am I doing thta buzz?
So my question is if we had checked that they had been
in within the past 3 months and they had had C. diff back then.
>> Yes.
So in that case it would still be healthcare facility onset,
because they -- it was the --
this lab ID event was collected greater than 3 days.
But then you get into their recurrent versus incident.
So remember, anything over 4 weeks but less than 8 --
wait, it's over 2 weeks but less than 8 is recurrent.
Good question.
So healthcare facility onset and community onset,
those are categorized solely based on the date of admission
and the date the specimen is collected, okay,
there's no history as far as that goes.
Now, community onset is further categorized
if that patient had been in your hospital
in the previous 4 weeks.
[ Silence ]
Okay. Case 4; what if the patient was symptomatic
on admission but the toxin was negative on admission
and positive on day 4 of admission?
Number 1, I can override NHSN and categorize the event
as community onset; wishful thinking.
Number 2, NHSN will categorize as community onset, or number 3,
NHSN will categorize as healthcare onset.
[ Background Talking ]
>> Male: 1, 2, 3, 4.
[ Background Talking ]
>> Are you guys clicking,
because I only see 2 responses.
[ Background Talking ]
You guys have broken the machine.
[Laughter] Uh-oh.
We're going to have a collection bucket for on the way out.
That will be $5 a person.
[Laughter] No.
[ Background Talking ]
So 100% of you were correct.
[ Cheering ]
NHSN will categorize as healthcare onset, okay?
So remember that it doesn't take
into consideration healthcare onset if the history
of that patient; so it's strictly based on when
that patient was admitted to your hospital and the date
that specimen is collected, okay?
So you've got -- I just want to go over this again,
I want to make sure you guys understand.
So NHSN will categorize as healthcare onset
if it's been greater than 3 days since admission.
Okay, it will be community onset in 3 days or less.
And then if it is community onset,
then it will be identified
as community onset healthcare facility associated
if the patient -- if it's a lab ID event that was collected
within 4 weeks from the current one.
Okay? And then back to the question at this table,
once that categorization is done,
then NHSN will further categorize as incident
versus recurrent, okay?
Incident is any lab ID event from a specimen obtained greater
than 8 weeks from the previous CDI lab ID event,
so remember it's based on the lab ID event you entered
into this application, or recurrent if it's greater
than 2 weeks, but less or equal than 8 weeks.
Okay? All right; let's move onto case 5.
In preparation for upcoming CMS reporting requirements
for CDI lab ID events, you are completing your NHSN monthly
reporting plan.
What locations will you select if you're only reporting based
on CMS requirements: number 1, ICU, NICU,
medical-surgical units, ED oncology; number 2,
ED outpatient surgery and affiliated physician offices;
number 3, back wide in,
which includes all inpatient locations except no monitoring
in NICU, specialty care nursery, and well baby locations;
or number 4, back wide out,
which includes all outpatient locations affiliated
with a facility?
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
Oh, thank you.
[ Background Talking ]
I am impressed.
Wow. [Cheering] Good job; 100% of you are correct,
it is number 3, back wide in.
Very good.
[Silence]
And just as a reminder, FacWideIN is a virtual location
within NHSN which means that the user does not define it
like other specific units or locations, and it's only used
in your monthly reporting plan.
Remember when you're selecting to monitor CDI lab ID
or MRSA lab ID you select "back wide in," right,
and then on your summary data reporting plan remember
where you go and enter your denominator data you're
selecting back wide in because your denominator is back wide,
okay, and then if you're conferring rights to a group
to have access to your date.
Those are the only times that you're going
to use the back wide in as your location.
Case 6; what denominator data is entered
for CDI lab ID event monitoring back wide in?
Number 1, patient admissions by each unit
and total patient days by unit.
Number 2, C. diff patient days and admissions
for all input patient locations,
minus NICU specialty care nursery
and well baby location counts, including LDRP locations.
