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HL7 Implementation Guide for CDA Release 2: NHSN Healthcare Associated Infection (HAI) Reports
Draft Standard for Trial Use
Release 1
February 2008
Publication of this Draft Standard for Trial Use (DSTU) and comment has been approved by Health Level Seven, Inc. (HL7) Distribution of this DSTU shall not continue beyond 24 months from the date of publication. It is expected that following this 24-month period, this DSTU, revised as necessary, will be submitted to the American National Standards Institute (ANSI) for approval as an American National Standard. A public review in accordance with established ANSI procedures is required at the end of the trial use period and before a DSTU may be submitted to ANSI for approval as an American National Standard. This DSTU is not an accredited American National Standard. Suggestions for revision should be directed to DanielA. Pollock, M.D., Surveillance Branch Chief, Division of Healthcare Quality Promotion, National Center for Prevention, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Mail Stop A24, Atlanta, GA 30333, HYPERLINK "mailto:dap1@cdc.gov" dap1@cdc.gov.
2008 Health Level Seven, Inc.Ann Arbor, MIAll rights reserved
Co-Editor:Marla AlbitzContractor to CDC, Lockheed Martin HYPERLINK "mailto:zhx4@cdc.gov" zhx4@cdc.govCo-Editor/Co-Chair:Liora AlschulerAlschuler Associates, LLCliora@alschulerassociates.comCo-Chair:Calvin BeebeMayo ClinicHYPERLINK "mailto:cbeebe@mayo.edu"cbeebe@mayo.eduCo-Chair:Keith W. BooneGE Healthcare HYPERLINK "mailto:keith.boone@ge.com" keith.boone@ge.comCo-Chair:Robert H. Dolin, M.D.Kaiser Permanente HYPERLINK "mailto:robert.h.dolin@kp.org" robert.h.dolin@kp.orgCo-EditorJonathan Edwards CDC HYPERLINK "mailto:jde3@CDC.GOV" jde3@cdc.gov Co-Editor:Rick GeimerAlschuler Associates, LLC HYPERLINK "mailto:rick@alschulerassociates.com" rick@alschulerassociates.comCo-Editor:
Gay Giannone M.S.N., R.N.Alschuler Associates LLC HYPERLINK "mailto:gay@alschulerassociates.com" gay@alschulerassociates.comCo-Editor:Kate HamiltonAlschuler Associates, LLC HYPERLINK "mailto:kate@alschulerassociates.com" kate@alschulerassociates.comCo-Editor:Daniel Pollock, M.D.CDC HYPERLINK "mailto:dap1@CDC.GOV" dap1@cdc.govAcknowledgments
This DSTU was produced and developed in conjunction with the Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), and Centers for Disease Control and Prevention (CDC). Its development and ultimate deployment is a result of the dedication of the team, led by Daniel A. Pollock, M.D., Surveillance Branch Chief, Division of Healthcare Quality Promotion, NCPDCID, CDC, and their support of the development of interoperable data standards for the CDCs National Healthcare Safety Network (NHSN).
The best standards are those driven by business requirements. Each stage of the development of this DSTU ha s b e e n m o n i t o r e d , e v a l u a t e d , a n d t e s t e d b y a s t r o n g s e t o f H A I s u r v e i l l a n c e a p p l i c a t i o n v e n d o r s . T h o s e v e n d o r s w h o p a r t i c i p a t e d i n t h e J u l y 2 0 0 7 p i l o t s u b m i s s i o n o f B l o o d S t r e a m I n f e c t i o n R e p o r t s d e s e r v e s p e c i a l t h a n k s a n d a c k n o w l e d g m e n t :
M e d M i n e d "! s e r v i c es from Cardinal Health
EpiQuest
ICPA
Premier
TheraDoc
Vecna Technologies
Throughout the development of this guide, Marla Albitz, Lockheed Martin, and Jonathan Edwards, CDC, provided essential translation of NHSN business and technical requirements so that Kate Hamilton and Rick Geimer, project leads for Alschuler Associates, LLC, could turn those requirements into a CDA-compliant specification. Liora Alschuler and Gay Giannone of Alschuler Associates, LLC, provided oversight and review. Additional contributors to the IG were Teresa Horan and Mary Andrus (data specifications), Wenkai Li (vocabulary), Sundak Ganesan (vocabulary and linkage to the Public Health Information Network Vocabulary Access and Distribution System [PHIN VADS]), Carlasha Jenkins (NHSN enrollment), Kelly Peterson (database administration), and Venu Sarraff (data importation).
This specification is a set of constraints on existing work and the extent to which it can accommodate the expressive requirements of HAI reporting over time is a function of the richness of the model on which it is built, the HL7 Reference Information Model (RIM) and the RIM document standard, and the Clinical Document Architecture Release 2 (CDA R2). Many thanks to all those who have worked for over a decade to produce these fundamental specifications and special thanks to structured documents co-chairs Bob Dolin, Keith Boone, and Calvin Beebe for their support of this project.
Revision History
[note: this table will be deleted in Release 1.0; it is here for SDTC review only]
RevDateNotes112 August 2007DSTU First Ballot23 December 2007DSTU Second Ballot. Substantive changes in this ballot include a move to use of standard terminology and compliance with the guidance on its. This draft uses standard vocabulary specification language, removes the requirement for eventId and clarifies use of CDA succession management technique, and adds location information such that it will be consistent across all HAI document types. For additional information, see the ballot reconciliation spreadsheet.319_ February 2008Change to Findings Observation to bring it into closer conformity with IHE/LAB
Updated to the table of required bug/drug tests
Reassignment of OIDs for value-sets, and regularize the naming convention
A new Procedure Risk Factors templateId, together with requirement for id to be present, in a Procedure Report, in -both Details- and Risk Factors section, with explanatory footnote about the use of the procedure id (responding to a ballot comment)
A new Risk Factors Measurement Observation to allow a measurement to be associated with a risk factor
A new value set to distinguish BSI and SSI in report onfection contributing to death
Replaced temporary value with correct OID for HL7 Healthcare Service Location Code
Added missing requirement for Risk Factors section to the body constraints for Procedure Report
Corrected the Occasion of HAI Detection Observation to use assertion pattern
Table of Contents
TOC \o "1-1" \h \z \t "Heading 2,2,Heading 3,3,Heading 4,4,subsection,3,TOC Heading 2,2,Heading 3 Appendix,3,Heading 2 Appendix,2,Heading ClinSttmt Appendix,2" HYPERLINK \l "_Toc191207790" 1 Introduction PAGEREF _Toc191207790 \h 12
HYPERLINK \l "_Toc191207791" 1.1 Purpose PAGEREF _Toc191207791 \h 12
HYPERLINK \l "_Toc191207792" 1.2 Audience PAGEREF _Toc191207792 \h 12
HYPERLINK \l "_Toc191207793" 1.3 Approach PAGEREF _Toc191207793 \h 12
HYPERLINK \l "_Toc191207794" 1.3.1 CDA R2 PAGEREF _Toc191207794 \h 13
HYPERLINK \l "_Toc191207795" 1.3.2 Development of This Specification PAGEREF _Toc191207795 \h 13
HYPERLINK \l "_Toc191207796" 1.3.3 Change Notification Process PAGEREF _Toc191207796 \h 14
HYPERLINK \l "_Toc191207797" 1.4 Future Work PAGEREF _Toc191207797 \h 14
HYPERLINK \l "_Toc191207798" 1.5 Organization of This Implementation Guide PAGEREF _Toc191207798 \h 14
HYPERLINK \l "_Toc191207799" 1.5.1 General HAI Report Requirements PAGEREF _Toc191207799 \h 15
HYPERLINK \l "_Toc191207800" 1.5.2 Document-level Requirements (Appendix A) PAGEREF _Toc191207800 \h 15
HYPERLINK \l "_Toc191207801" 1.5.3 Section Library (Appendix B) PAGEREF _Toc191207801 \h 15
HYPERLINK \l "_Toc191207802" 1.5.4 Clinical Statement Library (Appendix C) PAGEREF _Toc191207802 \h 15
HYPERLINK \l "_Toc191207803" 1.5.5 Vocabularies and Value Sets PAGEREF _Toc191207803 \h 15
HYPERLINK \l "_Toc191207804" 1.5.6 Template Ids (Appendix E) PAGEREF _Toc191207804 \h 16
HYPERLINK \l "_Toc191207805" 1.5.7 Instance Identifier OIDs (Appendix F) PAGEREF _Toc191207805 \h 16
