Att G17_Surgical Site Infection

Procedure-associated Module
SSI

Surgical Site Infection (SSI) Event
Introduction: In 2010, an estimated 16 million operative procedures were performed in acute
care hospitals in the United States1. A recent prevalence study found that SSIs were the most
common healthcare-associated infection, accounting for 31% of all HAIs among hospitalized
patients2. The CDC healthcare-associated infection (HAI) prevalence survey found that there
were an estimated 157,500 surgical site infections associated with inpatient surgeries in 20113.
NHSN data for 2006-2008 (16,147 SSIs following 849,659 operative procedures) showed an
overall SSI rate of 1.9%4.
While advances have been made in infection control practices, including improved operating
room ventilation, sterilization methods, barriers, surgical technique, and availability of
antimicrobial prophylaxis, SSIs remain a substantial cause of morbidity, prolonged
hospitalization, and death. SSI is associated with a mortality rate of 3%, and 75% of SSIassociated deaths are directly attributable to the SSI5.
Surveillance of SSI with feedback of appropriate data to surgeons has been shown to be an
important component of strategies to reduce SSI risk6-9. A successful surveillance program
includes the use of epidemiologically-sound infection definitions and effective surveillance
methods, stratification of SSI rates according to risk factors associated with SSI development,
and data feedback7,8. A new CDC and Healthcare Infection Control Practices Advisory
Committee guideline for the prevention of surgical site infection is scheduled for publication
soon, and will replace the previous Guideline for Prevention of Surgical Site Infection, 19999.
Settings: Surveillance of surgical patients will occur in any inpatient and/or outpatient setting
where the selected NHSN operative procedure(s) are performed.
Requirements: Perform surveillance for SSI following at least one NHSN operative
procedure category (Table 1) as indicated in the Patient Safety Monthly Reporting Plan (CDC
57.106). Collect SSI (numerator) and operative procedure category (denominator) data on all
procedures included in the selected procedure categories for at least one month to meet NHSN
requirements, or as otherwise specified by mandates and other reporting requirements. A
procedure must meet the NHSN definition of an operative procedure in order to be included in
the surveillance. All procedures included in the NHSN monthly surveillance plan are followed
for superficial, deep, and organ/space SSIs.
SSI monitoring requires active, patient-based, prospective surveillance. Post-discharge and
ante-discharge surveillance methods should be used to detect SSIs following inpatient and
outpatient operative procedures. These methods include, 1) direct examination of patients’
wounds during follow-up visits to either surgery clinics or physicians’ offices, 2) review of
medical records or surgery clinic patient records, 3) surgeon surveys by mail or telephone, and
4) patient surveys by mail or telephone (though patients may have a difficult time assessing
their infections). Any combination of these methods is acceptable for use; however, CDC
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criteria for SSI must be used. To minimize Infection Preventionists’ (IPs) workload of
collecting denominator data, operating room data may be downloaded (see file specifications
at: http://www.cdc.gov/nhsn/PDFs/training/ImportProcedureData8_3.pdf).
An SSI will be associated with a particular NHSN operative procedure and the facility in
which that procedure was performed. Refer to the NHSN application’s Help system for
instruction on linking an SSI to an operative procedure.
The International Classification of Diseases, 9th Revision Clinical Modifications (ICD-9-CM)
codes, which are defined by the ICD-9 Coordination and Maintenance Committee of the
National Center for Health Statistics and the Centers for Medicare and Medicaid Services
(CMS), are developed as a tool for classification of morbidity data. The wide use enables the
grouping of surgery types for the purpose of determining SSI rates. Table 1 lists NHSN
operative procedure category groupings by ICD-9-CM codes. Because ambulatory surgery
centers and hospital outpatient surgery departments may not use ICD-9-CM procedure codes,
Table 1 provides Current Procedural Terminology (CPT) code mapping for certain NHSN
operative procedure categories to assist users in determining the correct NHSN code to report
for outpatient surgery cases. However, when available, ICD-9-CM codes take precedence over
CPT codes when determining the appropriate NHSN operative procedure category for
inpatient surgery cases. Table 1 also includes a general description of the types of operations
contained in the NHSN operative procedure categories.
CDC continues to work on updated ICD-10-CM/PCS and CPT mappings to all NHSN
operative procedure categories for SSI surveillance. These mappings are anticipated to be
available by March 2015.
Note: ICD-10-CM/PCS codes will replace ICD-9-CM codes on October 1, 2015, however
NHSN will not have the ability to receive these codes until the January 2016 release. The
NHSN guidance for entry of surgical denominator data for the last quarter of 2015 data is to
enter the NHSN Procedure Code (e.g. COLO or HYST); but do not enter any ICD-10CM/PCS codes associated with the procedure.
Note: The infection window, Present on Admission, Hospital Associated Infection and Repeat
Infection Timeframe definitions should not be applied to the SSI protocol.
Definition of an NHSN Operative Procedure
An NHSN Operative Procedure is a Procedure:
 that is included in Table 1
And
 takes place during an operation where at least one incision (including laparoscopic
approach) is made through the skin or mucous membrane, or reoperation via an
incision that was left open during a prior operative procedure
And
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

takes place in an operating room (OR), defined as a patient care area that met the
Facilities Guidelines Institute’s (FGI) or American Institute of Architects’ (AIA)
criteria for an operating room when it was constructed or renovated10. This may include
an operating room, C-section room, interventional radiology room, or a cardiac
catheterization lab.

Exclusions: Otherwise eligible procedures that are assigned an ASA score of 6 are not eligible
for NHSN SSI surveillance
Note: Incisional closure method is NOT a part of the NHSN operative procedure definition; all
otherwise eligible procedures are included, regardless of closure type. Therefore both
primarily closed procedures and those that are not closed primarily should be entered into the
denominator data for procedures in the facility’s monthly reporting plan. Any SSIs attributable
to either primarily closed or non-primarily closed procedures should be reported.

Table 1. NHSN Operative Procedure Category Mappings to ICD-9-CM Codes and CPT
Codes
Notes:
 NHSN will provide updates as needed concerning the transition from ICD-9-CM to
ICD-10-CM/PCS procedure coding.
 When available, ICD-9-CM codes take precedence over CPT codes when determining
the appropriate NHSN operative procedure category for inpatient surgery cases.

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Legacy
Code
AAA

AMP

Operative
Procedure
Abdominal
aortic
aneurysm
repair
Limb
amputation

APPY

Appendix
surgery

AVSD
BILI

Shunt for
dialysis
Bile duct, liver
or pancreatic
surgery

BRST

Breast surgery

Description
Resection of abdominal aorta with
anastomosis or replacement

Total or partial amputation or
disarticulation of the upper or
lower limbs, including digits
Operation of appendix
Note: incidental APPY codes are
not part of this procedure group
and do not need to be reported.
Arteriovenostomy for renal
dialysis
Excision of bile ducts or operative
procedures on the biliary tract,
liver or pancreas (does not include
operations only on gallbladder)

Excision of lesion or tissue of
breast including radical, modified,
or quadrant resection,
lumpectomy, incisional biopsy, or
mammoplasty

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ICD-9-CM Codes / CPT
Codes
38.34, 38.44, 38.64

84.00-84.19, 84.91

47.01, 47.09, 47.2, 47.91,
47.92, 47.99

39.27, 39.42
50.0, 50.12, 50.14, 50.2150.23, 50.25, 50.26, 50.29,
50.3, 50.4, 50.61, 50.69,
51.31-51.37, 51.39, 51.4151.43, 51.49, 51.51, 51.59,
51.61-51.63, 51.69, 51.71,
51.72, 51.79, 51.81-51.83,
51.89, 51.91-51.95, 51.99,
52.09, 52.12, 52.22, 52.3, 52.4,
52.51-52.53, 52.59-52.6, 52.7,
52.92, 52.95, 52.96, 52.99
85.12, 85.20-85.23, 85.3185.36, 85.41-85.48, 85.50,
85.53-85.55, 85.6, 85.7085.76, 85.79, 85.93-85.96
19101, 19112, 19120, 19125,
19126, 19300, 19301, 19302,
19303, 19304, 19305, 19306,
19307, 19316, 19318, 19324,
19325, 19328, 19330, 19340,
19342, 19350, 19355, 19357,
19361, 19364, 19366, 19367,
19368, 19369, 19370, 19371,
19380

Procedure-associated Module
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CARD

Cardiac
surgery

Procedures on the heart; includes
valves or septum; does not
include coronary artery bypass
graft, surgery on vessels, heart
transplantation, or pacemaker
implantation

CEA

Carotid
endarterectomy

CBGB

Coronary
artery bypass
graft with both
chest and
donor site
incisions

Endarterectomy on vessels of
head and neck (includes carotid
artery and jugular vein)
Chest procedure to perform direct
revascularization of the heart;
includes obtaining suitable vein
from donor site for grafting

CBGC

Coronary
artery bypass
graft with chest
incision only

Chest procedure to perform direct
vascularization of the heart using,
for example the internal
mammary (thoracic) artery

36.15-36.17, 36.2

CHOL

Gallbladder
surgery

Cholecystectomy and
cholecystotomy

COLO

Colon surgery

Incision, resection, or anastomosis
of the large intestine; includes
large-to-small and small-to-large
bowel anastomosis

51.03, 51.04, 51.13, 51.2151.24
47480, 47562, 47563, 47564,
47600, 47605, 47610, 47612,
47620
17.31-17.36, 17.39, 45.03,
45.26, 45.41, 45.49, 45.52,
45.71-45.76, 45.79, 45.8145.83, 45.92-45.95, 46.03,
46.04, 46.10, 46.11, 46.13,
46.14, 46.43, 46.52, 46.75,
46.76, 46.94
44140, 44141, 44143, 44144,
44145, 44146, 44147, 44150,
44151, 44160, 44204, 44205,
44206, 44207, 44208, 44210

For rectal procedures see the REC
codes.