Number 3, total patient days and total admissions
for all inpatient locations.
Or number 4, total patient encounters?
[ Background Talking ]
Remember, this is denominator data
for your C. diff, if that helps.
[ Background Talking ]
Okay, the timer is rolling.
[ Background Talking ]
Okay. This is good.
[ Background Talking ]
So it's number 2.
So remember for C. diff you're entering patient days
in admissions minus the NICU specialty care
and well baby location counts.
>> [Inaudible].
>> Wait, I can't --
somebody tell me what you're saying.
>> The problem is [inaudible].
>> When we're right is because it says "C.
diff patient days."
That makes it sound like it's how many patient days you had
patients with C. diff in there?
It should just be patient days and --
>> I see what you're saying, okay.
Okay, I will agree with that.
[Laughter] So what it's supposed to mean is that, you know,
you have the 2 lines, the first line that is all
and then the second 1 is specific for C. diff patients.
That's what it's supposed to say,
but I can understand how this confused you
and I will update it for next time.
[Laughter] Okay.
All right; so this is just an example.
Remember, the top under general, that's your patient days
for all, and then under that if you're monitoring the C. diff.
Okay, very good.
Okay. Case 7; on 6-15 25-year-old patient
with Crohn's Disease is admitted from the ED
to a 3 East inpatient unit
for corticosteroid treatment and pain management.
Peripheral IV is inserted in the ED
and patient is receiving intravenous fluids.
On 6-16, patient requests beside commode and complains
of frequent urination and burning during urination.
A urine culture is collected via straight cath.
Patient is afebrile
On 6-18, the urine culture results are positive for E. coli
and MRSA, antibiotic treatment begun.
On 6-21, the patient spikes a temperature of 101.4 Fahrenheit,
blood cultures are collected from the peripheral IV site.
And on 6-22 2 of 2 blood cultures are positive for MRSA.
Since your facility participates
in MRSA bacteremia lab ID event reporting for back wide in,
would you report this positive blood culture as a lab ID event:
number 1, no, since the patient already had a positive urine
culture with MERSA for this month and location,
the MRSA blood is considered a duplicate; number 2, yes,
this is considered a unique blood source.
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
Okay; 99% of you got this correct.
Yes. This is considered a unique blood source.
[ Silence ]
Okay; continuing on with case 7,
what if the patient had a previous positive MRSA blood 1
week prior to this culture while in the same location?
Number 1, this would not be a MRSA bacteremia lab ID event;
number 2, I would report as a MRSA bacteremia lab ID event;
or number 3, I would report as an infection surveillance event.
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
This would not be a MRSA bacteremia lab ID event,
because a prior positive MRSA blood culture result in equal to
or less than 2 weeks from the same patient and same location;
remember this includes across calendar months.
It's considered a duplicate.
Case 8; on 6-1, Mr. Nasal, a location nursing home resident,
is admitted to ICU with a stage 4 sacral ulcer.
Upon admission into the ICU,
an active nasal screen tested positive for MRSA.
Blood cultures were also collected upon admission
to the ICU.
Should this positive MRSA nasal screen be entered into NHSN
as an NDRO MRSA lab ID event;
number 1, yes, number 2, no.
[ Background Talking ]
Okay the timer is going.
[ Background Talking ]
Okay; 99% of you are correct, no.
I'm not sure what happened to the 1% of you.
[Laughter] So remember that NDRO lab ID event reporting excludes
test related to active surveillance testing, okay?
[ Silence ]
Continuing on with case 8,
what if the blood culture also tested positive for MRSA;
number 1, no, I would not consider this
to be an NDRO lab ID event
since the patient had a MRSA positive nasal screen; or 2,
yes, since the blood culture was obtained
for clinical decision-making I would report this
as a MRSA bacteremia lab ID event.
The number 1 it should be a MRSA lab ID event, not NDRO.
It's a typo.
[ Silence ]
Okay; the timer is rolling.
