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