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35.00-35.04, 35.06, 35.08,
35.10-35.14, 35.20-35.28,
35.31-35.35, 35.39, 35.42,
35.50, 35.51, 35.53, 35.54,
35.60-35.63, 35.70-35.73,
35.81-35.84, 35.91-35.95,
35.98-35.99, 37.10-37.12,
37.31-37.33, 37.35-37.37,
37.41, 37.49, 37.60
38.12

36.10-36.14, 36.19

Procedure-associated Module
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CRAN

Craniotomy

Excision repair, or exploration of
the brain or meninges; does not
include taps or punctures

CSEC

Cesarean
section
Spinal fusion
Open reduction
of fracture

Obstetrical delivery by Cesarean
section
Immobilization of spinal column
Open reduction of fracture or
dislocation of long bones with or
without internal or external
fixation; does not include
placement of joint prosthesis

Gastric surgery

Incision or excision of stomach;
includes subtotal or total
gastrectomy; does not include
vagotomy and fundoplication

FUSN
FX

GAST

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9-6

01.12, 01.14, 01.20-01.25,
01.28, 01.29, 01.31, 01.32,
01.39, 01.41, 01.42, 01.5101.53, 01.59, 02.11-02.14,
02.91-02.93, 07.51-07.54,
07.59, 07.61-07.65, 07.68,
07.69, 07.71, 07.72, 07.79,
38.01, 38.11, 38.31, 38.41,
38.51, 38.61, 38.81, 39.28
74.0, 74.1, 74.2, 74.4, 74.91,
74.99
81.00-81.08
79.21, 79.22, 79.25, 79.26,
79.31, 79.32, 79.35, 79.36,
79.51, 79.52, 79.55, 79.56
23615, 23616, 23630, 23670,
23680, 24515, 24516, 24538,
24545, 24546, 24575, 24579,
24586, 24587, 24635, 24665,
24666, 24685, 25337, 25515,
25525, 25526, 25545, 25574,
25575, 25607, 25608, 25609,
25652, 27236, 27244, 27245,
27248, 27254, 27269, 27283,
27506, 27507, 27511, 27513,
27514, 27535, 27536, 27540,
27758, 27759, 27766, 27769,
27784, 27792, 27814, 27822,
27826, 27827, 27828
43.0, 43.42, 43.49, 43.5, 43.6,
43.7, 43.81, 43.82, 43.89,
43.91, 43.99, 44.15, 44.21,
44.29, 44.31, 44.38-44.42,
44.49, 44.5, 44.61-44.65,
44.68-44.69, 44.95-44.98

Procedure-associated Module
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HER

Herniorrhaphy

Repair of inguinal, femoral,
umbilical, or anterior abdominal
wall hernia; does not include
repair of diaphragmatic or hiatal
hernia or hernias at other body
sites

HPRO

Hip prosthesis

Arthroplasty of hip

HTP

Heart
transplant

Transplantation of heart

HYST

Abdominal
hysterectomy

Abdominal hysterectomy;
includes that by laparoscope

KPRO

Knee
prosthesis

Arthroplasty of knee

KTP

Kidney
transplant
Laminectomy

Transplantation of kidney

55.61, 55.69

Exploration or decompression of
spinal cord through excision or
incision into vertebral structures
Transplantation of liver

03.01, 03.02, 03.09, 80.50,
80.51, 80.53, 80.54, 80.59,
84.60-84.69, 84.80-84.85
50.51, 50.59

Major excision or incision of the
larynx and radical neck
dissection; does not include
thyroid and parathyroid
operations

30.1, 30.21, 30.22, 30.29, 30.3,
30.4, 31.45, 40.40-40.42

LAM

LTP
NECK

Liver
transplant
Neck surgery

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17.11-17.13, 17.21-17.24,
53.00-53.05, 53.10-53.17,
53.21, 53.29, 53.31, 53.39,
53.41-53.43, 53.49, 53.51,
53.59, 53.61-53.63, 53.69
49491, 49492, 49495, 49496,
49500, 49501, 49505, 49507,
49520, 49521, 49525, 49550,
49553, 49555, 49557, 49560,
49561, 49565, 49566, 49568,
49570, 49572, 49580, 49582,
49585, 49587, 49590, 49650,
49651, 49652, 49653, 49654,
49655, 49656, 49657, 49659,
55540
00.70-00.73, 00.85-00.87,
81.51-81.53
27125, 27130, 27132, 27134,
27137, 27138, 27236, 27299
37.51-37.55

68.31, 68.39, 68.41, 68.49,
68.61, 68.69
58150, 58152, 58180, 58200,
58210, 58541, 58542, 58543,
58544, 58548, 58570, 58571,
58572, 58573, 58951, 58953,
58954, 58956
00.80-00.84, 81.54, 81.55
27438, 27440, 27441, 27442,
27443, 27445, 27446, 27447,
27486, 27487

Procedure-associated Module
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NEPH

Kidney surgery

Resection or manipulation of the
kidney with or without removal of
related structures

OVRY

Ovarian
surgery

Operations on ovary and related
structures

PACE

Pacemaker
surgery

Insertion, manipulation or
replacement of pacemaker

PRST

Prostate
surgery

PVBY

Peripheral
vascular
bypass surgery
Rectal surgery

Suprapubic, retropubic, radical, or
perineal excision of the prostate;
does not include transurethral
resection of the prostate
Bypass operations on peripheral
arteries

REC

RFUSN

Operations on rectum

Refusion of
spine
Small bowel
surgery

Refusion of spine

SPLE

Spleen surgery

THOR

Thoracic
surgery

Resection or manipulation of
spleen
Noncardiac, nonvascular thoracic
surgery; includes pneumonectomy
and hiatal hernia repair or
diaphragmatic hernia repair
(except through abdominal
approach)

SB

Incision or resection of the small
intestine; does not include smallto-large bowel anastomosis

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55.01, 55.02, 55.11, 55.12,
55.24, 55.31, 55.32, 55.34,
55.35, 55.39, 55.4, 55.51,
55.52, 55.54, 55.91
65.01, 65.09, 65.12, 65.13,
65.21-65.25, 65.29, 65.31,
65.39, 65.41, 65.49, 65.5165.54, 65.61-65.64, 65.7165.76, 65.79, 65.81, 65.89,
65.92-65.95, 65.99
00.50-00.54, 17.51, 17.52,
37.70-37.77, 37.79-37.83,
37.85-37.87, 37.89, 37.9437.99
60.12, 60.3, 60.4, 60.5, 60.61,
60.69

39.29

48.25, 48.35, 48.40, 48.42,
48.43, 48.49-48.52, 48.59,
48.61-48.65, 48.69, 48.74
81.30-81.39
45.01, 45.02, 45.15, 45.3145.34, 45.51, 45.61-45.63,
45.91, 46.01, 46.02, 46.2046.24, 46.31, 46.39, 46.41,
46.51, 46.71-46.74, 46.93
41.2, 41.33, 41.41-41.43, 41.5,
41.93, 41.95, 41.99
32.09, 32.1, 32.20-32.23,
32.25, 32.26, 32.29, 32.30,
32.39, 32.41, 32.49, 32.50,
32.59, 32.6, 32.9, 33.0, 33.1,
33.20, 33.25, 33.28, 33.3133.34, 33.39, 33.41-33.43,
33.48, 33.49, 33.98, 33.99,
34.01-34.03, 34.06, 34.1,
34.20, 34.26, 34.3, 34.4, 34.51,
34.52, 34.59, 34.6, 34.8134.84, 34.89, 34.93, 34.99,
53.80-53.84

Procedure-associated Module
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THYR

Thyroid and/or
parathyroid
surgery

Resection or manipulation of
thyroid and/or parathyroid

VHYS

Vaginal
hysterectomy

Vaginal hysterectomy; includes
that by laparoscope

VSHN

Ventricular
shunt

XLAP

Exploratory
laparotomy

Ventricular shunt operations,
including revision and removal of
shunt
Procedures involving an incision
through abdominal wall to gain
access into the abdominal cavity;
diagnostic procedure on
abdominal region

06.02, 06.09, 06.12, 06.2,
06.31, 06.39, 06.4, 06.5006.52, 06.6, 06.7, 06.81, 06.89,
06.91-06.95, 06.98, 06.99
68.51, 68.59, 68.71, 68.79
02.21, 02.22, 02.31-02.35,
02.39, 02.42, 02.43, 54.95†
53.71, 53.72, 53.75, 54.0,
54.11, 54.12, 54.19, 54.3, 54.4,
54.51, 54.59, 54.61, 54.63,
54.64, 54.71-54.75, 54.92,
54.93

