The Validation of a Novel Surveillance System for Monitoring Bloodstream Infections in the Calgary Zone

Table 1

Definitions for classifying bloodstream infections (BSIs) by the electronic surveillance system and by medical record review.

Classification	Definition		References
	Chart review	Electronic surveillance system
Bloodstream infection	Patient has at least one sign or symptom, fever (>38°C), chills, or hypotension, and at least one of (1) pathogen recovered from >1 set of blood cultures and (2) isolation of organisms commonly associated with contamination from >2 sets of blood cultures within 5 days	Pathogen recovered from >1 set of blood cultures or isolation of organisms commonly associated with contamination from >2 sets of blood cultures within 5 days	[9]
Hospital-acquired	No evidence on the infection was present or incubating at the hospital admission, unless it was related to previous hospital admission	First positive culture obtained >48 hours after hospital admission or within 48 hours of discharge from hospital. If transferred from another institution then the duration of admission is calculated from admission time to first hospital	[9, 10]
Healthcare-associated community-onset	First positive culture obtained <48 hours of admission and at least one of (1) iv antibiotic therapy or specialized care at home other than oxygen, within the prior 30 days before bloodstream infection, (2) attending a hospital or hemodialysis clinic or iv chemotherapy within the prior 30 days before bloodstream infection, (3) admission to hospital for 2 or more days within the prior 90 days before bloodstream infection, and (4) resident of nursing home or long-term care facility	First positive culture obtained <48 hours of admission and at least one of (1) discharge from HPTP clinic within the prior 2–30 days before bloodstream infection, (2) attending a hospital clinic or ED within the prior 5–30 days before bloodstream infection, (3) admission to Calgary Zone acute care hospital for 2 or more days within the prior 90 days before bloodstream infection, (4) submission of a sample for culture from a patient who previously had a sample submitted from a nursing home or long-term care facility, (5) active dialysis, and (6) having an ICD-10-CA code for active, acute cancers as an indicator of those who likely attended or were admitted to the TBCC	[10–12]
Community-acquired	Bloodstream infections not fulfilling criteria for either hospital-acquired or healthcare-associated community-onset	First culture obtained <48 hours of admission and not fulfilling criteria for healthcare-associated community-onset	[10]
Primary BSI	Bloodstream infection is not related to infection at another site other than an infection associated with an intravascular device	No cultures obtained from any other site other than surveillance cultures or from intravascular devices within ±48 hours	[9, 13]
Secondary BSI	Bloodstream infection is related to infection at another body site (other than intravascular device) as determined on the basis of all available, clinical, radiographic, and laboratory evidence	At least one culture obtained from any other site other than surveillance cultures or from intravascular devices within ±48 hours	[9, 10]

Diphtheroids, Bacillus species, Propionibacterium species, coagulase-negative staphylococci, Streptococcus viridans group, and/or micrococci.