HYPERLINK \l "_Toc191207806" 1.6 Conventions Used in This Implementation Guide PAGEREF _Toc191207806 \h 16
HYPERLINK \l "_Toc191207807" 1.6.1 Keywords PAGEREF _Toc191207807 \h 16
HYPERLINK \l "_Toc191207808" 1.6.2 Conformance Requirements PAGEREF _Toc191207808 \h 16
HYPERLINK \l "_Toc191207809" 1.6.3 Explanatory Remarks PAGEREF _Toc191207809 \h 17
HYPERLINK \l "_Toc191207810" 1.6.4 Mentions of CDA Base Requirements PAGEREF _Toc191207810 \h 17
HYPERLINK \l "_Toc191207811" 1.6.5 Sample XML Code PAGEREF _Toc191207811 \h 17
HYPERLINK \l "_Toc191207812" 1.6.6 Succession Management PAGEREF _Toc191207812 \h 17
HYPERLINK \l "_Toc191207813" 1.6.7 Vocabulary Tables and Value Sets PAGEREF _Toc191207813 \h 18
HYPERLINK \l "_Toc191207814" 1.6.8 XPath Notation PAGEREF _Toc191207814 \h 18
HYPERLINK \l "_Toc191207815" 1.7 Use of Templates PAGEREF _Toc191207815 \h 18
HYPERLINK \l "_Toc191207816" 1.7.1 Originator Responsibilities: General Case PAGEREF _Toc191207816 \h 19
HYPERLINK \l "_Toc191207817" 1.7.2 Recipient Responsibilities: General Case PAGEREF _Toc191207817 \h 19
HYPERLINK \l "_Toc191207818" 1.7.3 Templates for NHSN Validation PAGEREF _Toc191207818 \h 19
HYPERLINK \l "_Toc191207819" 1.8 Supporting Tools PAGEREF _Toc191207819 \h 19
HYPERLINK \l "_Toc191207820" 1.8.1 Validation PAGEREF _Toc191207820 \h 19
HYPERLINK \l "_Toc191207821" 1.8.2 Generation of Narrative Block PAGEREF _Toc191207821 \h 20
HYPERLINK \l "_Toc191207822" 1.8.3 Display Transforms PAGEREF _Toc191207822 \h 20
HYPERLINK \l "_Toc191207823" 1.9 Content of the DSTU PAGEREF _Toc191207823 \h 21
HYPERLINK \l "_Toc191207824" 2 Generic HAI guide PAGEREF _Toc191207824 \h 22
HYPERLINK \l "_Toc191207825" 2.1 NHSN HAI Header Model PAGEREF _Toc191207825 \h 23
HYPERLINK \l "_Toc191207826" 2.2 Body Model PAGEREF _Toc191207826 \h 30
HYPERLINK \l "_Toc191207827" 2.3 Section Model PAGEREF _Toc191207827 \h 31
HYPERLINK \l "_Toc191207828" 3 References PAGEREF _Toc191207828 \h 33
HYPERLINK \l "_Toc191207829" Appendix A Document-level Requirements (non-normative) PAGEREF _Toc191207829 \h 34
HYPERLINK \l "_Toc191207830" Summary of templateId Use Across Report Types PAGEREF _Toc191207830 \h 34
HYPERLINK \l "_Toc191207831" BSI Numerator Report PAGEREF _Toc191207831 \h 36
HYPERLINK \l "_Toc191207832" BSI-specific Header Constraints PAGEREF _Toc191207832 \h 36
HYPERLINK \l "_Toc191207833" BSI-specific Body Constraints PAGEREF _Toc191207833 \h 36
HYPERLINK \l "_Toc191207834" SSI Numerator Report PAGEREF _Toc191207834 \h 37
HYPERLINK \l "_Toc191207835" SSI-specific Header Constraints PAGEREF _Toc191207835 \h 37
HYPERLINK \l "_Toc191207836" SSI-specific Body Constraints PAGEREF _Toc191207836 \h 37
HYPERLINK \l "_Toc191207837" ICU Denominator Report PAGEREF _Toc191207837 \h 38
HYPERLINK \l "_Toc191207838" ICU-specific Header Constraints PAGEREF _Toc191207838 \h 38
HYPERLINK \l "_Toc191207839" ICU-specific Body Constraints PAGEREF _Toc191207839 \h 38
HYPERLINK \l "_Toc191207840" Procedure Denominator Report PAGEREF _Toc191207840 \h 38
HYPERLINK \l "_Toc191207841" Procedure-specific Header Constraints PAGEREF _Toc191207841 \h 38
HYPERLINK \l "_Toc191207842" Procedure-specific Body Constraints PAGEREF _Toc191207842 \h 38
HYPERLINK \l "_Toc191207843" Appendix B Section Library (Non-normative) PAGEREF _Toc191207843 \h 39
HYPERLINK \l "_Toc191207844" Risk Factors Section PAGEREF _Toc191207844 \h 39
HYPERLINK \l "_Toc191207845" Risk Factors in a BSI Numerator Report PAGEREF _Toc191207845 \h 39
HYPERLINK \l "_Toc191207846" Risk Factors in a Procedure Denominator Report PAGEREF _Toc191207846 \h 40
HYPERLINK \l "_Toc191207847" Details Section PAGEREF _Toc191207847 \h 41
HYPERLINK \l "_Toc191207848" Details Entries in a BSI Numerator Report PAGEREF _Toc191207848 \h 43
HYPERLINK \l "_Toc191207849" Details Entries in a Procedure Denominator Report PAGEREF _Toc191207849 \h 43
HYPERLINK \l "_Toc191207850" Details Entries in an SSI Numerator Report PAGEREF _Toc191207850 \h 43
HYPERLINK \l "_Toc191207851" Procedure Details in an SSI Report PAGEREF _Toc191207851 \h 43
HYPERLINK \l "_Toc191207852" Procedure Details in a Procedure Report PAGEREF _Toc191207852 \h 44
HYPERLINK \l "_Toc191207853" Findings Section PAGEREF _Toc191207853 \h 47
HYPERLINK \l "_Toc191207854" Summary Section PAGEREF _Toc191207854 \h 47
HYPERLINK \l "_Toc191207855" Summary Encounter PAGEREF _Toc191207855 \h 49
HYPERLINK \l "_Toc191207856" Summary Encounter in an ICU Denominator Report PAGEREF _Toc191207856 \h 49
HYPERLINK \l "_Toc191207857" Appendix C Clinical Statement Library (Non-normative) PAGEREF _Toc191207857 \h 50
HYPERLINK \l "_Toc191207858" Risks Organizer PAGEREF _Toc191207858 \h 50
HYPERLINK \l "_Toc191207859" BSI Risk Factors Observation PAGEREF _Toc191207859 \h 51
HYPERLINK \l "_Toc191207860" Risk Factors Measurement Observation PAGEREF _Toc191207860 \h 52
HYPERLINK \l "_Toc191207861" Bloodstream Infection Type Observation PAGEREF _Toc191207861 \h 52
HYPERLINK \l "_Toc191207862" LCBI Pathway Observation PAGEREF _Toc191207862 \h 53
HYPERLINK \l "_Toc191207863" Procedure Risk Factors PAGEREF _Toc191207863 \h 54
HYPERLINK \l "_Toc191207864" Procedure Details PAGEREF _Toc191207864 \h 55
HYPERLINK \l "_Toc191207865" Death Observation PAGEREF _Toc191207865 \h 56
HYPERLINK \l "_Toc191207866" Infection Contributed to Death Observation PAGEREF _Toc191207866 \h 57
HYPERLINK \l "_Toc191207867" SSI Anatomic Site Observation PAGEREF _Toc191207867 \h 58
HYPERLINK \l "_Toc191207868" Wound Class Observation PAGEREF _Toc191207868 \h 59
HYPERLINK \l "_Toc191207869" Anesthesia Administration PAGEREF _Toc191207869 \h 61
HYPERLINK \l "_Toc191207870" ASA Class Observation PAGEREF _Toc191207870 \h 62
HYPERLINK \l "_Toc191207871" Trauma Observation PAGEREF _Toc191207871 \h 63
HYPERLINK \l "_Toc191207872" Endoscope Used Procedure PAGEREF _Toc191207872 \h 64
HYPERLINK \l "_Toc191207873" Multiple Procedure Observation PAGEREF _Toc191207873 \h 64
HYPERLINK \l "_Toc191207874" Diabetes Observation PAGEREF _Toc191207874 \h 65
HYPERLINK \l "_Toc191207875" Spinal Fusion Level Observation PAGEREF _Toc191207875 \h 66
HYPERLINK \l "_Toc191207876" Height Observation PAGEREF _Toc191207876 \h 67
HYPERLINK \l "_Toc191207877" Weight Observation PAGEREF _Toc191207877 \h 67
HYPERLINK \l "_Toc191207878" Duration of Labor Observation PAGEREF _Toc191207878 \h 68
HYPERLINK \l "_Toc191207879" Estimated Blood Loss Observation PAGEREF _Toc191207879 \h 69
HYPERLINK \l "_Toc191207880" SSI Detected Observation PAGEREF _Toc191207880 \h 69
HYPERLINK \l "_Toc191207881" Secondary Bloodstream Infection Observation PAGEREF _Toc191207881 \h 70
HYPERLINK \l "_Toc191207882" Findings Organizer PAGEREF _Toc191207882 \h 71
HYPERLINK \l "_Toc191207883" Pathogen Identified Observation PAGEREF _Toc191207883 \h 72
HYPERLINK \l "_Toc191207884" Pathogen Ranking Observation PAGEREF _Toc191207884 \h 73
HYPERLINK \l "_Toc191207885" Drug-susceptibility Test Observation PAGEREF _Toc191207885 \h 73
HYPERLINK \l "_Toc191207886" Pathogens Identified Observation (Negated) PAGEREF _Toc191207886 \h 74
HYPERLINK \l "_Toc191207887" Summary Data Observation PAGEREF _Toc191207887 \h 75
HYPERLINK \l "_Toc191207888" Appendix D Large Vocabularies (Non-normative) PAGEREF _Toc191207888 \h 77
HYPERLINK \l "_Toc191207889" Drug-susceptibility Test Codes PAGEREF _Toc191207889 \h 77
HYPERLINK \l "_Toc191207890" Pathogen Codes PAGEREF _Toc191207890 \h 78
HYPERLINK \l "_Toc191207891" Required Pathogen-specific Drug-susceptibility Tests PAGEREF _Toc191207891 \h 109
HYPERLINK \l "_Toc191207892" Procedure Category Codes PAGEREF _Toc191207892 \h 111
HYPERLINK \l "_Toc191207893" NHSN Surgical Site Infection Anatomic Site Code System PAGEREF _Toc191207893 \h 117
HYPERLINK \l "_Toc191207894" NHSN Healthcare Service Location Codes PAGEREF _Toc191207894 \h 118