†Include

only if this procedure involves ventricular shunt (i.e., is not a Ladd procedure to
repair malrotation of intestines).
For a complete list of all ICD-9-CM codes mapped to their assignment as an NHSN operative
procedure category, a surgical procedure other than an NHSN operative procedure (OTH), or a
non-operative procedure (NO), see ICD-9-CM Procedure Code Mapping to NHSN Operative
Procedure Categories at http://www.cdc.gov/nhsn/XLS/ICD-9-cmCODEScurrent.xlsx.
Denominator for Procedure Definitions:
ASA physical status: Assessment by the anesthesiologist of the patient’s preoperative physical
condition using the American Society of Anesthesiologists’ (ASA) Classification of Physical
Status11,12. Patient is assigned one of the following:
1. A normally healthy patient
2. A patient with mild systemic disease
3. A patient with severe systemic disease
4. A patient with severe systemic disease that is a constant threat to life
5. A moribund patient who is not expected to survive without the operation.
Note: Do NOT report procedures with an ASA physical status of 6 (a declared brain-dead
patient whose organs are being removed for donor purposes) to NHSN.
Date of event (DOE): For an SSI the date of event is the date when the first element used to
meet the SSI infection criterion occurs for the first time during the surveillance period.
Synonym: infection date.
Diabetes: The NHSN SSI surveillance definition of diabetes indicates that the patient has a
diagnosis of diabetes requiring management with insulin or a non-insulin anti-diabetic agent.
This includes patients with “insulin resistance” who are on management with anti-diabetic
agents. This also includes patients with a diagnosis of diabetes who are noncompliant with
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their diabetes medications. The discharge ICD-9-CM codes in the 250 to 250.93 range are also
acceptable for use to answer YES to the diabetes field question.
The NHSN definition excludes patients with no diagnosis of diabetes. The definition excludes
patients who receive insulin for perioperative control of hyperglycemia but have no diagnosis
of diabetes.
Duration of operative procedure: The interval in hours and minutes between the
Procedure/Surgery Start Time, and the Procedure/Surgery Finish Time, as defined by the
Association of Anesthesia Clinical Directors (AACD)13:
 Procedure/Surgery Start Time (PST): Time when the procedure is begun (e.g., incision
for a surgical procedure).
 Procedure/Surgery Finish (PF): Time when all instrument and sponge counts are
completed and verified as correct, all postoperative radiologic studies to be done in the
OR are completed, all dressings and drains are secured, and the physicians/surgeons
have completed all procedure-related activities on the patient.
Emergency operative procedure: A nonelective, unscheduled operative procedure. Emergency
operative procedures are those that do not allow for the standard immediate preoperative
preparation normally done within the facility for a scheduled operation (e.g., stable vital signs,
adequate antiseptic skin preparation, colon decontamination in advance of colon surgery, etc.).
General anesthesia: The administration of drugs or gases that enter the general circulation and
affect the central nervous system to render the patient pain free, amnesic, unconscious, and
often paralyzed with relaxed muscles.
Height: The patient’s most recent height documented in the medical record in feet (ft.) and
inches (in), or meters (m).
NHSN Inpatient Operative Procedure: An NHSN operative procedure performed on a patient
whose date of admission to the healthcare facility and the date of discharge are different
calendar days.
NHSN Outpatient Operative Procedure: An NHSN operative procedure performed on a
patient whose date of admission to the healthcare facility and date of discharge are the same
calendar day. Procedures performed at ASC should be designated at outpatient procedures.
Non-primary Closure is defined as closure that is other than primary and includes surgeries in
which the skin level is left completely open during the original surgery and therefore cannot be
classified as having primary closure. For surgeries with non-primary closure, the deep tissue
layers may be closed by some means (with the skin level left open), or the deep and superficial
layers may both be left completely open. An example of a surgery with non-primary closure
would be a laparotomy in which the incision was closed to the level of the deep tissue layers,
sometimes called “fascial layers” or “deep fascia,” but the skin level was left open. Another
example would be an “open abdomen” case in which the abdomen is left completely open after
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the surgery. Wounds with non-primary closure may or may not be described as "packed” with
gauze or other material, and may or may not be covered with plastic, “wound vacs,” or other
synthetic devices or materials.
Primary Closure is defined as closure of the skin level during the original surgery, regardless
of the presence of wires, wicks, drains, or other devices or objects extruding through the
incision. This category includes surgeries where the skin is closed by some means. Thus, if
any portion of the incision is closed at the skin level, by any manner, a designation of primary
closure should be assigned to the surgery.
Note: If a procedure has multiple incision/laparoscopic trocar sites and any of the incisions are
closed primarily then the procedure technique is recorded as primary closed.
Scope: An instrument used to visualize the interior of a body cavity or organ. In the context of
an NHSN operative procedure, use of a scope involves creation of several small incisions to
perform or assist in the performance of an operation rather than use of a traditional larger
incision (i.e., open approach). Robotic assistance is considered equivalent to use of a scope for
NHSN SSI surveillance. See also Instructions for Completion of Denominator for Procedure
Form and both Numerator Data and Denominator Data reporting instructions in this chapter.
Note: If a scope site has to be extended for hand assist or removal of specimen this will still
meet scope = Yes. If the procedure is converted to an open procedure it will be scope = No.
Secondary BSI Attribution Period: The secondary BSI attribution period for SSI is a 17-day
period that includes the date of event, 3 days prior and 13 days after.
Trauma: Blunt or penetrating injury occurring prior to the start of the procedure.
Weight: The patient’s most recent weight documented in the medical record in pounds (lbs.) or
kilograms (kg) prior to or otherwise closest to the procedure.
Wound class: An assessment of the degree of contamination of a surgical wound at the time of
the operation. Wound class should be assigned by a person involved in the surgical procedure
(e.g., surgeon, circulating nurse, etc.). The wound class system used in NHSN is an adaptation
of the American College of Surgeons wound classification schema.
There are a group of NHSN procedures that can never be coded as clean. NHSN reached the
decision regarding which NHSN operative procedures can never be classified as clean based
on feedback from external experts in the field of surgery.
The procedures that can never be entered as clean are: APPY, BILI, CHOL, COLO, REC, SB
and VHYS. Therefore, for these procedures in the application clean is not an option on the
drop down menu.

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For all other procedures clean is available as a choice and if the surgical team deems the
procedure to be clean it can be entered as such into the NHSN application. For example
CSEC, HYST, or OVRY can be a clean wound class if documented as such.
Wounds are divided into four classes:
1. Clean: An uninfected operative wound in which no inflammation is encountered and
the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In
addition, clean wounds are primarily closed and, if necessary, drained with closed
drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma
should be included in this category if they meet the criteria.
Note: The clean wound classification level will not be available for denominator data
entry for the following NHSN operative procedure categories: APPY, BILI, CHOL,
COLO, REC, SB, and VHYS
2. Clean-Contaminated: Operative wounds in which the respiratory, alimentary, genital,
or urinary tracts are entered under controlled conditions and without unusual
contamination. Specifically, operations involving the biliary tract, appendix, vagina,
and oropharynx are included in this category, provided no evidence of infection or
major break in technique is encountered.
3. Contaminated: Open, fresh, accidental wounds. In addition, operations with major
breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the
gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is
encountered including necrotic tissue without evidence of purulent drainage (e.g., dry
gangrene) are included in this category.
4. Dirty or Infected: Includes old traumatic wounds with retained devitalized tissue and
those that involve existing clinical infection or perforated viscera. This definition
suggests that the organisms causing postoperative infection were present in the
operative field before the operation.

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Table 2. Surgical Site Infection Criteria

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Criterion

Surgical Site Infection (SSI)
Superficial incisional SSI
Must meet the following criteria:
Infection occurs within 30 days after any NHSN operative procedure
(where day 1 = the procedure date), including those coded as ‘OTH’*
AND
involves only skin and subcutaneous tissue of the incision
AND
patient has at least one of the following:
a.
purulent drainage from the superficial incision.
b.
organisms isolated from an aseptically-obtained culture
from the superficial incision or subcutaneous tissue.
c.
superficial incision that is deliberately opened by a surgeon,
attending physician** or other designee and is not cultured
AND
patient has at least one of the following signs or symptoms: pain
or tenderness; localized swelling; erythema; or heat. A culture
negative finding does not meet this criterion.
d. diagnosis of a superficial incisional SSI by the surgeon or
attending physician** or other designee.
*http://www.cdc.gov/nhsn/XLS/ICD-9-cmCODEScurrent.xlsx

Comments

** The term attending physician for the purposes of application of the
NHSN SSI criteria may be interpreted to mean the surgeon(s), infectious
disease, other physician on the case, emergency physician or physician’s
designee (nurse practitioner or physician’s assistant).
There are two specific types of superficial incisional SSIs:
1. Superficial Incisional Primary (SIP) – a superficial incisional SSI
that is identified in the primary incision in a patient that has had an
operation with one or more incisions (e.g., C-section incision or
chest incision for CBGB)
2. Superficial Incisional Secondary (SIS) – a superficial incisional
SSI that is identified in the secondary incision in a patient that has
had an operation with more than one incision (e.g., donor site
incision for CBGB)

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Reporting
Instructions
for
Superficial
SSI

The following do not qualify as criteria for meeting the NHSN
definition of superficial SSI:
 Diagnosis/treatment of cellulitis (redness/warmth/swelling), by itself,
does not meet criterion d for superficial incisional SSI. An incision
that is draining or culture (+) is not considered a cellulitis.
 A stitch abscess alone (minimal inflammation and discharge confined
to the points of suture penetration)
 A localized stab wound or pin site infection. While it would be
considered either a skin (SKIN) or soft tissue (ST) infection,
depending on its depth, it is not reportable under this module.
Note: a laparoscopic trocar site for an NHSN operative procedure is
not considered a stab wound.
 Circumcision is not an NHSN operative procedure. An infected
circumcision site in newborns is classified as CIRC and is not
reportable under this module.
 An infected burn wound is classified as BURN and is not reportable
under this module.
Deep incisional SSI
Must meet the following criteria:
Infection occurs within 30 or 90 days after the NHSN operative procedure
(where day 1 = the procedure date) according to the list in Table 3
AND
involves deep soft tissues of the incision (e.g., fascial and muscle layers)
AND
patient has at least one of the following:
a. purulent drainage from the deep incision.
b. a deep incision that spontaneously dehisces, or is deliberately
opened or aspirated by a surgeon, attending physician** or other
designee and is culture positive or not cultured
AND
patient has at least one of the following signs or symptoms: fever
(>38°C); localized pain or tenderness. A culture negative finding
does not meet this criterion.
c. an abscess or other evidence of infection involving the deep
incision that is detected on gross anatomical or histopathologic
exam, or imaging test.
** The term attending physician for the purposes of application of the
NHSN SSI criteria may be interpreted to mean the surgeon(s), infectious
disease, other physician on the case, emergency physician or physician’s
designee (nurse practitioner or physician’s assistant).

