The “Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals” protocol adopts the following definition of Skin and Soft Tissue Infections (SST):

 

SST-SKIN: skin infection.

Skin infections must meet at least one of the following criteria:

  • patient has purulent drainage, pustules, vesicles, or boils;
  • patient has at least two of the following signs or symptoms with no other recognised cause: pain or tenderness, localised swelling, redness, or heat;

and at least one of the following:

    • organisms cultured from aspirate or drainage from affected site; if organisms are normal skin flora (i.e. diphtheroids [Corynebacterium spp.], Bacillus [not B. anthracis] spp., Propionibacterium spp., coagulasenegative staphylococci [including S epidermidis], viridans group streptococci, Aerococcus spp., Micrococcus spp.), they must be a pure culture;
    • organisms cultured from blood;
    • positive antigen test performed on infected tissue or blood (e.g. herpes simplex, varicella zoster, H.influenzae, N. meningitidis);
    • multinucleated giant cells seen on microscopic examination of affected tissue;
    • diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen.

SST-ST: soft tissue (necrotizing fascitis, infectious gangrene, necrotizing cellulitis, infectious myositis, lymphadenitis, or lymphangitis).

Soft tissue infections must meet at least one of the following criteria:

  • patient has organisms cultured from tissue or drainage from affected site;
  • patient has purulent drainage at affected site;
  • patient has an abscess or other evidence of infection seen during a surgical operation or histopathologic examination;
  • patient has at least two of the following signs or symptoms at the affected site with no other recognised cause: localised pain or tenderness, redness, swelling, or heat;

and at least one of the following:

    • organisms cultured from blood;
    • positive antigen test performed on blood or urine (e.g. H. influenzae, S. pneumoniae, N. meningitidis,Group B Streptococcus, Candida spp.);
    • diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen.

An infection of deep pelvic tissues must be reported as REPR-ORE.

 

SST-DECU: decubitus ulcer, including both superficial and deep infections.

Decubitus ulcer infections must meet the following criterion:

  • patient has at least two of the following signs or symptoms with no other recognised cause: redness, tenderness, or swelling of decubitus wound edges

and at least one of the following:

    • organisms cultured from properly collected fluid or tissue;
    • organisms cultured from blood.

A purulent drainage alone is not sufficient evidence of an infection;

An organisms cultured from the surface of a decubitus ulcer are not sufficient evidence that the ulcer is infected. A properly collected specimen from a decubitus ulcer involves needle aspiration of fluid or biopsy of tissue from the ulcer margin.

 

SST-BURN: burn.

Burn infections must meet at least one of the following criteria:

  • patient has a change in burn wound appearance or character, such as rapid eschar separation, or dark brown, black, or violaceous discoloration of the eschar, or oedema at wound margin and histologic examination of burn biopsy shows invasion of organisms into adjacent viable tissue;
  • patient has a change in burn wound appearance or character, such as rapid eschar separation, or dark brown, black, or violaceous discoloration of the eschar, or oedema at wound margin;

and at least one of the following:

    • organisms cultured from blood in the absence of other identifiable infection;
    • isolation of herpes simplex virus, histologic identification of inclusions by light or electron microscopy, or visualisation of viral particles by electron microscopy in biopsies or lesion scrapings.
  • patient with a burn has at least two of the following signs or symptoms with no other recognised cause:fever (> 38 °C) or hypothermia (< 36 °C), hypotension, oliguria (< 20 cc/hr), hyperglycemia at previously tolerated level of dietary carbohydrate, or mental confusion;

and at least one of the following:

    • histologic examination of burn biopsy shows invasion of organisms into adjacent viable tissue
    • organisms cultured from blood;
    • isolation of herpes simplex virus, histologic identification of inclusions by light or electron microscopy, or visualisation of viral particles by electron microscopy in biopsies or lesion scrapings.

A purulence alone at the burn wound site is not adequate for the diagnosis of burn infection; such purulence may reflect incomplete wound care;

Fever alone in a burn patient is not adequate for the diagnosis of a burn infection because fever may be the result of tissue trauma or the patient may have an infection at another site.

 

SST-BRST: *** abscess or mastitis.

A *** abscess or mastitis must meet at least one of the following criteria:

  • patient has a positive culture of affected *** tissue or fluid obtained by incision and drainage or needle aspiration;
  • patient has a *** abscess or other evidence of infection seen during a surgical operation or histopathologic examination;
  • patient has fever (> 38 °C) and local inflammation of the *** and physician diagnosis of *** abscess.

A *** abscesses occur most frequently after childbirth. Those that occur within seven days after childbirth should be considered healthcare associated.

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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