QA Infection

Purpose

The Critical Care QA Team is monitoring Central Line Infections and VAPs in the ICUs.

Specs

ICU

Dates

• Start Date: Saturday August 22, 2009
• End Date: NONE - Continued project with the CCVSM cross Canada Collaborative--TOstryzniuk 16:53, 4 October 2010 (CDT)
• Units Collecting: all ICU's in the Region.
• STB_CICU or STB_CCU do not submit Line count forms.

Medicine wards

• part B only - The "Diagnosis" of a Central Line Infection

Dates

• Start Date: Monday October 19, 2009
• End Date: NONE. Ongoing project for CCVSM cross Canada Collaborative.--TOstryzniuk 16:51, 4 October 2010 (CDT)
• Units Collecting: Medicine wards: HSC, STB, VIC, GRA
  • Med wards do not submit Line count forms.

Data Collection Instructions

A. VAP

If an ICU patient has a Complication of VAP, the following entry must be made in the L_TmpV2 file:

• Project: QAInf
• Item: VAP Infection
• Infx Dt: Date of infection (no time) is the date POSITIVE SPUTUM CULTURE was sent to micro lab.
• if no positive sputum culture, than not a VAP.
• Go to VAP article for more information about VAP.

The site where the VAP had "first" occurred at is the site that must get the credit for where this complication had occurred.

NOTE

VAP cannot be coded as a complication on a Medicine ward but can be used as an Admitting diagnosis if patient came from an ICU and requires ongoing treatment for this problem. If resolved in the ICU, don't code as an admitting DX to you ward.

B. Central Line Infection

1. If a patient develops a Complication of Central Line Infection while in your unit, the following entry must be made in the L_TmpV2 file:
   • Project: QAInf
   • Item: Central Line Infection
   • DATE of infection (no time) is the date positive blood culture was sent to micro lab.
   • if no positive culture than not a CLR-BSI
2. Patient already has a CLR-BSI present on admission to your unit:
   • in the admitting diagnosis field, enter Central Line Infection.
   • do not enter the DATE of positive culture in the Temp Studies field.
   • if the patient is from another ICU in the city, email the collector at that site to check if CLR_BSI was captured as a "complication" at that site.

The site where the CLR-BSI had "first" occurred at is the site that must get the credit for where this complication had occurred.

• Go to Central Line Infection article for more information about CLR-BSI.

Line Count Form used by ICU's

• Form is completed daily by CRN (charge nurse) or manager and FAXED to the Database Research office once per week (every Monday with previous weeks data).
• Data Processor makes a phone call to specific contact people in each ICU every week if the form is not submitted by Wednesday each week.
• Data Processor manually enters values from this form into an Access database on our office share drive X.

• • The same form is used by ICU charge nurses for the QA ETT unschedule extubations project and for Central Line Infection Rate counting and QAInf ITEM B above. & article Central Line Infection

• • HSC Form
  • HSC-IICU Form
  • All other ICU's form This form is excluded for STB_CICU and STB_CCU & Medicine wards.

Data Integrity Rules

Tmp Checker will check for the following:

Dx but no tmp

If Complication Diagnosis is one of:

• Central line infection (code 86)
• VAP (code 39)

then

• L_TmpV2 entry with project "ICU Infection Audit" with date needed

Tmp but no dx

If "QAInf" entry is present in L_TmpV2 then

• program must be "CC"
• the corresponding diagnosis must exist

DtTm has to be during admission

DtTm of QAInf entry has to be during patient admission.

Data Integrity Rules Under Discussion

VAP as AdmitDx but start date exists

• If VAP is in ADMIT DX (to ICU) which is possible when transferred from another ICU, a start Date is not needed in tmpV2.
  • could not the patient have arrived with a VAP and then developed a second one? Ttenbergen 16:21, 4 May 2011 (CDT)
    • Yes this is possible. Can be same or diff bug - found 10 cases from 2006 to present. It is also possible to have more than 1 acquired VAP (we have cases of this as well). JMojica 17:27, 4 May 2011 (CDT)
      • Patient could of arrived from one ICU to another with a VAP and then developed another one with a different bug however, we will stick to the guidelines of "in a unit" for at least 48 hrs with a ET tube to be considered a VAP or a new VAP acquired in that unit. If cultures are sent on the same day of admission to the second ICU and it ends up being positive with a different pathogen, this pathogen was quite likely present PRIOR transferring to another ICU. We are therefore making it look like that the new unit is now responsible for acquired VAP within the first 2 days of admission, when in all likely hood the pathogen was already starting it's party over in the previous unit before transfer. --TOstryzniuk 13:21, 6 May 2011 (CDT)

Send mode

Data for all patients meeting requirements for this study, including patients you are not sending this batch, will be sent every time complete patients are sent.