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Comments

There are two specific types of deep incisional SSIs:
1. Deep Incisional Primary (DIP) – a deep incisional SSI that is
identified in a primary incision in a patient that has had an
operation with one or more incisions (e.g., C-section incision or
chest incision for CBGB)
2. Deep Incisional Secondary (DIS) – a deep incisional SSI that is
identified in the secondary incision in a patient that has had an
operation with more than one incision (e.g., donor site incision for
CBGB)
Organ/Space SSI
Must meet the following criteria:
Infection occurs within 30 or 90 days after the NHSN operative procedure
(where day 1 = the procedure date) according to the list in Table 3
AND
infection involves any part of the body deeper than the fascial/muscle
layers, that is opened or manipulated during the operative procedure
AND
patient has at least one of the following:
a. purulent drainage from a drain that is placed into the organ/space
(e.g., closed suction drainage system, open drain, T-tube drain, CT
guided drainage)
b. organisms isolated from an aseptically-obtained culture of fluid or
tissue in the organ/space
c. an abscess or other evidence of infection involving the
organ/space that is detected on gross anatomical or histopathologic
exam, or imaging test
AND
meets at least one criterion for a specific organ/space infection site listed
in Table 4. These criteria are in the Surveillance Definitions for Specific
Types of Infections chapter.

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Table 3. Surveillance Period for Deep Incisional or Organ/Space SSI Following Selected
NHSN Operative Procedure Categories. Day 1 = the date of the procedure.

30-day Surveillance
Code
AAA
AMP
APPY
AVSD
BILI
CEA
CHOL
COLO
CSEC
GAST
HTP

Operative Procedure
Abdominal aortic aneurysm repair
Limb amputation
Appendix surgery
Shunt for dialysis
Bile duct, liver or pancreatic surgery
Carotid endarterectomy
Gallbladder surgery
Colon surgery
Cesarean section
Gastric surgery
Heart transplant

Code
LAM
LTP
NECK
NEPH
OVRY
PRST
REC
SB
SPLE
THOR
THYR

HYST
KTP

Abdominal hysterectomy
Kidney transplant

VHYS
XLAP
OTH

Operative Procedure
Laminectomy
Liver transplant
Neck surgery
Kidney surgery
Ovarian surgery
Prostate surgery
Rectal surgery
Small bowel surgery
Spleen surgery
Thoracic surgery
Thyroid and/or parathyroid
surgery
Vaginal hysterectomy
Exploratory Laparotomy
Other NHSN operative
procedures not included in these
categories

90-day Surveillance
Code
BRST
CARD
CBGB
CBGC
CRAN
FUSN
FX
HER
HPRO
KPRO
PACE
PVBY
RFUSN
VSHN

Operative Procedure
Breast surgery
Cardiac surgery
Coronary artery bypass graft with both chest and donor site incisions
Coronary artery bypass graft with chest incision only
Craniotomy
Spinal fusion
Open reduction of fracture
Herniorrhaphy
Hip prosthesis
Knee prosthesis
Pacemaker surgery
Peripheral vascular bypass surgery
Refusion of spine
Ventricular shunt

Note: Superficial incisional SSIs are only followed for a 30-day period for all procedure types.

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Table 4. Specific Sites of an Organ/Space SSI.
Code
BONE

Osteomyelitis

Site

BRST
CARD
DISC
EAR

Breast abscess or mastitis
Myocarditis or pericarditis
Disc space
Ear, mastoid

EMET
ENDO
EYE
GIT
HEP
IAB
IC
JNT

Endometritis
Endocarditis
Eye, other than conjunctivitis
GI tract
Hepatitis
Intraabdominal, not specified
Intracranial, brain abscess or dura
Joint or bursa

Code
Site
LUNG Other infections of the respiratory
tract
MED
Mediastinitis
MEN
Meningitis or ventriculitis
ORAL Oral cavity (mouth, tongue, or gums)
OREP Other infections of the male or female
reproductive tract
PJI
Periprosthetic Joint Infection
SA
Spinal abscess without meningitis
SINU Sinusitis
UR
Upper respiratory tract
USI
Urinary System Infection
VASC Arterial or venous infection
VCUF Vaginal cuff

(Criteria for these sites can be found in the NHSN Help system [must be logged in to NHSN]
or the Surveillance Definitions for Specific Types of Infections chapter).

Numerator Data: All patients having any of the procedures included in the selected NHSN
operative procedure category(s) are monitored for signs of SSI. The Surgical Site Infection
(SSI) form is completed for each such patient found to have an SSI. If no SSI events are
identified during the surveillance month, check the “Report No Events” field in the Missing
PA Events tab of the Incomplete/Missing List.
The Instructions for Completion of the Surgical Site Infection form include brief instructions
for collection and entry of each data element on the form. The SSI form includes patient
demographic information and information about the operative procedure, including the date
and type of procedure. Information about the SSI includes the date of SSI, specific criteria met
for identifying the SSI, when/how the SSI was detected, whether the patient developed a
secondary bloodstream infection, whether the patient died, and the organisms isolated from
cultures and the organisms’ antimicrobial susceptibilities.

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SSI Event Reporting Instructions:
1. Attributing SSI to an NHSN procedure when there is evidence of infection at the time
of the primary surgery: POA definition does not apply to the SSI protocol. If there was
evidence of infection at the time of the procedure and then later in the surveillance period
the patient develops an infection that meets the NHSN SSI criteria it is attributed to the
procedure (see PATOS below). A high wound class is not exclusion for a patient later
meeting criteria for an SSI.
2. Infection present at time of surgery (PATOS): PATOS denotes that there is evidence of
an infection or abscess at the start of or during the index surgical procedure (in other
words, it is present preoperatively). PATOS is a YES/NO field on the SSI Event form.
PATOS does not apply if there is a period of wellness between the time of a preoperative
condition and surgery. The evidence of infection or abscess must be noted/documented
preoperatively or found intraoperatively in a pre-operative or intraoperative note. Only
select PATOS = YES if it applies to the depth of SSI that is being attributed to the
procedures (e.g., if a patient had evidence of an intraabdominal infection at the time of
surgery and then later return with an organ/space SSI the PATOS field would be selected
as a YES. If the patient returned with a superficial or deep incisional SSI the PATOS field
would be selected as a NO). The patient does not have to meet the NHSN definition of an
SSI at the time of the primary procedure but there must be notation that there is evidence
of an infection or abscess present at the time of surgery.
a) Example: Patient admitted with an acute abdomen. Sent to OR for an XLAP where
there is a finding of an abscess due to ruptured appendix and an APPY is performed.
Patient returns two weeks later and meets criteria for an organ/space IAB SSI. The
PATOS field would be selected as YES on the SSI event.
b) Example: Patient is admitted with a ruptured diverticulum. In the OR note the surgeon
documents that there are multiple abscesses in the intraabdominal cavity. Patient
returns three weeks later and meets criteria for a superficial SSI. The PATOS field
would be selected as NO since there was no documentation of evidence of infection or
abscess of the superficial area at the time of the procedure.
c) Example: During an unplanned cesarean section (CSEC) the surgeon nicks the bowel
and there is contamination of the intraabdominal cavity. One week later the patient
returns and meets criteria for an organ/space OREP (other reproductive) SSI. The
PATOS field would be selected as NO since there was no documentation of evidence
of infection or abscess at the time of the CSEC. The colon nick was a complication but
there was no infection present at the time of surgery.

