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Eye, Ear, Nose or Mouth Infection

Last modified at 4/25/2016 3:47 PM by Vladimir Prikazsky

The “Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals” protocol adopts the following definition of Eye, Ear, Nose or Mouth Infection (EENT).

EENT-CONJ: conjunctivitis

Conjunctivitis must meet at least one of the following criteria:

  • patient has pathogens cultured from purulent exudate obtained from the conjunctiva or contiguous tissues, such as eyelid, cornea, meibomian glands, or lacrimal glands;
  • patient has pain or redness of conjunctiva or around eye;

and at least one of the following:

  • WBCs and organisms seen on Gram’s stain of exudates;
  • purulent exudates;
  • positive antigen test (e.g. ELISA or IF for Chlamydia trachomatis, herpes simplex virus, adenovirus) on exudate or conjunctival scraping;
  • multinucleated giant cells seen on microscopic examination of conjunctival exudate or scrapings
  • positive viral culture;
  • diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen.

Further instructions for reporting:

  • do not report chemical conjunctivitis caused by silver nitrate (AgNO3) as a health care–associated infection;
  • do not report conjunctivitis that occurs as a part of a more widely disseminated viral illness (such as measles, chickenpox, or a URI).

 

EENT-EYE: eye, other than conjunctivitis

An infection of the eye, other than conjunctivitis, must meet at least one of the following criteria:

  • patient has organisms cultured from anterior or posterior chamber or vitreous fluid.
  • patient has at least two of the following signs or symptoms with no other recognised cause: eye pain, visual disturbance, or hypopyon

and at least one of the following:

  • physician diagnosis of an eye infection
  • positive antigen test on blood (e.g. H. influenzae, S. pneumoniae)
  • organisms cultured from blood.

 

EENT-EAR: ear mastoid

Ear and mastoid infections must meet at least one of the following criteria:

Otitis externa must meet at least one of the following criteria:

  • patient has pathogens cultured from purulent drainage from ear canal;
  • patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, redness, or drainage from ear canal and organisms seen on Gram’s stain of purulent drainage.

Otitis media must meet at least one of the following criteria:

  • patient has organisms cultured from fluid from middle ear obtained by tympanocentesis or at surgical operation;
  • patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain in the eardrum, inflammation, retraction or decreased mobility of eardrum, or fluid behind eardrum.

Otitis interna must meet at least one of the following criteria:

  • patient has organisms cultured from fluid from inner ear obtained at surgical operation;
  • patient has a physician diagnosis of inner ear infection.

Mastoiditis must meet at least one of the following criteria:

  • patient has organisms cultured from purulent drainage from mastoid;
  • patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, tenderness, erythema, headache, or facial paralysis;

and at least one of the following:

  • organisms seen on Gram’s stain of purulent material from mastoid;
  • b. positive antigen test on blood.

 

EENT-ORAL: oral cavity (mouth, tongue, or gums).

Oral cavity infections must meet at least one of the following criteria:

  • patient has organisms cultured from purulent material from tissues of oral cavity;
  • patient has an abscess or other evidence of oral cavity infection seen on direct examination, during a surgical operation, or during a histopathologic examination;
  • patient has at least one of the following signs or symptoms with no other recognised cause: abscess, ulceration, or raised white patches on inflamed mucosa, or plaques on oral mucosa;

and at least one of the following:

  • organisms seen on Gram’s stain;
  • positive KOH (potassium hydroxide) stain;
  • multinucleated giant cells seen on microscopic examination of mucosal scrapings;
  • positive antigen test on oral secretions;
  • diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen;
  • physician diagnosis of infection and treatment with topical or oral antifungal therapy.

An healthcare-associated primary herpes simplex infections of the oral cavity must be reported as EENT-ORAL; recurrent herpes infections are not healthcare-associated.

 

EENT-SINU: sinusitis

Sinusitis must meet at least one of the following criteria:

  • patient has organisms cultured from purulent material obtained from sinus cavity;
  • patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain or tenderness over the involved sinus, headache, purulent exudate, or nasal obstruction;

and at least one of the following:

  • positive transillumination;
  • positive radiographic examination (including CT scan).

 

EENT-UR: upper respiratory tract, pharyngitis, laryngitis, epiglottitis

Upper respiratory tract infections must meet at least one of the following criteria:

  • Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), erythema of pharynx, sore throat, cough, hoarseness, or purulent exudate in throat;

and at least one of the following:

    • organisms cultured from the specific site;
    • organisms cultured from blood;
    • positive antigen test on blood or respiratory secretions;
    • diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen;
    • physician diagnosis of an upper respiratory infection.
  • Patient has an abscess seen on direct examination, during a surgical operation, or during a histopathologic examination.

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Link to European IC/HH Core Competencies

Area 3. Surveillance and investigation of healthcare associated infection (HAI)

References

http://www.ecdc.europa.eu/en/publications/Publications/0512-TED-PPS-HAI-antimicrobial-use-protocol.pdf