HYPERLINK \l "_Toc191207895" Appendix E Template IDs (Non-normative) PAGEREF _Toc191207895 \h 125
HYPERLINK \l "_Toc191207896" Appendix F Instance Identifier OIDS(Non-normative) PAGEREF _Toc191207896 \h 127
HYPERLINK \l "_Toc191207897" Appendix G Document and Section Codes(Non-normative) PAGEREF _Toc191207897 \h 128
HYPERLINK \l "_Toc191207898" Appendix H Summary of Vocabularies (Non-normative) PAGEREF _Toc191207898 \h 129
HYPERLINK \l "_Toc191207899" Appendix I Summary of HAI Value Sets (Non-normative) PAGEREF _Toc191207899 \h 130
HYPERLINK \l "_Toc191207900" Appendix J Summary of HAI Single-Value Bindings (Non-normative) PAGEREF _Toc191207900 \h 139
HYPERLINK \l "_Toc191207901" Appendix K Policy on use of local or Standard Codes (Non-normative) PAGEREF _Toc191207901 \h 141
Table of Tables
TOC \h \z \c "Table" HYPERLINK \l "_Toc191207902" Table 1: Encounter Type Value Set PAGEREF _Toc191207902 \h 29
HYPERLINK \l "_Toc191207903" Table 5: Surgical Site Infection Location Type Value Set PAGEREF _Toc191207903 \h 44
HYPERLINK \l "_Toc191207904" Table 2: Spinal Fusion Approach Value Set PAGEREF _Toc191207904 \h 45
HYPERLINK \l "_Toc191207905" Table 3: Hip Replacement Value Set PAGEREF _Toc191207905 \h 46
HYPERLINK \l "_Toc191207906" Table 4: Knee Replacement Value Set PAGEREF _Toc191207906 \h 46
HYPERLINK \l "_Toc191207907" Table 6: BSI Risk Factors Value Set PAGEREF _Toc191207907 \h 50
HYPERLINK \l "_Toc191207908" Table 7: Blood Stream Infection Value Set PAGEREF _Toc191207908 \h 52
HYPERLINK \l "_Toc191207909" Table 8: LCBI Pathways Value Set PAGEREF _Toc191207909 \h 53
HYPERLINK \l "_Toc191207910" Table 9: Procedure Category Code (excerpt) PAGEREF _Toc191207910 \h 54
HYPERLINK \l "_Toc191207911" Table 10: Infection Type Value Set PAGEREF _Toc191207911 \h 57
HYPERLINK \l "_Toc191207912" Table 11: Surgical Site Infection Anatomic Site Value Set (excerpt) PAGEREF _Toc191207912 \h 58
HYPERLINK \l "_Toc191207913" Table 12: Wound Class Value Set PAGEREF _Toc191207913 \h 59
HYPERLINK \l "_Toc191207914" Table 13: ASA Class Value Set PAGEREF _Toc191207914 \h 62
HYPERLINK \l "_Toc191207915" Table 14: Spinal Fusion Level Value Set PAGEREF _Toc191207915 \h 65
HYPERLINK \l "_Toc191207916" Table 15: Occasion of Detection Value Set PAGEREF _Toc191207916 \h 69
HYPERLINK \l "_Toc191207917" Table 16: Drug-susceptibility Finding Value Set PAGEREF _Toc191207917 \h 73
HYPERLINK \l "_Toc191207918" Table 17: Summary Data Value Set PAGEREF _Toc191207918 \h 75
HYPERLINK \l "_Toc191207919" Table 18: Drug-susceptibility Tests Value Set PAGEREF _Toc191207919 \h 76
HYPERLINK \l "_Toc191207920" Table 19: Pathogens Value Set PAGEREF _Toc191207920 \h 78
HYPERLINK \l "_Toc191207921" Table 20: Required Pathogen-specific Drug-susceptibility Tests PAGEREF _Toc191207921 \h 108
HYPERLINK \l "_Toc191207922" Table 21: Procedure Category Value Set PAGEREF _Toc191207922 \h 111
HYPERLINK \l "_Toc191207923" Table 22: SSI Anatomic Site Value Set PAGEREF _Toc191207923 \h 116
HYPERLINK \l "_Toc191207924" Table 23: Healthcare Service Location Value Set PAGEREF _Toc191207924 \h 117
HYPERLINK \l "_Toc191207925" Table 24: NHSN Temporary Template IDs PAGEREF _Toc191207925 \h 124
HYPERLINK \l "_Toc191207926" Table 25: Instance Identifier OIDs PAGEREF _Toc191207926 \h 126
HYPERLINK \l "_Toc191207927" Table 26: Document and Section Codes PAGEREF _Toc191207927 \h 127
HYPERLINK \l "_Toc191207928" Table 27: List of Vocabularies PAGEREF _Toc191207928 \h 128
HYPERLINK \l "_Toc191207929" Table 28: HAI Value Sets Summary Table PAGEREF _Toc191207929 \h 129
HYPERLINK \l "_Toc191207930" Table 29: HAI Single-value Bindings PAGEREF _Toc191207930 \h 138
Table of Figures
TOC \h \z \c "Figure" HYPERLINK \l "_Toc191207931" Figure 1: CDA Header Template Identifiers PAGEREF _Toc191207931 \h 23
HYPERLINK \l "_Toc191207932" Figure 2: CDA Header Document Information PAGEREF _Toc191207932 \h 25
HYPERLINK \l "_Toc191207933" Figure 3: CDA Header recordTarget PAGEREF _Toc191207933 \h 26
HYPERLINK \l "_Toc191207934" Figure 4: CDA Header author, custodian, and legalAuthenticator PAGEREF _Toc191207934 \h 27
HYPERLINK \l "_Toc191207935" Figure 5: CDA Header participant (Summary Documents) PAGEREF _Toc191207935 \h 28
HYPERLINK \l "_Toc191207936" Figure 6: CDA Header documentationOf PAGEREF _Toc191207936 \h 28
HYPERLINK \l "_Toc191207937" Figure 7: CDA Header componentOf PAGEREF _Toc191207937 \h 30
HYPERLINK \l "_Toc191207938" Figure 8: Structured Body PAGEREF _Toc191207938 \h 31
HYPERLINK \l "_Toc191207939" Figure 9: Section PAGEREF _Toc191207939 \h 32
HYPERLINK \l "_Toc191207940" Figure 10: Document-level Constraints PAGEREF _Toc191207940 \h 37
HYPERLINK \l "_Toc191207941" Figure 11: Risk Factors Section PAGEREF _Toc191207941 \h 39
HYPERLINK \l "_Toc191207942" Figure 12: Risk Factors in a Procedure Report PAGEREF _Toc191207942 \h 41
HYPERLINK \l "_Toc191207943" Figure 13: Details Section PAGEREF _Toc191207943 \h 42
HYPERLINK \l "_Toc191207944" Figure 17: SSI Location Type methodCode PAGEREF _Toc191207944 \h 44
HYPERLINK \l "_Toc191207945" Figure 14: Spinal Fusion Approach PAGEREF _Toc191207945 \h 46
HYPERLINK \l "_Toc191207946" Figure 15: NHSN Hip Replacement methodCode PAGEREF _Toc191207946 \h 46
HYPERLINK \l "_Toc191207947" Figure 16: NHSN Knee Replacement methodCode PAGEREF _Toc191207947 \h 47
HYPERLINK \l "_Toc191207948" Figure 18: Findings Section PAGEREF _Toc191207948 \h 47
HYPERLINK \l "_Toc191207949" Figure 19: Summary Section PAGEREF _Toc191207949 \h 48
HYPERLINK \l "_Toc191207950" Figure 20: Summary Encounter PAGEREF _Toc191207950 \h 48
HYPERLINK \l "_Toc191207951" Figure 21: Risks Entry and Organizer PAGEREF _Toc191207951 \h 49
HYPERLINK \l "_Toc191207952" Figure 22: Risk Factor Observation PAGEREF _Toc191207952 \h 50
HYPERLINK \l "_Toc191207953" Figure 23: Bloodstream Infection Type Observation PAGEREF _Toc191207953 \h 52
HYPERLINK \l "_Toc191207954" Figure 24: LCBI Pathway Observation PAGEREF _Toc191207954 \h 53
HYPERLINK \l "_Toc191207955" Figure 25: Procedure Risk Factors PAGEREF _Toc191207955 \h 54
HYPERLINK \l "_Toc191207956" Figure 26: Procedure Details PAGEREF _Toc191207956 \h 55
HYPERLINK \l "_Toc191207957" Figure 27: Death Observation PAGEREF _Toc191207957 \h 56
HYPERLINK \l "_Toc191207958" Figure 28: Infection Type Obseration PAGEREF _Toc191207958 \h 57
HYPERLINK \l "_Toc191207959" Figure 29: SSI Anatomic Site Observation PAGEREF _Toc191207959 \h 58
HYPERLINK \l "_Toc191207960" Figure 30: Wound Class Observation PAGEREF _Toc191207960 \h 60
HYPERLINK \l "_Toc191207961" Figure 31: General Anesthesia Observation PAGEREF _Toc191207961 \h 61
HYPERLINK \l "_Toc191207962" Figure 32: ASA Class Observation PAGEREF _Toc191207962 \h 62
HYPERLINK \l "_Toc191207963" Figure 33: Trauma Observation PAGEREF _Toc191207963 \h 63
HYPERLINK \l "_Toc191207964" Figure 34: Endoscope Used Procedure PAGEREF _Toc191207964 \h 63
HYPERLINK \l "_Toc191207965" Figure 35: Multiple Procedure Observation PAGEREF _Toc191207965 \h 64
HYPERLINK \l "_Toc191207966" Figure 36: Diabetes Observation PAGEREF _Toc191207966 \h 65
HYPERLINK \l "_Toc191207967" Figure 37: Spinal Fusion Level Observation PAGEREF _Toc191207967 \h 66
HYPERLINK \l "_Toc191207968" Figure 38: Height Observation PAGEREF _Toc191207968 \h 66
HYPERLINK \l "_Toc191207969" Figure 39: Weight Observation PAGEREF _Toc191207969 \h 67
HYPERLINK \l "_Toc191207970" Figure 40: Duration of Labor Observation PAGEREF _Toc191207970 \h 67
HYPERLINK \l "_Toc191207971" Figure 41: Estimated Blood Loss Observation PAGEREF _Toc191207971 \h 68
HYPERLINK \l "_Toc191207972" Figure 42: SSI Detected Observation PAGEREF _Toc191207972 \h 69
HYPERLINK \l "_Toc191207973" Figure 43: SSI Secondary Bloodstream Infection Observation PAGEREF _Toc191207973 \h 70
HYPERLINK \l "_Toc191207974" Figure 44: Findings Organizer PAGEREF _Toc191207974 \h 71