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3. Multiple tissue levels are involved in the infection: The type of SSI (superficial
incisional, deep incisional, or organ/space) reported should reflect the deepest tissue layer
involved in the infection during the surveillance period:
a) Report infection that involves the organ/space as an organ/space SSI, whether or
not it also involves the superficial or deep incision sites.
b) Report infection that involves the superficial and deep incisional sites as a deep
incisional SSI.
c) If an SSI started as a superficial SSI on day 10 of the SSI surveillance period and
then a week later, (day 17 of the SSI surveillance period) meets criteria for a deep
incisional SSI the date of event would be the date the of deep incisional SSI.
4. Reporting of SSI after a non-primary closure: If a patient develops an SSI after a nonprimary closure it should be reported as attributable to that procedure if it meets criteria for
an SSI within the surveillance period.
5. Attributing SSI to a NHSN procedure when several are performed on different dates:
If a patient has several NHSN operative procedures performed on different dates prior to
an infection, report the operative procedure code of the operation that was performed most
closely in time prior to the infection date, unless there is evidence that the infection was
associated with a different operation.
Note: for multiple NHSN operative procedures performed within a 24 hour period, see
Denominator Reporting Instruction #9.
6. Attributing SSI to NHSN procedures that involve multiple primary incision sites: If
multiple primary incision sites of the same NHSN operative procedure become infected,
only report as a single SSI, and assign the type of SSI (superficial incisional, deep
incisional, or organ/space) that represents the deepest tissue level involved at any of the
infected sites. For example:
a) If one laparoscopic incision meets criteria for a superficial incisional SSI and
another meets criteria for a deep incisional SSI, only report one deep incisional SSI.
b) If one or more laparoscopic incision sites meet criteria for superficial incisional SSI
but the patient also has an organ/space SSI related to the laparoscopic procedure,
only report one organ/space SSI.
c) If an operative procedure is limited to a single breast and involves multiple
incisions in that breast that become infected, only report a single SSI.
d) In a colostomy formation or reversal (take down) procedure, the stoma and other
abdominal incision sites are considered primary incisions. If both the stoma and
another abdominal incision site develop superficial incisional SSI, report only as
one SSI (SIP).
7. Attributing SSI to NHSN procedures that have secondary incision sites: Certain
procedures can involve secondary incisions (i.e., BRST, CBGB, CEA, FUSN, PVBY,
REC, RFUSN, and VSHN). The surveillance period for all secondary sites is 30 days,
regardless of the required deep incisional or organ/space SSI surveillance period for the
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primary incision site(s) (Table 3). Procedures meeting this designation are reported as only
one operative procedure. For example:
a) A saphenous vein harvest incision site in a CBGB procedure is considered the
secondary incision. One CBGB procedure is reported, the saphenous vein harvest
site is monitored for 30 days after surgery for SSI, and the chest incision is
monitored for 90 days. If the patient has a superficial infection of the leg site and a
deep incisional SSI of the chest site two SSIs are reported.
b) A tissue harvest site (e.g., Transverse Rectus Abdominis Myocutaneous [TRAM]
flap) in a BRST procedure is considered the secondary incision site. One BRST
procedure is reported, and if the secondary incision gets infected, report as either
SIS or DIS as appropriate.
8. SSI detected at another facility: It is required that if an SSI is detected at a facility other
than the one in which the operation was performed, notify the IP of the index facility with
enough detail so the infection can be reported to NHSN. When reporting the SSI, the index
facility should indicate that Detected = RO – (Readmission to facility other than where
procedure was performed).
9. SSI Attribution after Multiple types of NHSN procedures are performed during a
single trip to the OR: If more than one NHSN operative procedure category was
performed through a single incision/laparoscopic sites during a single trip to the operating
room, attribute the SSI to the procedure that is thought to be associated with the infection.
If it is not clear, as is often the case when the infection is an incisional SSI, use the NHSN
Principal Operative Procedure Category Selection Lists (Table 5) to select the operative
procedure to which the SSI should be attributed. For example, if a patient develops SSI
after a single trip to the OR in which both a COLO and SB were performed, and the source
of the SSI is not apparent, assign the SSI to the COLO procedure.
10. SSI following invasive manipulation/accession of the operative site: If during the postoperative period the surgical site has an invasive manipulation/accession for diagnostic or
therapeutic purposes (e.g., needle aspiration), and following this manipulation/accession an
SSI develops, the infection is not attributed to the operation. This reporting instruction
does NOT apply to closed manipulation (e.g., closed reduction of a dislocated hip after an
orthopedic procedure). Invasive manipulation does not include wound packing, or
changing of wound packing materials as part of postoperative care.
11.

Reporting instructions for specific post-operative infection scenarios: An SSI that
otherwise meets the NHSN definitions should be reported to NHSN without regard to postoperative accidents, falls, inappropriate showering or bathing practices, or other
occurrences that may or may not be attributable to patients’ intentional or unintentional
postoperative actions. Also, SSI should also be reported regardless of the presence of
certain skin conditions (e.g., dermatitis, blister, impetigo) that occur near an incision, and
regardless of the possible occurrence of a “seeding” event from an unrelated procedure
(e.g., dental work). This instruction concerning various postoperative circumstances is

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necessary to reduce subjectivity and data collection burden associated with the previously
exempted scenarios.
Table 5. NHSN Principal Operative Procedure Category Selection Lists
(The following lists are derived from the operative procedures listed in Table 1. The
categories with the highest risk of SSI are listed before those with lower risks).
Priority
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Priority
1
2
3
4
5
Priority
1
2
3
4
5
Priority
1
2

Code
LTP
COLO
BILI
SB
REC
KTP
GAST
AAA
HYST
CSEC
XLAP
APPY
HER
NEPH
VHYS
SPLE
CHOL
OVRY
Code
HTP
CBGB
CBGC
CARD
THOR
Code
VSHN
RFUSN
CRAN
FUSN
LAM
Code
NECK
THYR

January 2015 (Modified April 2015)

Abdominal Operations
Liver transplant
Colon surgery
Bile duct, liver or pancreatic surgery
Small bowel surgery
Rectal surgery
Kidney transplant
Gastric surgery
Abdominal aortic aneurysm repair
Abdominal hysterectomy
Cesarean section
Laparotomy
Appendix surgery
Herniorrhaphy
Kidney surgery
Vaginal Hysterectomy
Spleen surgery
Gall bladder surgery
Ovarian surgery
Thoracic Operations
Heart transplant
Coronary artery bypass graft with donor incision(s)
Coronary artery bypass graft, chest incision only
Cardiac surgery
Thoracic surgery
Neurosurgical (Brain/Spine) Operations
Ventricular shunt
Refusion of spine
Craniotomy
Spinal fusion
Laminectomy
Neck Operations
Neck surgery
Thyroid and or parathyroid surgery

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Denominator Data: For all patients having any of the procedures included in the NHSN
Operative Procedure category(s) selected for surveillance during the month, complete the
Denominator for Procedure form. The data are collected individually for each operative
procedure performed during the month specified on the Patient Safety Monthly Reporting
Plan. The Instructions for Completion of the Denominator for Procedure Form include brief
instructions for collection and entry of each data element on the form.
Denominator Reporting Instructions:
1. Closure type: Incisional closure is NOT a part of the NHSN operative procedure
definition; all otherwise eligible procedures are included in the denominator reporting,
regardless of closure type. The closure technique is entered for each denominator for
procedure. If a procedure has multiple incision sites and any of the incisions are closed
primarily then the procedure is entered as a primary closure.
Note: When the patient returns to the OR within 24 hours of the end of the first procedure
assign the surgical wound closure that applies when the patient leaves the OR from the first
operative procedure.
2. Wound class: A high wound class is not exclusion for denominator reporting. If the
procedure meets the definition of an NHSN operative procedure it should be reported in
the denominator data regardless of wound class. NHSN will use the wound class for risk
adjustment, as appropriate.
3. Different operative procedure categories performed during same trip to the OR: If
procedures in more than one NHSN operative procedure category are performed during the
same trip to the operating room through the same or different incisions, a Denominator for
Procedure form is reported for each NHSN operative procedure category being monitored.
For example, if a CARD and CBGC are done through the same incision, a Denominator
for Procedure form is reported for each. In another example, if following a motor vehicle
accident, a patient has an open reduction of fracture (FX) and splenectomy (SPLE)
performed during the same trip to the operating room and both procedure categories are
being monitored, complete a Denominator for Procedure form for each.
EXCEPTION: If a patient has both a CBGC and CBGB during the same trip to the
operating room, report only as a CBGB. Only report as a CBGC if there is only a chest
incision. CBGB and CBGC are never reported for the same patient for the same trip to the
operating room.
4. Duration of the procedure when more than one category of NHSN operative
procedure is performed through the same incision: If more than one NHSN operative
procedure category is performed through the same incision during the same trip to the
operating room, record the combined duration of all procedures, which is the time from
procedure/surgery start time to procedure/surgery finish time. For example, if a CBGC and

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a CARD are performed on a patient during the same trip to the operating room, the time
from start time to finish time is reported for both operative procedures.
5. Duration of Operative procedures if patient has two different NHSN operative
procedures performed via separate incisions on the same trip to the OR; try to
determine the correct duration for each separate procedure (if this is documented),
otherwise, take the time for both procedures and split it evenly between the two.
6. Same operative procedure category but different ICD-9-CM codes during same trip
to the OR: If procedures of different ICD-9-CM codes from the same NHSN operative
procedure category are performed through the same incision/laparoscopic sites, record only
one procedure for that category. For example, a facility is performing surveillance for
CARD procedures. A patient undergoes a replacement of both the mitral and tricuspid
valves (35.23 and 35.27, both CARD) during the same trip to the operating room.
Complete one CARD Denominator for Procedure form because ICD-9-CM codes 35.23
and 35.27 fall in the same operative procedure category [CARD] (see Table 1).
7. For revision HPRO and KPRO procedures: If total or partial revision HPRO or KPRO
is performed, also evaluate if any of the following ICD-9-CM diagnosis or procedure
codes (below) were coded in the 90 days prior to and including the index HPRO or KPRO
revision. If any of the specified codes is recorded, indicate that the revision was associated
with ‘prior infection at index joint.’ Note that the ‘prior infection at index joint’ variable
only applies to revision HPRO and KPRO. Additionally, it is not necessary to review the
medical record for additional details concerning the prior infection; this variable is defined
by the presence of one or more of the following ICD-9-CM codes in the 90-day
preoperative (including index revision) period:
 84.56 Insertion or replacement of (cement) spacer
 84.57 Removal of (cement) spacer
 V88.21 Acquired absence of hip joint, with or without the presence of an antibioticimpregnated spacer
 V88.22 Acquired absence of knee joint, with or without the presence of an antibioticimpregnated spacer