I can't wait to see the answer here; to see the votes.
[ Silence ]
Wow, I'm impressed, 100% of you are correct.
Yes; since this was the first positive MRSA blood culture
for this patient and location,
it is considered a MRSA bacteremia lab ID event.
Very good.
Case 9; what denominator data is entered
for MRSA bacteremia lab ID event monitoring
for a back wide in?
Number 1, patient admissions by each unit and total patient days
by unit; number 2, patient days and admissions
for all inpatient locations minus NICU
and well baby location counts; number 3, patient days
and admissions for all inpatient locations; or number 4,
total patient encounters?
[ Background Talking ]
I'm going to have to speed up a little bit because we have
about 20 minutes to go,
and I have some really good case studies I want to get to.
So I'm going to go ahead and start the timer.
[ Background Talking ]
Okay; so 86% of you are correct,
we're going to enter patient days and admissions
for all inpatient locations.
Remember that for MRSA we are not excluding the babies.
That's just for C. difficile, okay?
Case 10; in preparation
for upcoming CMS reporting requirements
for MRSA bacteremia lab ID events,
you are completing your NHSN monthly reporting plan.
What locations will you select
if you're only reporting based on CMS requirements?
Number 1, ICU, NICU, medical surgical units, ED oncology;
number 2, back wide in,
which includes all in-patient locations; number 3,
back wide in, which includes all inpatient locations except no
monitoring in NICU and well baby locations; or number 4,
back wide out, which includes all outpatient locations
affiliated with a facility?
[ Silence ]
Okay; the timer is rolling.
[ Silence ]
Wow, good job.
So it's number 2, back wide in;
okay and there's just a screen shot here,
in case you forgot what it looks like.
Good job. Okay; I'm not going to read this again.
Okay, case 11, a positive MRSA blood specimen collected
from an inpatient on day 4
of admission would be categorized as:
healthcare facility onset; number 2, community onset;
number 3, community onset/healthcare facility
associated; or number 4,
it depends on the patient's history.
[ Background Talking ]
I know you're not going to be burned by this one again.
[Laughter]
>> Okay; the timer is rolling.
[ Background Talking ]
Raise your hand if you think it's number 4.
[Laughter] Ooh, should we have them stand up?
[Laughter] Okay, so 97% of you are awake;
healthcare facility onset, okay?
Remember it's based on the date admitted to the facility
and the date the specimen is collected.
Alrighty. Continuing on, case 11;
what if the patient was symptomatic
for seppus [phonetic] on admission
but the blood culture was not collected
until day 4 of admission?
Number 1, I can override NHSN and categorize the event
as community onset; number 2, NHSN will categorize
as community onset; or number 3,
NHSN will categorize as healthcare onset?
Remember, this is not subjective.
[ Background Talking ]
Okay; the timer is rolling.
[ Background Talking ]
That's a little better.
Very good.
NHSN will categorize as healthcare onset.
I know we have some tricksters in here.
[ Laughter ]
So, remember a specimen collected on or after day 4
of admission will be healthcare onset.
[ Silence ]
Okay. Case 12; for back wide in reporting,
are lab ID events reported to NHSN for patients housed
in observation locations?
[ Background Talking ]
Okay, the timer is rolling.
[ Background Talking ]
Okay; so let's go over this one again.
So 84% of you said no, and 16% said yes.
Oh, I don't have the explanation on this next screen.
Oh, we have the explanation on the next screen
so let's do this one first.
So are patients housed
in observation locations included inpatient day
and admission counts for back wide in reporting?
[ Silence ]
Okay, little better; 90% of you said no.
Okay, so let's go over this.
So remember an observation location
such as a 24-hour observation area is considered an outpatient
unit, right?
So the time spent in this unit does not ever contribute
to inpatient counts, right; you don't count device days
in there, no patient days.
So as such admissions to such outpatient units represents
encounters, okay, for the purpose of outpatient only.