HYPERLINK \l "_Toc191207975" Figure 45: Microorganism Identified Observation PAGEREF _Toc191207975 \h 72
HYPERLINK \l "_Toc191207976" Figure 46: Pathogen Ranking Observation PAGEREF _Toc191207976 \h 72
HYPERLINK \l "_Toc191207977" Figure 47: Drug-susceptibility Test Observation PAGEREF _Toc191207977 \h 73
HYPERLINK \l "_Toc191207978" Figure 48: Pathogens Identified Observation PAGEREF _Toc191207978 \h 74
HYPERLINK \l "_Toc191207979" Figure 49: Summary Data Observation PAGEREF _Toc191207979 \h 75
TOC \f \h \z \t "Caption,1,subsection,3,Ballot,1"
Introduction
Purpose
The purpose of this Implementation Guide (IG) is to specify a standard for electronic submission of Healthcare Associated Infection (HAI ) Reports to the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC). This Draft Standard for Trial Use (DSTU) defines the overall approach and method of electronic submission and develops a set of appendices defining specific HAI Report types. As Reports are modified and new Report types are defined, additional appendices will be developed and published by CDC and HL7.
Throughout this process, CDC remains the authority on NHSN data collection protocols. Occurrences such as specific reportable procedures (even those without complications) and events such as a bloodstream infection, either confirmed by a positive blood culture or suspected by a patients clinical symptoms, are reportable to the CDC when health care enterprises choose to participate in NHSN. This specification opens the channel for data submission to all applications compliant with the data coding requirements defined here.
Note that participation in the NHSN requires enrollment and filing of reporting plans, which are not defined by this specification. For full information on NHSN participation requirements, see:
HYPERLINK "http://www.cdc.gov/ncidod/dhqp/nhsn_howToEnroll.html" www.cdc.gov/ncidod/dhqp/nhsn_howToEnroll.html
For an overview of NHSN, see:
HYPERLINK "http://www.cdc.gov/ncidod/dhqp/nhsn.html" www.cdc.gov/ncidod/dhqp/nhsn.html
Note that provisions of the Public Health Service Act protect all data reported to NHSN from discovery through the Freedom Of Information Act.
Audience
The audience for this DSTU is all developers of software systems who want to enable their systems for reporting HAI data to the NHSN.
Approach
Overall, the approach taken here is consistent with balloted IGs for CDA. These publications view the ultimate implementation specification as a series of layered constraints. CDA itself is a set of constraints on the HL7 Reference Information Model (RIM) defined in the Clinical Document Architecture Release2 (CDA R2) Refined Message Information Model (RMIM). IGs such as this and the Continuity of Care Document (CCD) add constraints to CDA through conformance statements that further define and restrict the sequence and cardinality of CDA objects and the vocabulary sets for coded elements.
CDA R2
CDA R2 is a document markup standard that specifies the structure and semantics of clinical documents for the purpose of exchange. (CDA R2, Section1.1. See REF _Ref184372449 \r \h \* MERGEFORMAT 3 REF _Ref184372449 \h \* MERGEFORMAT References.) Clinical documents, according to CDA, have the following characteristics:
Persistence
Stewardship
Potential for authentication
Context
Wholeness
Human readability
CDA defines a header that is used for classification and management, and a document body that carries the clinical record. While the header metadata is prescriptive and designed for consistency across all instances, the body is highly generic, leaving the designation of semantic requirements to implementation.
Development of This Specification
The approach taken in the development of this specification was to compare the baseline requirements for HAI reporting against CDA R2 to make an initial determination whether CDA, designed for clinical Reports that become part of a patient chart, is suitable for HAI reporting or whether significant modifications would be required. That analysis determined that the only anomaly between the two was the requirement for a single record target (patient), which is appropriate for single-patient-focused Reports, such as the Blood Stream Infection (BSI) numerator, and not appropriate for others, such as the Intensive Care Unit (ICU) denominator, which summarizes data for many patients over a period of time. This IG addresses this issue through use of a null flavor for a record target and a participant defined as a group on summary Reports.
After the initial evaluation, four HAI Report types were analyzed and mapped to the CDA header and body, noting similarities and differences between the Report types. From this analysis was developed the first in a set of straw man instances illustrating the proposed approach. These samples have been reviewed informally by the Structured Documents Technical Committee (SDTC), which is the sponsor of this ballot within HL7; the stakeholders in HAI exchange; the NHSN, which is the overall sponsor of the activity; and the software vendors whose systems will use the specification for NHSN reporting.
Design considerations included consistency with published CDA IGs and with the RMIMs of related domain committees, specifically those developed for laboratory reporting, while retaining fidelity with the data structures of the NHSN database.
A preliminary design for the BSI and ICU Summary forms was tested in an implementation pilot that ran in late July 2007. Findings from that pilot have been reviewed and incorporated.
In response to comments received on the first ballot for DSTU, a rigorous evaluation was done to ensure use of standard codes in every instance where their use was fully expressive and supported by NHSN. The criteria for this evaluation are described in REF _Ref184369544 \w \h \* MERGEFORMAT Appendix K REF _Ref184369544 \h \* MERGEFORMAT Policy on use of local or Standard Codes (Non-normative).
Change Notification Process
CDC maintains an e-mail list of contacts at organizations interested in or responsible for implementations of CDA for HAI reporting to NHSN. To be added to the list, send a request with your contact information to HYPERLINK "mailto:nhsn@cdc.gov" nhsn@cdc.gov. CDC uses the list for e-mail notifications of changes, including new data requirements, to this IG and other documents such as business rules that are needed to implement and support CDA for HAI reporting to NHSN. In addition, access to the current version of this IG will be provided through the CDA tab at the NHSN members website: HYPERLINK "http://www.cdc.gov/ncidod/dhqp/nhsn_members.html" http://www.cdc.gov/ncidod/dhqp/nhsn_members.html.
Note: Ancillary files, including an up-to-date display transform and validating rule set, are posted on the Mayo wiki site (see REF _Ref184516867 \r \h \* MERGEFORMAT 1.8 REF _Ref184516867 \h \* MERGEFORMAT Supporting Tools). Upon publication, these tools will also be available from the NHSN site.
Future Work
This implementation is the first use of the CDA R2 for public health reporting. Future work may develop an overarching set of principles for use of CDA in this context under the project tenatively named CDA for Reporting.
Within the scope of this project, future work will expand the set of HAI forms covered by the specification. Other projects may include coordination and harmonization with other public health reporting initiatives.
In the future, vocabulary for implementations of CDA for HAI reporting to NHSN will be made available through CDCs Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS). A link to this vocabulary in PHIN VADS will be available and the link and other pertinent information will be distributed using the e-mail list notification process described in REF _Ref184188172 \r \h \* MERGEFORMAT 1.3.3 above.