Complications peculiar to certain specified procedures, infection and inflammatory
reaction due to internal prosthetic device, implant and graft (extensions of 996, 996.6):
o 996.60 Due to unspecified device, implant and graft
o 996.66 Due to internal joint prosthesis
o 996.67 Due to other internal orthopedic device, implant, and graft
o 996.69 Due to other internal prosthetic device, implant, and graft

8. Same NHSN operative procedure via separate incisions: For operative procedures that
can be performed via separate incisions during same trip to operating room (i.e., AMP,
BRST, CEA, FUSN, FX, HER, HPRO, KPRO, LAM, NEPH, OVRY, PVBY, REFUSN),
separate Denominator for Procedure forms are completed. To document the duration of
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the procedures, indicate the procedure/surgery start time to procedure/surgery finish time
for each procedure separately or, alternatively, take the total time for the procedures and
split it evenly between procedures.
Note: Laparoscopic hernia repairs are considered one procedure, regardless of the number
of hernias that are repaired in that trip to the OR. In most cases there will be only one
incision time documented for this procedure. If more than one time is documented, total
the durations. Open (i.e., non-laparoscopic) hernia repairs are reported as one procedure for
each hernia repaired via a separate incision, (i.e., if two incisions are made to repair two
defects), then two procedures will be reported. It is anticipated that separate incision times
will be recorded for these procedures. If not, take the total time for both procedures and
split it evenly between the two.
9. More than one operative procedure through same incision within 24 hours: If a
patient goes to the operating room more than once during the same admission and another
procedure of the same or different NHSN procedure category is performed through the
same incision and the start time of the second procedure is within 24 hours of the finish
time of the original operative incision, report only one Denominator for Procedure form
for the original procedure, combining the durations for both procedures based on the
procedure start times and finish times for both procedures. For example, a patient has a
CBGB lasting 4 hours. He returns to the OR six hours later to correct a bleeding vessel
(OTH). The second operation has duration of 1.5 hours. Record the operative procedure as
one CBGB and the duration of operation as 5 hour 30 minutes. If the wound class has
changed, report the higher wound class. If the ASA class has changed, report the higher
ASA class. Do not report the ‘OTH’ procedure.
Note: When the patient returns to the OR within 24 hours of the end of the first procedure
assign the surgical wound closure technique that applies when the patient leaves the OR
from the first operative procedure.
10. Patient expires in the OR: If a patient expires in the operating room, do not complete a
Denominator for Procedure form. This operative procedure is excluded from the
denominator.
11. Laparoscopic hysterectomy – HYST or VHYS: When assigning the correct ICD-9-CM
hysterectomy procedure code, a trained coder must determine what structures were
detached and how they were detached based on the medical record documentation. The
code assignment is based on the surgical technique or approach used for the detachment of
those structures, not on the location of where the structures were physically removed from
the patient’s body.

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Data Analyses: The Standardized Infection Ratio (SIR) is calculated by dividing the number
of observed infections by the number of predicted (i.e., expected) infections. The number of
predicted infections is calculated using SSI probabilities estimated from multivariate logistic
regression models constructed from NHSN data during a baseline time period, which
represents a standard population’s SSI experience4.
There are three SSI SIR models available from NHSN, each briefly described in the table
below.
All SSI SIR
Model





Complex
A/R SSI
Model




Complex
30-day SSI
model (used
for CMS
IPPS)








Includes Superficial, Deep & Organ/Space SSIs
Superficial & Deep incisional SSIs limited to primary incisional SSIs only
Includes SSIs identified on admission, readmission & via post-discharge
surveillance
Includes only Deep incisional primary SSIs & Organ/Space SSIs
Includes only SSIs identified on Admission/Readmission to facility where
procedure was performed
Includes only inpatient procedures
Used for the HAI Progress Report, published annually by CDC
Includes only in-plan, inpatient COLO and HYST procedures in adult
patients (i.e., ≥ 18 years of age)
Includes only deep incisional primary SSIs and organ/space SSIs with an
event date within 30 days of the procedure
Uses only age and ASA to determine risk
Used only for CMS IPPS reporting and for public reporting on Hospital
Compare

While the SSI SIR can be calculated for single procedure categories and for specific surgeons,
the measure also allows you to summarize your data across multiple procedure categories
while adjusting for differences in the estimated probability of infection among the patients
included across the procedure categories. For example, you will be able to obtain one SSI SIR
adjusting for all procedures reported. Alternatively, you can obtain one SSI SIR for all colon
surgeries (COLO) only within your facility.
Additional Notes about SSI SIRS:
1. Primary closure: All of the SSI SIRs that use the 2006-2008 SSI baseline data will
include only those procedures that were reported with a primary closure method.3
2. Infection present at time of surgery (PATOS): All of the SSI SIRs that use the 20062008 SSI baseline will include SSIs that are reported as present at time of surgery.
3. SIRs based on Procedure Date: SSIs will be included in the numerator of an SIR
based on the date of procedure, not the date of event.

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Procedure-associated Module
SSI

4. Calculation of the SIR: The SIR will be calculated only if the number of predicted
HAIs (“numExp” in the NHSN application) is ≥ 1 to help enforce a minimum precision
criterion.
SIR = Observed (O) HAIs
Expected (E) HAIs
SSI rates per 100 operative procedures are calculated by dividing the number of SSIs by the
number of specific operative procedures and multiplying the results by 100. SSIs will be
included in the numerator of a rate based on the date of procedure, not the date of event. Using
the advanced analysis feature of the NHSN application, SSI rate calculations can be performed
separately for the different types of operative procedures and stratified by the basic risk index.
Descriptive analysis options of numerator and denominator data are available in the NHSN
application, such as line listings, frequency tables, and bar and pie charts. SIRs and SSI rates
and run charts are also available. Guides on using NHSN analysis features are available from:
http://www.cdc.gov/nhsn/PS-Analysis-resources/reference-guides.html

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Procedure-associated Module
SSI

References
1.

2.

3.
4.

5.
6.
7.

8.

9.

10.
11.
12.

13.

14.

CDC. Data from the National Hospital Discharge Survey. 2010 [cited 2013 Dec
10]; Available from:
http://www.cdc.gov/nchs/data/nhds/4procedures/2010pro_numberpercentage.pdf.
Magill, S.S., et al., "Prevalence of healthcare-associated infections in acute care
hospitals in Jacksonville, Florida". Infection Control Hospital Epidemiology, 33(3):
(2012): 283-91.
Magill, S.S., et al., "Multistate point-prevalence survey of health care-associated
infections". New England Journal of Medicine, 370(13): (2014): 1198-208.
Mu, Y., et al., "Improving risk-adjusted measures of surgical site infection for the
national healthcare safety network". Infection Control Hospital Epidemiology, 32(10):
(2011): 970-86.
Awad, S.S., "Adherence to surgical care improvement project measures and postoperative surgical site infections". Surgical Infection (Larchmt), 13(4): (2012): 234-7.
Condon, R.E., et al., "Effectiveness of a surgical wound surveillance program".
Archives of Surgery, 118(3): (1983): 303-7.
Consensus paper on the surveillance of surgical wound infections. The Society for
Hospital Epidemiology of America; The Association for Practitioners in Infection
Control; The Centers for Disease Control; The Surgical Infection Society. Infection
Control Hospital Epidemiology, 13(10): (1992): 599-605.
Haley, R.W., et al., "The efficacy of infection surveillance and control programs
in preventing nosocomial infections in US hospitals". American Journal of
Epidemiology, 121(2) :(1985):182-205.
Mangram, A.J., et al., "Guideline for prevention of surgical site infection, 1999".
Hospital Infection Control Practices Advisory Committee. Infection Control Hospital
Epidemiology, 20(4): (1999): 250-78; quiz 279-80.
Institute, F.G., Guidelines for design and construction of health care facilities. 2010, Chicago,
IL: American Society for Healthcare Engineering.
Anonymous, "New classification of physical status". Anesthesiology, 24: (1963):
111.
ASA. ASA Physical Status Classification System. [cited 2013 Dec 10]; Available
from: http://www.asahq.org/Home/For-Members/Clinical-Information/ASA-PhysicalStatus-Classification-System.
Donham, R.T., W.J. Mazzei, and R.L. Jones, Association of Anesthesia Clinical
Directors' Procedure Times Glossary. American Journal of Anesthesiology, 23(5S):
(1996):S1-S12.
Centers for Disease Control and Prevention. The National Healthcare Safety
Network (NHSN) Manual: Patient Safety Component. Atlanta, GA: Division of
Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious
Diseases. Available at: http://www.cdc.gov/nhsn/acute-care-hospital/index.html.