So these patients are not included
and with your inpatient counts for back wide in, okay?
If you have an observation patient who was housed
in an inpatient location, do we include those patients?
>> Group: Yes.
>> Yes.
Okay; so think location, okay, not so much patient
when you're doing lab ID event reporting.
[ Silence ]
I feel like we're having some duplication here.
Okay; case 13, for back wide in reporting,
are lab ID events reported to NHSN
for observation patients housed
in inpatient locations within the facility?
We should have 100% accuracy.
[ Laughter and Background Talking ]
Okay, the timer is rolling.
[ Background Talking ]
Close; I'll take it.
Yes; okay, so remember the observation patients housed
in inpatient locations are included.
Okay. All right; we'll try on this one.
Case 13; are observation patients housed
in inpatient locations included in patient day
in admission counts for back wide in reporting?
[ Background Talking ]
So if you have observation patients in your ICU and 2 West,
would you include those patients in your patient day counts?
[ Background Talking ]
Okay, the timer is rolling.
[ Background Talking ]
Good job; yes, you would.
[ Background Talking ]
Okay; so remember if an observation patient is sent
to an inpatient location for monitoring,
the patient should be included for all patient
and device that counts.
Okay; so the facility assignment of the patient
as an observation patient or an inpatient has no bearing
in this instance for counting purposes.
Okay; so since the patient's being housed, monitored
and cared for at an inpatient location, they are included.
Okay. So the next two case studies I tried
to replicate a line listing.
This may not look like your line listings, but I did my best.
So what you're looking at here are our patients for today.
Okay; we're going to assume that all specimens collected
for these patients are shown in this line listing, okay?
The clickers do not work with these next few slides.
So this will be interactive.
So and we have patient, Jack.
We see that he is on our line listing for today.
He was admitted on 6-1 to the ICU.
On 6-1 he also had a specimen collected --
a stool specimen collected that was positive for C. diff.
; toxin positive.
Is this a lab ID event?
Raise your hand if you think yes.
Okay. Yes; and it would be attributed to the ICU,
since the specimen was collected on the same calendar date
of the patient admission.
Okay? Looking at Jack again, on 6-2 while
in the ICU he had a blood specimen
that was positive for MRSA.
Raise your hand if you think that this is a lab ID event.
Good job; yes, for the ICU
because this is considered a unique blood specimen
from the ICU the first one no previous blood specimen
within 14 days from the ICU.
Okay; looking at Jack, on 6-12 he had another blood specimen
that was positive for MRSA.
Would we include this as a lab ID event?
Same patient; all of these are Jack, same patient.
Raise your hand if you think yes.
Oh, you guys are good.
Raise your hand if you think no.
Okay. Very good.
So he had a previous within 14 days from the same location.
Okay. Now, we're going to get a little tricky.
So looking at 6-20, while still in the ICU,
he had another positive MRSA blood.
Would we enter this as a lab ID event?
[ Background Talking ]
Aha. So remember, we are looking
at the last positive blood specimen,
not the last lab ID event.
Okay; so it's still important
that you keep these line listings.
So just because I want to be entertained, raise your hand
if you think yes, we should enter this.
Ah, you guys are -- oh, ooh, oh I saw some almost --
okay, so we all agree that this should not be entered?
Okay; so remember, within 14 days from the last specimen,
which would be the 6-12 specimen, okay?
Now, Jack had another positive blood while still
in the ICU on 7-10.
Would we enter this as a lab ID event?
>> Group: Yes.
>> Yes, we would.
Okay, just one more time for Jack.
He was transferred on 7-15 to 2 East,
and while on 2 East he had a blood specimen drawn
that was positive for MRSA.
Would you enter this as a lab ID event?
>> Group: Yes.
>> Very good; yes, because he's in a new location.
Good job. Okay, let's try again.
This time we've got Bill, Dog and Joe.
So Bill was admitted to CCU on 6-15.