Organization of This Implementation Guide
The requirements laid out in the body of this document are normative and are subject to change only through the ballot process. These cover the header and high-level body and section requirements for each Report type. The requirements described in the appendices are non-normative and may be updated by NHSN without ballot. These cover the specific reporting details for each section.
General HAI Report Requirements
General HAI Report requirements apply to any HAI CDA document. They apply to constraints on the CDA Header and also include the requirement that the body be represented by a structuredBody element.
Document-level Requirements (Appendix A)
This appendix contains constraints specific to a particular document type, such as the Blood Stream Infection (BSI) Report. They include, for each document type, the templateId, the recordTarget (which has a nullFlavor for summary Reports), and the required sections.
Section Library (Appendix B)
This appendix specifies section- and entry-level constraints. Several types of sections and entries are used in more than one type of HAI Report. For example, the Findings section for pathogen susceptibility results is used in both the BSI Numerator Report and the Surgical Site Infection (SSI) Numerator Report. To avoid repeating identical details for each Report, the section- and entry-level requirements are provided in a single location.
Clinical Statement Library (Appendix C)
This appendix defines the core semantic units of the Reports, including conformance requirements for CDA entries and associated vocabularies and value sets.
Vocabularies and Value Sets
Vocabularies are sets of terms that may be in general use (standard codes) or which may have been created by NHSN specifically for HAI reporting (NHSN codes or local codes). A value set is a subset of the vocabulary chosen as appropriate for HAI reporting to NHSN. In either case, conformance may require use of any term from the specified vocabulary or from one of its value sets.
Large vocabularies, specifically those for pathogens, antimicrobials, procedures, and location types, are presented in abbreviated form where conformance requirements are defined and listed in full in REF _Ref184461597 \r \h \* MERGEFORMAT Appendix D REF _Ref184461597 \h \* MERGEFORMAT Large Vocabularies (Non-normative). Short tables, for ease of reference, are shown with the conformance statements to which they pertain.
REF _Ref184369005 \w \h \* MERGEFORMAT Appendix H REF _Ref184369028 \h \* MERGEFORMAT Summary of Vocabularies (Non-normative) lists all vocabularies used in this IG. Value sets are summarized in REF _Ref184368918 \w \h \* MERGEFORMAT Appendix I REF _Ref184368918 \h \* MERGEFORMAT Summary of HAI Value Sets (Non-normative)and single-value bindings in REF _Ref184368960 \w \h \* MERGEFORMAT Appendix J REF _Ref184368966 \h \* MERGEFORMAT Summary of HAI Single-Value Bindings (Non-normative).
Template Ids (Appendix E)
This appendix lists the template identifiers assigned for use in HAI reporting to NHSN. These template identifiers are assigned at the document, section, and entry level. Intepretation of these identifiers is described in REF _Ref190933759 \r \h \* MERGEFORMAT 1.7 REF _Ref190914905 \h \* MERGEFORMAT Use of Templates.
Instance Identifier OIDs (Appendix F)
Much of the development of this DSTU was driven by a pilot project in July 2007. The pilot project assigned OIDs (under a root owned by Alschuler Associates, LLC) to a fictional facility and vendor as a base for displaying the numbering schemes for which facilities and vendors are responsible.
These pilot OIDs are used in the examples in this IG and in the accompanying sample files. Where appropriate, they will be replaced in a future release.
These sample instance identifiers begin with 2.16.840.1.113883.3.117.1.1.5.
Conventions Used in This Implementation Guide
Keywords
The keywords shall, should, may, need not, should not, and shall not in this document are to be interpreted as described in the HYPERLINK "http://www.hl7.org/v3ballot/html/help/pfg/pfg.htm" HL7 Version 3 Publishing Facilitator's Guide.
Conformance Requirements
Where no constraints are stated in this IG, HAI instances are subject to and are to be created in accordance with the base CDA R2 specification. For example, where the CDA R2 specification declares an attribute to be optional and the HAI IG contains no additional constraints, that attribute remains optional for use in an HAI instance.
Conformance requirements specific to this document are numbered sequentially and are displayed as follows:
CONF-ex1: A ClinicalDocument/templateId element shall be present ...
Formalisms for value set constraints are based on the latest recommendations from the HL7 Vocabulary Committee. Value set constraints can be STATIC, meaning that they are bound to a specified version of a value set, or DYNAMIC, meaning that they are bound to the most current version of the value set. A simplified constraint is used when binding is to a single code.
Syntax for vocabulary binding to DYNAMIC or STATIC value sets:
The value for (pathName of coded element) (shall | SHOULD | MAY) be selected from ValueSet valueSetOID localValueSetName [DYNAMIC | STATIC (valueSetEffectiveDate)].
CONF-ex2: The value for ClinicalDocument/code element SHALL be selected from ValueSet 2.16.840.1.113883.19.3 LoincDocumentTypeCode DYNAMIC.
CONF-ex3: The value for ClinicalDocument/code element SHALL be selected from ValueSet 2.16.840.1.113883.19.3 LoincDocumentTypeCode STATIC 20061017.
Syntax for vocabulary binding to a single code:
The value for (pathname of coded element) (SHALL | SHOULD | MAY) be (code [displayName] codeSystemOID [codeSystemName] STATIC.
CONF-ex4: The value for ClinicalDocument/code element SHALL be 34133-9 Summarization of episode note 2.16.840.1.113883.6.1 LOINC STATIC.
Explanatory Remarks
Text that summarizes the intention of the conformance statements that follow it is shown in Roman type, as follows:
This entry records whether the patient died and, if so, whether the event being reported contributed to that death.
Mentions of CDA Base Requirements
As noted, HAI instances must conform to baseline CDA requirements. These requirements are not documented here except where their omission would be confusing. To distinguish IG-imposed constraints from those inherited from CDA R2 and mentioned here, the CDA R2 requirements appear in italics. For example:
The top level of an NHSN Healthcare-Associated Infection Report will be a ClinicalDocument element in the urn:hl7-org:v3 namespace.
Sample XML Code
Sample XML code is shown in boxed figures. Portions of the XML content may be elided for brevity, as shown here:
...
Succession Management
Submission of CDA-conformant HAI instances uses the elements defined in the CDA Header: documentID, setID, version number, and document relationship typecode. As with all CDA documents, the ClinicalDocument/id uniquely identifies a document instance (an electronic file). Subsequent versions of the document are identified by incrementing the version number.
NHSN will assign each participating vendor a root OID. ClinicalDocument/setId is generated by the vendor system. The vendor is responsible for extending its OID as necessary to support the several unique numbering schemes it must generate. These include document IDs, facility-generated event IDs, and facility-generated procedure IDs.
Vocabulary Tables and Value Sets
A number of controlled vocabularies, or code system tables, are provided in this document. These controlled vocabularies are defined in various supporting specifications and may be maintained by other bodies, as is the case for the LOINC and SNOMED CT.
Very long tables are, for the convenience of the reader working with the conformance statements, relegated to an appendix at the back of this IG. [See REF _Ref184461597 \r \h \* MERGEFORMAT Appendix D REF _Ref184461597 \h \* MERGEFORMAT Large Vocabularies (Non-normative)]. Short tables appear with the conformance statements to which they pertain.
Note that where identifiers for standard vocabularies are issued by the publisher of the code set, the set of allowed values from the vocabulary is maintained here in a value set conformance statement and the value set is issued a value set identifier where listed in this IG. The value set identifiers do not appear in submissions; they tie the conformance requirement to the appropriate code set for validation.
Identifiers for NHSN vocabularies are temporary in this version of the DSTU and will be replaced by permanent OIDs issued by SDTC before the DSTU is published.
XPath Notation
Instead of the traditional dotted notation used by HL7 to represent RIM classes, this IG uses XPath notation in conformance statements and elsewhere to identify the XML elements and attributes within the CDA document instance to which various constraints are applied.
Element names and their content, and attribute names and their values, are shown in a monospace font, as follows:
The legalAuthenticator element shall contain a time element that represents the time of authentication of the document, a signatureCode element where the value of @code is S, and an assignedEntity element that represents the authenticator of the document.
Use of Templates
Templates are collections of constraints that specify and validate agreed-to requirements for exchange. Collecting individual constraints and assigning a unique template identifier to the collection establishes a shorthand mechanism for the instance creator to assert conformance to those constraints. The template identifier itself carries no semantics. Validation errors against a template must not be construed as anything other than failure to meet the exact requirements of the template, and absence of a template identifier need not be construed as failure to meet the constraints required by the template.
Originator Responsibilities: General Case
An originator needs to apply a templateId in order to assert conformance with a particular template (e.g., an originator must include the appropriate HAI NHSN templateId to assert that an instance is a conformant document).
In the most general forms of CDA exchange, an originator does not have to apply a templateId for every template that an object in an instance document conforms to (e.g., the originator of a CDA R2 operative Report does not have to include the templateId for a Medications section in an unrelated IG, even if the Reports Medications section does conform to that template).
Recipient Responsibilities: General Case
A recipient may reject an instance that does not contain a particular templateId (e.g., a recipient looking to only receive CCD documents can reject an instance without the CCD templateId).