January 2015 (Modified April 2015)

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SSI

Instructions for Completion of Surgical Site Infection (SSI) Form
(CDC 57.120)
Data Field
Facility ID
Event #
Patient ID

Social Security #
Secondary ID
Medicare #
Patient Name
Gender
Date of Birth
Ethnicity
Race

Event Type
Date of Event

NHSN Procedure
Code

ICD-10-CM or CPT
Procedure Code

Instructions for Data Collection
The NHSN-assigned facility ID will be auto-entered by the computer.
Event ID number will be auto-entered by the computer.
Required. Enter the alphanumeric patient ID number. This is the patient
identifier assigned by the hospital and may consist of any combination of
numbers and/or letters.
Optional. Enter the 9-digit numeric patient Social Security Number.
Optional. Enter the alphanumeric ID number assigned by the facility.
Conditionally required. Enter the patient’s Medicare number for all events
reported as part of a CMS Quality Reporting Program.
Optional. Enter the last, first, and middle name of the patient.
Required. Check Female, Male, or Other to indicate the gender of the patient.
Required. Record the date of the patient birth using this format:
MM/DD/YYYY.
Optional. Specify if the patient is either Hispanic or Latino, or Not Hispanic or
Not Latino.
Optional. Specify one or more of the choices below to identify the patient’s
race:
American Indian/Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
White
Required. Enter SSI.
Required. The date when the first element used to meet the SSI infection
criterion occurred for the first time during the surveillance period.
Synonyms: infection date, date of infection.
Date of event must be within 30 days or 90 days of the date of procedure,
depending on the operative procedure category (see Table 3 of the SSI chapter).
Required. Enter the appropriate NHSN procedure code. For detailed
instructions on how to report NHSN operative procedures, see the SSI chapter.
Note: An SSI cannot be “linked” to an operative procedure unless that
procedure has already been added to NHSN. If the procedure was previously
added, and the “Link to Procedure” button is clicked, the fields pertaining to the
operation will be auto-entered by the computer.
Optional. The ICD-10-CM or CPT code may be entered here instead of (or in
addition to) the NHSN Procedure Code. If the ICD-10-CM or CPT code is
entered, the NHSN code will be auto-entered by the computer. If the NHSN
code is entered first, you will have the option to select the appropriate ICD-10CM or CPT code. In either case, it is optional to select the ICD-10-CM or
CPTcode. The only allowed ICD-10-CM or CPT codes are shown in ? excel

January 2015 (Modified April 2015)

29

SSI

spread sheet with list of ICD-10-CM and CPT codes found in the Supporting
Materials section of the SSI section of the NHSN website.
Date of Procedure
Outpatient Procedure

MDRO Infection
Surveillance

Required. Record the date when the NHSN procedure started using this format:
MM/DD/YYYY.
Required. Check Y, if NHSN operative procedure is performed on a patient
whose date of admission to the healthcare facility and date of discharge are the
same calendar day, otherwise check N.
Required. Enter “Yes”, if the pathogen is being followed for Infection
Surveillance in the MDRO/CDI Module in that location as part of your
Monthly Reporting Plan: MRSA, MSSA (MRSA/MSSA), VRE, CephRKlebsiella, CRE (E. coli, Klebsiella pneumoniae, Klebsiella oxytoca, or
Enterobacter), MDR-Acinetobacter, or C. difficile.
If the pathogen for this infection happens to be an MDRO but your facility is
not following the Infection Surveillance in the MDRO/CDI Module in your
Monthly Reporting Plan, answer “No” to this question.
Note: For an SSI, the location of attribution is the post-op location, therefore
answer YES to this question if:


the event occurs in a different calendar month from the surgical procedure

AND


Date Admitted to
Facility

Location

the facility is performing Infection Surveillance for the organism causing the
SSI in the post-op location for the month reported in the Date of Event.

Required. Enter date patient admitted to facility using this format:
MM/DD/YYYY. If a patient is readmitted with a previously unreported SSI
associated with an operative procedure performed during a previous admission,
enter the date of admission of the facility stay in which the operative procedure
was performed.
When determining a patient’s admission dates to both the facility and specific
inpatient location, the NHSN user must take into account all such days,
including any days spent in an inpatient location as an “observation” patient
before being officially admitted as an inpatient to the facility, as these days
contribute to exposure risk. Therefore, all such days are included in the counts
of admissions and patient days for the facility and specific location, and facility
and admission dates must be moved back to the first day spent in the inpatient
location.
Conditionally required if MDRO Infection Surveillance field is Yes. Enter the
inpatient location to which the patient was assigned on the date of the SSI
event. If the date of the SSI occurs on the day of transfer/discharge or the next
day, indicate the transferring/discharging location, not the current location of
the patient, in accordance with the Transfer Rule (see Key Terms section).
If the patient is readmitted with the SSI during the surveillance period use the
location that the patient was discharge from the stay that the OR procedure was
performed.

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SSI

Event Details:
Specific event

Event Details:
Specify Criteria Used

Infection present at
the time of surgery
(PATOS)

Event Details:
Detected

Event Details:
Secondary
bloodstream infection

Event Details:
Died
Event Details:
SSI Contributed to
Death
Event Details:
Discharge Date

Inpatient or outpatient locations are allowed, but Operating Room locations are
not allowed.
Required. Check the appropriate level of SSI from the list
___Superficial incisional primary (SIP)
___Superficial incisional secondary (SIS)
___Deep incisional primary (DIP)
___Deep incisional secondary (DIS)
___ Organ/space: __ (Indicate specific site code from Table 2 of the SSI
chapter.)
Required. Check each of the elements of the definition that were used to
identify the specific type of SSI. Specific organ/space event types have their
own unique criteria which must be met. They are found in the Surveillance
Definitions chapter.
Required. Check Y if there is evidence of an infection or abscess at the start of,
or during, the index surgical procedure (in other words, it is present
preoperatively). PATOS does not apply if there is a period of wellness between
the time of a preoperative condition and surgery. The evidence of infection or
abscess must be noted/documented preoperatively or found intraoperatively in a
pre-operative or intraoperative note.
Required.
Check A if SSI was identified before the patient was discharged from the
facility following the operation.
Check P if SSI was identified only as part of post-discharge surveillance.
Include as P those SSI identified in the Emergency Department but not
readmitted to the facility. Alternatively, if patient was identified by postdischarge surveillance but was also readmitted to the facility, check either RF
or RO as appropriate.
Check RF if SSI was identified due to patient readmission to the facility where
the operation was performed.
Check RO if SSI was identified due to readmission to facility other than where
the operation was performed.
Required. Check Y if there is a culture-confirmed bloodstream infection (BSI)
and a related healthcare-associated infection at the surgical site, otherwise
check N. For detailed instructions on identifying whether the blood culture
represents a secondary BSI, refer to the Secondary BSI Guide (Appendix 1 of
the BSI Event Protocol). The secondary BSI attribution period for SSI is a 17day period that includes the date of event, 3 days prior and 13 days after.
Required. Check Y if patient died during the hospitalization, otherwise check
N.
Conditionally required. If patient died, check Y if such evidence is available
(e.g., death/discharge note, autopsy report, etc.), otherwise check N.
Optional. Enter date patient discharged from facility using this format:
MM/DD/YYYY. If a patient is readmitted with a previously unreported SSI
associated with an operative procedure performed in a previous admission,

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SSI

Event Details:
Pathogens Identified
Pathogen # for
specified Grampositive Organisms,
Gram-negative
Organisms, Fungal
Organisms, or Other
Organisms
Antimicrobial agent
and susceptibility
results

Custom Fields

Comments

enter the date of discharge of the facility stay in which the operative procedure
was performed.
Required. Enter Y if a pathogen was identified, N if otherwise. If Y, specify
organism name on reverse.
Up to three pathogens may be reported. If multiple pathogens are identified,
enter the pathogen judged to be the most important cause of infection as #1, the
next most as #2, and the least as #3 (usually this order will be indicated on the
laboratory report). If secondary BSI pathogens are entered, they should be
entered only after site-specific pathogens are entered. If the species is not given
on the lab report or is not found on the NHSN organism list, then select the
“spp” choice for the genus (e.g., Bacillus natto is not on the list so would be
reported as Bacillus spp.).
Conditionally required if Pathogen Identified = Y.
 For those organisms shown on the back of an event form, susceptibility
results are required only for the agents listed.
 For organisms that are not listed on the back of an event form, the entry
of susceptibility results is optional.
Circle the pathogen’s susceptibility result using the codes on the event forms.
For each box listing several drugs of the same class, at least one drug
susceptibility must be recorded.
Optional. Up to 50 fields may be customized for local or group use in any
combination of the following formats: date (MM/DD/YYYY), numeric, or
alphanumeric.
Note: Each Custom Field must be set up in the Facility/Custom Options section
of the application before the field can be selected for use.
Optional. Enter any information on the event.

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SSI

Instructions for Completion of Denominator for Procedure Form
(CDC 57.121)
This form is used for reporting data on each patient having one of the NHSN operative procedures
selected for monitoring.
Data Field
Facility ID
Procedure #

The NHSN-assigned Procedure # will be auto-entered by
the computer.
Required. Enter the alphanumeric patient ID number.
This is the patient identifier assigned by the hospital and
may consist of any combination of numbers and/or letters.

Patient ID

Social Security #

Optional. Enter the 9-digit numeric patient Social
Security Number.
Optional. Enter the alphanumeric ID number assigned by
the facility.
Optional. Enter the patient’s Medicare number.

Secondary ID #
Medicare #
Patient name
Gender
Date of birth
Ethnicity

Instructions for Data Collection
The NHSN-assigned facility ID will be auto-entered by
the computer.

Optional. Enter the last, first, and middle name of the
patient.
Required. Check Female, Male, or Other to indicate the
gender of the patient.
Required. Record the date of the patient birth using this
format: MM/DD/YYYY.
Optional.
Hispanic or Latino If patient is Hispanic or Latino, check this box.

Not Hispanic or Not Latino If patient is not Hispanic or not Latino, check this box.
Race
Optional. Check all the boxes that apply to identify the
patient’s race.
Event type
Required. Enter the code for procedure (PROC).
NHSN Procedure code
Date of procedure

January 2015 (modified April 2015)

Required. Enter the appropriate NHSN procedure code.
Required. Record the date when the NHSN procedure
started using this format: MM/DD/YYYY.