On 6-16, he had blood drawn while in CCU
that was positive for MRSA.
Would we enter this as a lab ID event?
>> Group: Yes.
>> Yes.
It's the first positive within 14 days,
same patient, same location.
Okay. And then it looks like on 6-20 he was transferred
to 3 East where he had another positive MRSA blood.
Would we enter this?
>> Group: Yes.
>> Good job.
Okay, new location; then we're moving to a new patient, Dog.
On 7-2, he was admitted to ICU, okay.
On 7-1, he had a positive still specimen
for toxin positive C. diff.
Would we enter this as a lab ID?
>> Group: No.
>> You guys are good.
No; because it was collected before his admission date.
Oop. Okay; then on 7-6 while in the ICU he had a stool
that was positive for C. diff.
Would we enter this?
>> Group: Yes.
>> Yes; because it was the first
within 14 days while an inpatient
for inpatient status, okay?
And then on 7-10 he was transferred to 2 West
where he had another stool positive
for C. diff, positive toxin.
Would we enter this?
>> Group: Yes.
>> Yes; new location.
Okay; now we have Joe on line 6.
He was admitted on 6-1 to the ICU.
On 6-6, he had a positive stool sample
that was C. diff equivalent, toxin equivalent.
Would we enter this?
Ah, sorry.
Well, now you know.
No; so we get this question sometimes so I wanted
to include this in here.
It must be a toxin positive or a PCR positive.
If you have an equivalent or if it's just assay positive,
you do not enter it, okay?
Okay, last line listing; I see Courtney coming for me.
Okay. Jim admitted 8-2 to the CCU.
On the same date he had a positive MRSA-nairs,
would we enter this as a lab ID event?
>> Group: No.
>> Good job; surveillance cultures excluded.
Jim, same patient, on 8-6 he had a positive blood MRSA
in CCU; would we enter this?
>> Group: Yes.
>> Yes.
Okay. Then we're moving to Sam, who was admitted on 7-2
into the ICU, and then on 7-9 he had a positive assay
and negative toxin stool.
Would we enter this?
>> Group: No.
>> No; because remember it must be toxin positive,
and that includes your PCR genes positive, okay?
All right; for Tim 7-2 admitted to the NICU,
on 7-6 Tim had a positive stool for C. diff.
Would we enter this?
>> Group: No.
Yes. [Inaudible].
>> Oh, I apologize, you have a typo in yours.
I fixed it on my slides before -- after you guys.
So do number 4, that should be Tim.
I didn't realize that I had the same name
until I printed your slides.
Sorry.
[Background Talking]
So Tim -- so number 4 should say, "Tim, admitted to the NICU
with a positive C. diff."
Remember, NICU excluded; we all -- everybody good with that?
>> Group: Yes.
>> Okay.
And number 5, we have Paul admitted on 8-2
to the medical-surgical.
On 8-5 he had a wound that was positive for MRSA.
>> Group: No.
>> So this one is kind of a tricky one.
So I put yes, but with a star,
because you would only report yes
if you're reporting all MRSA specimen.
So this is for you states that have to report all MRSA's.
You would potentially enter this, okay,
but if you're just reporting via MRSA bacteremia, this would not
because it's not a blood specimen, right?
>> Group: Yes.
>> Okay.
Then Paul again; on 8-5 he had a blood
that was positive for MRSA.
Would we enter this?
>> Group: Yes.
>> And for those of you
who are reporting all specimens, would you enter this?
>> Yes.
>> Yes.
Okay; and I think that was it.
And I have like -- I have one announcement to make.
There was a question earlier about electronic transfer.
And I just wanted to let you know that NHSN does
through CDA reporting, for those of you
who do electronically transfer your data, if you participate
in that, you can submit your numerator
and denominator data electronically
for lab ID event reporting.
Okay; that would save you a lifetime.
Okay, I'm done.
Thank you guys for your participation and patience.
[ Applause ]