A recipient may process objects in an instance document that do not contain a templateId (e.g., a recipient can process entries that contain substanceAdministration acts within a Medications section, even if the entries do not have templateIds).
If an object does not have a templateId, a recipient must not report a conformance error about a failure to conform to a particular template on classes that do not claim conformance to that template and are not required to be conformant by other templates (e.g., substanceAdministration acts within the CCD Medications section that do not have a templateId need not conform to the CCD template for medication clinical statements. However, within a CCD Payers section, the Act representing the patient coverage is only allowed, and is further required, to have components that meet the reqirements of the policy act template. Therefore, a recipient may indicate that those acts present inside the coverage act that do NOT meet the requirements of the policy act template are not allowed).
Templates for NHSN Validation
Template identifiers are critical to the validation methods chosen at this time for submissions to the NHSN. Submission of instances that do not conform to the template identifier constraints defined here may be rejected as nonconformant.
Supporting Tools
Validation
Validation of instances that conform to this DSTU can be done using supplied schemas in two stages: first, using the CDA schema CDA.xsd to validate the basic structural and semantic requirements of any CDA instance and second, using a set of XPath statements compiled into a Schematron schema to validate the specific requirements of this DSTU. Schematron is a language for making assertions about patterns found in XML documents.
For more information, see:
HYPERLINK "http://www.schematron.com" www.schematron.com.
A Schematron schema for this document will be maintained on the HL7 wiki hosted by the Mayo Clinic. The project wiki page can be found at:
HYPERLINK "http://informatics.mayo.edu/wiki/index.php/Healthcare_Associated_Infection_Reports" http://informatics.mayo.edu/wiki/index.php/Healthcare_Associated_Infection_Reports The user name is "wiki" and the password is "wikiwiki."
The CDA Validator is an online application that validates a CDA documents conformance to several standards and IGs The Schematron files described above are included. The Validator can be found at:
HYPERLINK "http://www.alschulerassociates.com/validator" http://www.alschulerassociates.com/validator
Generation of Narrative Block
Clinical documents generated by clinicians for a patient chart can assume an almost infinite set of semantic structures. For this reason, CDA relies on a narrative block ( element in the XML) to convey the comprehensive clinical Report, i.e., all the information that a human reader would consider the definitive, legal content of the record. (Human readability and rendering requirements are described in CDA R2, Section 1.2.3. See REF _Ref184372449 \r \h \* MERGEFORMAT 3 REF _Ref184372449 \h \* MERGEFORMAT References.)
In contrast, the structure and semantics of HAI Reports to the NHSN must be tightly defined and constrained for unambiguous insertion into the NHSN database. Relatively few elements of such Reports consist of unstructured, uncoded narrative. Unlike most CDA instances, the definitive, human-readable, legal contents of a Report can be derived entirely from the CDA titles and coded entries.
Therefore, for the convenience of implementers who wish to avoid redundant entry and eliminate possible conflicts between the entries and the narrative block, this project created a set of transforms that derives the displayed narrative block from the CDA entries. Coded elements are extracted from an ancillary voc.xml file used by a pop-narr.xsl transform. The latest version of the transforms is available from the project wike site. (See instructions for accessing the wiki in REF _Ref184357592 \r \h \* MERGEFORMAT 1.8.1 REF _Ref184357592 \h \* MERGEFORMAT Validation.)
Use of this transform is not required; implementers can use local methods to create the CDA narrative block.
Display Transforms
The content required for correct interpretation by a human reader of a compliant instance must be displayable using any CDA stylesheet. Thus, instances conforming to this IG can be viewed using CDA.XSL or any other stylesheet that conforms to the requirements for CDA display of human-readable text.
In addition, this project has a customized stylesheet that conforms more closely to the display format typical of such records. This stylesheet, hai-display.xsl, will be maintained on the project wiki. (See instructions for accessing the wiki in REF _Ref184357592 \r \h \* MERGEFORMAT 1.8.1 REF _Ref184357592 \h \* MERGEFORMAT Validation.)
Content of the DSTU
This DSTU is comprised of the following files:
FilenameDescriptionCDAR2_HAIRPT_R1.docImplementation Guidebsi-num.xmlBSI numerator sample fileicu-denom.xmlICU denominator sample filessi-num.xmlSSI numerator sample fileproc-denom.xmlProcedure denominator sample filehai-display.xslStylesheet for display of HAI instancesGeneric HAI guide
The namespace for CDA Release 2.0 is urn:hl7-org:v3. Appropriate namespace declarations shall be used in the XML instance of the Clinical Document. In the examples in this specification, all elements are shown unprefixed, assuming that the default namespace is declared to be urn:hl7-org:v3. This IG does not require use of any specific namespace prefix. Instances should not include the xsi:schemaLocation element.
The top level of an NHSN Healthcare-Associated Infection Report will be a ClinicalDocument element in the urn:hl7-org:v3 namespace.
Header constraints are expressed in relation to the document element (ClinicalDocument).
The Header requirements for single-patient Reports (such as the BSI numerator Report or the Procedure Report) and for summary Reports (such as the ICU denominator Report) differ in only a few details.
Single-patient Reports are Reports about an individual patient and may be either numerator or denominator Reports. Summary patient records are Reports about defined groups of patients. The final calculation for numerator and denominator calculations can be drawn from both single and summary patient Reports. The specific inclusion and exclusion criteria used to refine the numerators and denominators for the Reports are available from the NHSN. REF _Ref184462038 \r \h \* MERGEFORMAT Appendix A REF _Ref184462044 \h \* MERGEFORMAT Document-level Requirements (non-normative) provides constraints and information that are specific to a particular Report type in particular, the templateId that identifies the Report type and whether the Report type represents a single patient or is a summary.
CDA Element in a ...Single-patient ReportSummary Report recordTarget/patientRole
id
patient
Has a value
Is required
Has nullFlavor
Is not used
documentationOfIs not usedIs required (records the period documented)componentOf/encompassingEncounter
id
effectiveTime
code
Is required
Is required (records the admission date)
Is required in procedure record
Is not used
Has nullFlavorparticipant
@typeCode
@contextControlCode
associatedEntity
@classCode
code
@code
@codeSystemIs not used
"SBJ"
"OP"
"PRS"
"389109008"
"2.16.840.1.113883.6.96"Varies by Report typecomponentOf/encompassingEncounter
location
Is usually required; exceptions are stated in the document-level header requirementNHSN HAI Header Model
CDA requires that a ClinicalDocument/typeId be present to identify the constraints imposed by CDA Release 2.0, essentially acting as a CDA version identifier.
The realmCode element shall be present where the value of @code is US.
The value of typeId/@root shall be 2.16.840.1.113883.1.3 and the value of typeId/@extension shall be POCD_HD000040.
A templateId element shall be present representing conformance to the generic constraints of this Guide. (templateId 2.16.840.1.113883.3.117.1.1.1).
A templateId element shall be present representing conformance to report-specific requirements of this Guide. See the appropriate report-specific section for the required detail.
...
Figure SEQ Figure \* ARABIC 1: CDA Header Template Identifiers
CDA provides id, setId, versionNumber, and relatedDocument elements to support succession management (document versioning). The id element identifies the CDA document instance (the electronic file). The vendor software is responsible for generating the necessary values and for ensuring uniqueness.
The setId element identifies the set of documents in a version tree and is consistent across all versions, whereas the id changes with each version.
The versionNumber element stores the version number as an integer (the first version is 1, the second is 2, et cetera). Since NHSN HAI documents are sometimes updated, this IG will require the use of setId and versionNumber to ensure that succession management can be easily performed.
The relatedDocument element stores the id of the parent document if this document replaces another one. The typeCode attribute stores the type of document relationship, but for this DSTU, the only supported value is RPLC (replace).
Note that NHSN issues its own internal event identifiers to submitted Reports, therefore the CDA eventId is not valued for submissions.
An id element shall be present where the value of @root is a globally unique identifier.
CDA requires a code element that specifies the type of the clinical document.
The value of code/@codeSystem shall be 2.16.840.1.113883.6.1 and the value of code/@code shall be x-HAI. STATIC 20071130
The preferred title content for each Report type is given in REF _Ref184459785 \r \h \* MERGEFORMAT Appendix A REF _Ref184459807 \h \* MERGEFORMAT Document-level Requirements (non-normative).
A title element shall be present.
CDA requires an effectiveTime element and a confidentialityCode element:
An effectiveTime element shall be present representing the time of creation of the CDA document instance.
CDA requires a confidentiality code that indicates the sensitivity of the document. All HAI submissions carry the same value of normal. Note that this designation does not affect local policy on safeguarding confidentiality of patient-identifiable personal health information.
A confidentialityCode/@codeSystem element shall be present where the value of @codeSystem is 2.16.840.1.113883.5.25 and the value of @code is N.
A languageCode element shall be present where the value of @code is en-US.
A setId element and a versionNumber element shall be present.
If versionNumber/@value is greater than 1, relatedDocument/@typeCode shall be RPLC (replace) and relatedDocument/parentDocument/id SHALL be populated with the id of the document being replaced.
...
Blood Stream Infection Report (BSI)
...
Figure SEQ Figure \* ARABIC 2: CDA Header Document Information
CDA requires a recordTarget element which must contain a patientRole element.