33

SSI

Data Field
ICD-9-CM procedure code

Instructions for Data Collection
Optional. The ICD-10-CM or CPTcode may be entered
here instead of (or in addition to) the NHSN Procedure
Code. If the ICD-10-CM or CPT code is entered, the
NHSN code will be auto-entered by the computer. If the
NHSN code is entered first, you will have the option to
select the appropriate ICD-10-CM or CPTcode. In either
case, it is optional to select the ICD-10 -CM or CPT code.
The only allowed ICD-10-CM or CPT codes are shown in
? excel spread sheet with list of ICD-10-CM and CPT
codes found in the Supporting Materials section of the
SSI section of the NHSN website.

Procedure Details:
Outpatient: Required. Check Y if the NHSN operative procedure was
performed on a patient whose date of admission to the
healthcare facility and date of discharge are the same
calendar day, otherwise check N., otherwise check N.

Duration: Required. The interval in hours and minutes between the
Procedure/Surgery Start Time, and the Procedure/Surgery
Finish Time, as defined by the Association of Anesthesia
Clinical Directors (AACD):
 Procedure/Surgery Start Time (PST): Time when
the procedure is begun (e.g., incision for a surgical
procedure).
 Procedure/Surgery Finish (PF): Time when all
instrument and sponge counts are completed and
verified as correct, all postoperative radiologic
studies to be done in the OR are completed, all
dressings and drains are secured, and the
physicians/surgeons have completed all
procedure-related activities on the patient.

Wound class: Required. Check the appropriate wound class from the
list. If the wound class is unknown or not listed work with
your OR liaison to obtain a wound class for the
procedure. If this is not possible, assign a wound class
based on the operative procedure and OR notes.
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SSI

Data Field

Instructions for Data Collection

General anesthesia: Required. Check Y if general anesthesia was used for the
operative procedure, otherwise check N. General
anesthesia is defined as the administration of drugs or
gases that enter the general circulation and affect the
central nervous system to render the patient pain free,
amnesic, unconscious, and often paralyzed with relaxed
muscles.
ASA score: Conditionally Required. Required for Inpatient
procedures only. Check numeric ASA classification at the
time of the operative procedure. NOTE: Do NOT report
procedures with an ASA physical status of 6 (a declared
brain-dead patient whose organs are being removed for
donor purposes) to NHSN.
Emergency: Required. Check Y if this operative procedure was a nonelective, unscheduled operative procedure, otherwise
check N. Emergency operative procedures are those that
do not allow for the standard immediate preoperative
preparation normally done within the facility for a
scheduled operation (e.g., stable vital signs, adequate
antiseptic skin preparation, colon decontamination in
advance of colon surgery, etc.).
Trauma: Required. Check Y if operative procedure was performed
because of blunt or penetrating traumatic injury to the
patient, otherwise check N.
Scope: Required. Check Y if the NHSN operative procedure was
a laparoscopic procedure performed using a
laparoscope/robotic assist method, otherwise check N
NOTES:




If a scope site has to be extended for hand assist or
removal of specimen this will still meet scope = Yes. If
the procedure is converted to an open procedure
would it will be scope = No.
For CBGB, if the donor vessel was harvested using a
scope, check Y.

Diabetes Mellitus Required. Indicate Y if the patient has a diagnosis of
diabetes requiring management with insulin or a noninsulin anti-diabetic agent. This includes patients with
January 2015 (modified April 2015)

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SSI

Data Field

Instructions for Data Collection
“insulin resistance” who are on management with an antidiabetic agent. This also includes patients with a
diagnosis of diabetes requiring management with an antidiabetic agent, but who are noted to be non-compliant
with their prescribed medications.
Indicate N if the patient has no known diagnosis of
diabetes, or a diagnosis of diabetes that is controlled by
diet alone. Also indicate N if the patient receives insulin
for perioperative control of hyperglycemia but has no
diagnosis of diabetes.
The discharge ICD-9-CM codes in the 250 to 250.93
range are also acceptable for use to answer YES to the
diabetes field question.
The NHSN definition excludes patients with no diagnosis
of diabetes. The definition excludes patients who receive
insulin for perioperative control of hyperglycemia but
have no diagnosis of diabetes.
Height Required. Height: The patient’s most recent height
documented in the medical record in feet and inches or
meters (m) prior to or otherwise closest to the operative
procedure.
Weight Required. Weight: The patient’s most recent weight
documented in the medical record in pounds (lbs) or
kilograms (kg) prior to or otherwise closest to the
procedure.

Closure Technique Required. Select Primary or Other than Primary
* Primary Closure is defined as closure of the skin level
during the original surgery, regardless of the presence of
wires, wicks, drains, or other devices or objects extruding
through the incision. This category includes surgeries
where the skin is closed by some means. Thus, if any
portion of the incision is closed at the skin level, by any
manner, a designation of primary closure should be
assigned to the surgery. NOTE: If a procedure has
multiple incision/laparoscopic trocar sites and any of the
incisions are closed primarily then the procedure
technique is recorded as primary closed.

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SSI

Data Field

Instructions for Data Collection
Other than Primary is defined as closure that is other than
primary and includes surgeries in which the skin level is
left completely open during the original surgery and
therefore cannot be classified as having primary closure.
For surgeries with non-primary closure, the deep tissue
layers may be closed by some means (with the skin level
left open), or the deep and superficial layers may both be
left completely open. An example of a surgery with nonprimary closure would be a laparotomy in which the
incision was closed to the level of the deep tissue layers,
sometimes called “fascial layers” or “deep fascia,” but the
skin level was left open. Another example would be an
“open abdomen” case in which the abdomen is left
completely open after the surgery. Wounds with nonprimary closure may or may not be described as "packed”
with gauze or other material, and may or may not be
covered with plastic, “wound vacs,” or other synthetic
devices or materials.

Surgeon code: Optional. Enter code of the surgeon who performed the
principal operative procedure.

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SSI

Data Field
CSEC: Duration of labor

Instructions for Data Collection
Conditionally required. If operative procedure is CSEC,
enter number of hours the patient labored in the hospital
from beginning of active labor to delivery of the infant,
expressed in hours. The documentation of active labor
can be supplied in the chart by a member of the
healthcare team or physician. Active labor may be
defined by the individual facility’s policies and
procedures, but should reflect the onset of regular
contractions or induction that leads to delivery during this
admission.
If a patient is admitted for a scheduled CSEC and has not
yet gone into labor, the duration of labor would be 0.
Hours should be rounded in the following manner: ≤30
minutes round down; >30 minutes round up.

Circle one: FUSN RFUSN
FUSN/RFUSN: Spinal level

Conditionally required. If operative procedure is FUSN or
RFUSN, circle the procedure that was done.
Conditionally required. If operative procedure is FUSN or
RFUSN, check appropriate spinal level of procedure from
list.

Atlas-Axis – C1 and/or C2 only

Atlas-Axis/Cervical – C1-C7 (any combination
excluding C1 and/or C2 only)

Cervical – C3-C7 (any combination)

Cervical/Dorsal/Dorsolumbar – Extends from any
cervical through any lumbar levels

Dorsal/Dorsolumbar – T1 – L5 (any combination
of thoracic and lumbar)

Lumbar/Lumbosacral – L1-S5 (any combination
of lumbar and sacral)
If more than one level is fused, report category in which
the most vertebra were fused.

FUSN/RFUSN: Approach/Technique

January 2015 (modified April 2015)

Conditionally required. If operative procedure is FUSN or
RFUSN, check appropriate surgical approach or
technique from list.

38

SSI

Data Field
HPRO:

Instructions for Data Collection
Conditionally required. If operative procedure is HPRO,
select TOT (Total), HEMI (Hemi), or RES (Resurfacing)
from the list.
If Total HPRO, select TOTPRIM (Total Primary) or
TOTREV (Total Revision)
If Hemi HPRO, select PARTPRIM (Partial Primary) or
PARTREV (Partial Revision)
If Resurfacing HPRO, select TOTPRIM (Total Primary)
or PARTPRIM (Partial Primary)
NOTE: When hardware is inserted for the first time, use
the “primary” designation; otherwise, indicate that the
procedure was a revision.

KPRO:

Conditionally required. If operative procedure is KPRO,
select TOT – Primary (Total) or HEMI - Hemi from list.
If Total KPRO, select TOTPRIM (Total Primary) or
TOTREV (Total Revision
If Hemi KPRO, select PARTPRIM (Partial Primary) or
PARTREV (Partial Revision)
NOTE: When hardware is inserted for the first time, use
the “primary” designation; otherwise, indicate that the
procedure was a revision.

If total or partial revision, was the
revision associated with prior infection
at index joint?

Conditionally required. If operative procedure is an
HPRO or KPRO revision. Check Y if operative procedure
was performed on a joint with a prior history of infection
in the 90 days prior to and including the index HPRO or
KPRO revision procedure, otherwise check N.
NOTE: See SSI protocol for complete details.

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SSI

Data Field
Custom Fields

Instructions for Data Collection
Optional. Up to 50 fields may be customized for local or
group use in any combination of the following formats:
date (MMDDYYY), numeric, or alphanumeric.
NOTE: Each Custom Field must be set up in the
Facility/Custom Options section of NHSN before the
field can be selected for use. Data in these fields may be
analyzed.

January 2015 (modified April 2015)

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