If the document is a summary report, the patientRole shall contain an id element where the value of @nullFlavor is NI.
If the document is a single-patient report, the patientRole element shall contain id elements that represent the patient ID assigned by the local facility, may contain other id elements that represent a secondary ID for the patient, and shall contain a patient element. The patient element may contain a name element, and shall contain an administrativeGenderCode element where the value of @codeSystem is 2.16.840.1.113883.5.1 (HL7 gender codes) and a birthTime element.
...
DoeJohnD.
...
Figure SEQ Figure \* ARABIC 3: CDA Header recordTarget
The author may be software or may be someone in the role of infection control professional (ICP).
An author element shall be present. The author element shall contain a time element that represents the time of authoring of the information, and an assignedAuthor element that represents the author of the information. The assignedAuthor element shall contain an id element.
CDA requires that the document custodian be recorded. The NHSN is the custodian of NHSN HAI Reports.
A custodian/assignedCustodian/representedCustodianOrganization/id element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2 and the value of @extension is NHSN.
CDA requires that a legalAuthenticator element be present if the document has been legally authenticated. Local policy may delegate the function of legal authentication to a device or system that generates the CDA document. In these cases, the legal authenticator must still be a person accepting responsibility for the document, not the device or system.
The legalAuthenticator element shall contain a time element that represents the time of authentication of the document, a signatureCode element where the value of @code is S, and an assignedEntity element that represents the authenticator of the document. The assignedEntity element shall contain an id element.
...
...
Figure SEQ Figure \* ARABIC 4: CDA Header author, custodian, and legalAuthenticator
The subject of a summary document is a group rather than an individual patient. This is defined using a participant with the SBJ (subject) type code and the SNOMED CT code for "group.
If the document is a summary report, a participant element SHALL be present where @typeCode is SBJ and @contextControlCode is OP. The participant element SHALL contain an associatedEntity element where @classCode is PRS. The associatedEntity element SHALL contain a code element where @code is 389109008 and @codeSystem is 2.16.840.1.113883.6.96.
Figure SEQ Figure \* ARABIC 5: CDA Header participant (Summary Documents)
If the document is a summary report, a documentationOf element shall be present and shall contain a serviceEvent element where the value of @classCode is CASE. The serviceEvent element shall contain an effectiveTime element that contains a low element and a high element representing respectively the first and last days of the period reported.
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Figure SEQ Figure \* ARABIC 6: CDA Header documentationOf
In a summary report, encompassingEncounter/effectiveTime is recorded with a nullFlavor. The element is required by CDA, but the dates of the service event being recorded are already documented in the documentationOf element (above).
A componentOf element shall be present and shall contain an encompassingEncounter element.
If the document is a single-patient report, the encompassingEncounter element shall contain an id element that represents the event or procedure number assigned by the facility and an effectiveTime element that contains a low element representing the date admitted to the facility.
A procedure denominator Report records whether the patient was an outpatient. The HL7 actCode AMB corresponds to NHSNs outpatient datum.
If the document is a procedure denominator report, the encompassingEncounter element shall contain a code element representing whether the patient was an outpatient. The value for code/@code shall be selected from Value Set NHSNEncounterTypeCode 2.16.840.1.113883.3.117.1.1.6.10 STATIC 20071130.
Value Set: NHSNEncounterTypeCode 2.16.840.1.113883.3.117.1.1.6.10
Code System: HL7 actCode 2.16.840.1.113883.5.4Concept IDPrint NameAMBAmbulatory IMPInpatientTable SEQ Table \* ARABIC 1: Encounter Type Value Set
If the document is a summary record, the encompassingEncounter element shall contain an effectiveTime element where the value of @nullFlavor is NI.
NHSN provides a data constraint on the value of the admission date.
The value of effectiveTime/low/@value, if present, shall not be earlier than January 1, 1986, shall not be earlier than the date of birth, and shall not be later than the event date.
Physical location is recorded in healthCareFacility/id as a combination of @root representing the facility OID (assigned by NHSN) and @extension representing the facilitys unit identifier, such as 9W. The type of location, such as Critical Care Unit, is recorded in healthCareFacility/code.
The encompassingEncounter element shall contain a location element that contains a healthCareFacility element. The healthCareFacility element if present shall contain an id element where the value of @root represents the facility OID assigned by NHSN and the value of @extension represents the facility-assigned unit ID, and a code element where the value of @codeSystem is 2.16.840.1.113883.6.259 (HL7 Healthcare Service Location Code) and the value of @code is drawn from REF _Ref190948773 \h \* MERGEFORMAT Table 23: Healthcare Service Location Value Set REF _Ref184365699 \h \* MERGEFORMAT Table 23: Healthcare Service Location .
NHSN provides a data constraint on the facilitys location identifier and a data constraint on the combination of location type and gender.
The value of healthCareFacility/id/@extension shall be a value previously registered with NHSN.
If the value of the NHSN location type (code/@code) is one of the following, the patients administrativeGenderCode shall not be a code representing male (for example, "M" from code system 2.16.840.1.113883.5.1, AdministrativeGender complete) :
IN:ACUTE:CC:PNATLIN:ACUTE:WARD:GYNIN:ACUTE:WARD:LDIN:ACUTE:WARD:LD_PPIN:ACUTE:WARD:PPIN:ACUTE:OR:LDOUT:NONACUTE:CLINIC:GYNOUT:NONACUTE:CLINIC:PNATL
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Figure SEQ Figure \* ARABIC 7: CDA Header componentOf
Body Model
A component element shall be present and shall contain a single structuredBody element.
The structuredBody element shall contain a component element for each section appropriate to the particular report being made. REF _Ref184459927 \r \h \* MERGEFORMAT Appendix A REF _Ref184459945 \h \* MERGEFORMAT Document-level Requirements (non-normative) sets out which sections are required for each report type.
For the requirements of a particular Report type, first consult REF _Ref184459927 \r \h \* MERGEFORMAT Appendix A REF _Ref184459945 \h \* MERGEFORMAT Document-level Requirements (non-normative), which sets out the header requirements and section requirements that are specific to each Report type. For example, an SSI Report must contain two sections, Details and Findings. Then consult REF _Ref184460009 \r \h \* MERGEFORMAT Appendix B REF _Ref184460016 \h \* MERGEFORMAT Section Library (Non-normative) for the detailed conformance statements for those sections and their entries.
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Figure SEQ Figure \* ARABIC 8: Structured Body
Section Model
Each section element will have a templateId, a code, a title, a narrative block (text element), and the specific entries required by the Report type.
A section element shall contain a templateId element, where the value of @root is as specified in the appropriate report-specific Appendix.
A section element shall contain a code element where the value of @codeSystem is 2.16.840.1.113883.6.1, and the value of @code is a LOINC code corresponding to the section type as specified in the appropriate report-specific Appendix.
A section element shall contain a title element that provides a title for the section.
A section element shall contain a narrative block followed by at least one entry element.
Bug-Drug Tests
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...
Figure SEQ Figure \* ARABIC 9: Section
If the narrative block is derived solely from entry elements, the entry elements should have a @typeCode attribute with the value DRIV. This attribute is not shown in the code samples. It is the senders responsibility to ensure that the narrative block is the equivalent of the entries, regardless of how the narrative block was created.
References
Dolin RH, Alschuler L, Boyer S, Beebe C, Behlen FM, Biron PV, Shabo A, (Editors). HL7 Clinical Document Architecture, Release2.0. ANSI-approved HL7 Standard; May 2005. Ann Arbor, Mich.: Health Level Seven, Inc. Available at: HYPERLINK "http://www.hl7.org/documentcenter/private/standards/cda/r2/cda_r2_normativewebedition.zip" http://www.hl7.org/documentcenter/private/standards/cda/r2/cda_r2_normativewebedition.zip.
HYPERLINK "http://www.regenstrief.org/loinc" LOINC: Logical Observation Identifiers Names and Codes, Regenstrief Institute. Available at HYPERLINK "http://www.regenstrief.org/medinformatics/loinc/" http://www.regenstrief.org/medinformatics/loinc/
HYPERLINK "http://www.snomed.org/snomedct/index.html" SNOMED CT: SNOMED Clinical Terms SNOMED International Organization. Available at: HYPERLINK "http://www.ihtsdo.org/" http://www.ihtsdo.org/. HYPERLINK ""
Schematron, HYPERLINK "http://www.schematron.com/" www.schematron.com.
Extensible Markup Language, HYPERLINK "http://www.w3.org/XML" www.w3.org/XML.
Dolin RH, Alschuler L, Boyer S, Beebe C, Behlen FM, Biron PV, Shabo A., HL7 Clinical Document Architecture, Release2. J Am Med Inform Assoc. 2006;13:3039. Available at: HYPERLINK "http://www.jamia.org/cgi/reprint/13/1/30" http://www.jamia.org/cgi/reprint/13/1/30.
HYPERLINK "http://www.alschulerassociates.com/cda/?topic=quick-start-guides" The Clinical Document Architecture Quick Start Guide (CDA QSG) Alschuler Associates, LLC. Available at: HYPERLINK "http://www.alschulerassociates.com/cda/?topic=quick-start-guides" http://www.alschulerassociates.com/cda/?topic=quick-start-guides.
Document-level Requirements (non-normative)
This appendix details the document-level requirements for each Report type. In general, these requirements state whether the Report is a single-patient or a summary Report, specifying the templateId value that identifies the report type and specifying the sections required for that report type.
For generic details of the NHSN HAI Header, see REF _Ref190861896 \r \h \* MERGEFORMAT 2.1 REF _Ref190861907 \h \* MERGEFORMAT NHSN HAI Header Model. Note that some details depend on whether the Report is a single-patient or a summary Report.
For conformance statements that apply to each section type and its entries, see REF _Ref184461117 \r \h \* MERGEFORMAT Appendix B REF _Ref184461122 \h \* MERGEFORMAT Section Library (Non-normative).
The Report types covered by this appendix are:
Report TypeAbbreviationBlood Stream Infection Numerator ReportBSI ReportSurgical Site Infection Numerator ReportSSI ReportProcedure Denominator ReportDenominator for Intensive Care Unit (ICU)/Other Locations (not NICU or SCA) ReportICU ReportSummary of templateId Use Across Report Types
All templateIds in this IG begin with 2.16.840.1.113883.3.117.1.1. This is abbreviated in the table below as ...1.1. For example:
HAI implementation guide
2.16.840.1.113883.3.117.1.1.1 shown here as ...1.1.1
BSI report
2.16.840.1.113883.3.117.1.1.3.1 shown here as ...1.1.3.1
The following chart summarizes the sequence of sections/templates within the report types described here.
HAI Implementation Guide (...1.1.1)DocumentSection and Clinical Statements Libraries Bloodstream Infection Report
(...1.1.3.1)Risks Section (...1.1.2.1)
Risks Organizer (...1.1.2.1.1)
Risk Factors Observation(s) (...1.1.2.1.1, ...1.1.2.1.2)
Details Section (...1.1.2.2)
Bloodstream Infection Type Observation (...1.1.2.2.3)
Death Observation (...1.1.2.2.4) (if pt died)
Infection Contributed to Death Observation (...1.1.2.2.7.16)
Findings Section (...1.1.2.5)
Findings Organizer(s) (...1.1.2.5.0)
Pathogen Identified Observation (...1.1.2.5.1)
Pathogen Ranking Observation (...1.1.2.5.1.1)
Drug-susceptibility Test Observation(s) (...1.1.2.5.1.2)
or
Pathogens Identified Observation (...1.1.2.5.2) (negated)Surgical Site
Infection Report
(...1.1.3.2)Details Section (...1.1.2.2)
Procedure Details (...1.1.2.2.7 and ...1.1.2.7.2)
SSI Anatomic Site Observation (...1.1.2.2.7.13)
Secondary Bloodstream Infection Observation (...1.1.2.2.7.15)
SSI Detected Observation (...1.1.2.2.5)
Death Observation (...1.1.2.2.4) (if pt died)
Infection Contributed to Death Observation (...1.1.2.2.7.16)
Findings Section (...1.1.2.5)
Findings Organizer(s) (...1.1.2.5.0)
Pathogen Identified Observation (...1.1.2.5.1)
Pathogen Ranking Observation (...1.1.2.5.2)
Drug-susceptibility Test Observation(s) (...1.1.2.5.1.2)Procedure Denominator Report
(...1.1.3.4)Risk Factors Section (...1.1.2.1)
Procedure Risk Factors (...1.1.2.7.17)
Wound Class Observation (...1.1.2.1.2)
Endoscope Used Procedure(...1.1.2.1.3)
ASA Class Observation (...1.1.2.2.7.4)
Trauma Observation (...1.1.2.2.7.5)
Multiple Procedures Observation (...1.1.2.2.7.6)
If Procedure = Spinal fusion or refusion include
Diabetes Observation (...1.1.2.2.7.7)
If Procedure = Cesarean include
Height Observation (...1.1.2.2.7.9)
Weight Observation (...1.1.2.2.7.10)
Duration of Labor Observation (...1.1.2.2.7.11)
Blood Loss Observation (...1.1.2.2.7.12)
Details Section (...1.1.2.2)
Procedure Details (...1.1.2.2.7 and ...1.1.2.2.7.1)
Anesthesia Administration (...1.1.2.2.7.3)
If procedure = fusion/refusion include
Spinal Fusion Level Observation (...1.1.2.2.7.8)ICU Denominator Report
(...1.1.3.3)Summary Section (...1.1.2.6)
Summary Encounter (...1.1.2.6.1 and ...1.1.2.6.2)
Summary Data Observations (...1.1.2.6.1.1)
BSI Numerator Report
The preferred title for the CDA document is Blood Stream Infection Report (BSI).
BSI-specific Header Constraints
The BSI numerator is a single-patient Report.
A templateId element shall be present in the CDA header where @root has the value 2.16.840.1.113883.3.117.1.1.3.1 representing conformance to the constraints for the BSI numerator report.
BSI-specific Body Constraints
The structuredBody element shall contain a Risk Factors section (templateId 2.16.840.1.113883.3.117.1.1.2.1) and a Details section (templateId 2.16.840.1.113883.3.117.1.1.2.2).
The structuredBody element shall contain a Findings section (templateId 2.16.840.1.113883.3.117.1.1.2.5).
...
...
Blood Stream Infection Report (BSI)
...
...
...
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Figure SEQ Figure \* ARABIC 10: Document-level Constraints
SSI Numerator Report
The preferred title for the CDA document is Surgical Site Infection Report (SSI).
SSI-specific Header Constraints
The SSI numerator is a single-person Report.
A templateId element shall be present in the CDA header where @root has the value 2.16.840.1.113883.3.117.1.1.3.2, representing conformance to the constraints for the the SSI numerator report.
SSI-specific Body Constraints
The structuredBody of a Surgical Site Infection numerator report shall contain a Details section (templateId 2.16.840.1.113883.3.117.1.1.2.2).
The structuredBody element shall contain a Findings section (templateId 2.16.840.1.113883.3.117.1.1.2.5).
ICU Denominator Report
The preferred title for the CDA document is Denominator for Intensive Care Unit (ICU)/Other Locations (not NICU or SCA) Report.
ICU-specific Header Constraints
The ICU denominator is a summary Report.
A templateId element shall be present in the CDA header where @root has the value 2.16.840.1.113883.3.117.1.1.3.3 representing conformance to the constraints for the ICU denominator Report
ICU-specific Body Constraints
The structuredBody of an ICU Denominator Report shall contain a Summary section (templateId 2.16.840.1.113883.3.117.1.1.2.6).
Procedure Denominator Report
The preferred title for the CDA document is Denominator for Procedure Report.
Procedure-specific Header Constraints
The Procedure denominator is a single-person Report.
A templateId element shall be present in the CDA header where @root has the base value 2.16.840.1.113883.3.117.1.1.3.4, representing conformance to the constraints for the Procedure denominator report.
A Procedure denominator report shall not record the location of the encounter (healthCareFacility in componentOf/encompassingEncounter).
Procedure-specific Body Constraints
The structuredBody element of a Procedure denominator report shall contain a Details section (templateId 2.16.840.1.113883.3.117.1.1.2.2) and a Risk Factors section (templateId 2.16.840.1.113883.3.117.1.1.2.1)
Section Library (Non-normative)
The Section Library provides the requirements for sections and their entries in NHSN HAI Reports. Several types of section and entry are used in more than one type of HAI Report. For example, the Findings section for pathogen susceptibility results is used in the BSI Numerator Report and the SSI Numerator Report. To avoid repeating identical details for each Report, the section- and entry-level requirements are provided in a single location, which is this Section Library. The requirements for the specified clinical statements are provided in REF _Ref184461027 \r \h \* MERGEFORMAT Appendix C REF _Ref184461171 \h \* MERGEFORMAT Clinical Statement Library (Non-normative).
Where requirements vary somewhat by report type, the general requirements are provided first, followed by a subsection specifying the report-specific details. For example, the BSI, SSI, and Procedure reports all have a Details section, but the BSI report requires an entry recording the infection type, whereas the Procedure report requires an entry recording the procedure type.
Constraints for a section type are followed by constraints on the entries within that section type.
Risk Factors Section
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.1.
A code element shall be present where the value of @codeSystem is 2.16.840.1.113883.6.1, and the value of @code is x-RISKS.
Risk Factors
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Figure SEQ Figure \* ARABIC 11: Risk Factors Section
Risk Factors in a BSI Numerator Report
In a BSI numerator report, a single entry element shall be present containing a Risks Organizer (templateId 2.16.840.1.113883.3.117.1.1.2.1.1).
Risk Factors in a Procedure Denominator Report
The following chart summarizes the requirements for the Risk Factors section in a procedure report.
On an entry/procedure elementAs entry/observationEmergency (as methodCode)
Wound Class
Endoscope
ASA Class
Trauma
Multiple Procedures
If spinal fusion or refusion:
Diabetes
If Cesarean:
Height
Weight
Labor duration
Estimated blood loss
In a procedure denominator report, an entry element shall be present containing a procedure element recording Procedure Risk Factors (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.17).
In a procedure denominator report, an entry element shall be present for each of the following: ASA Class Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.4), Trauma Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.5), and Multiple Procedures Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.6).
In a procedure denominator report, if the procedure was a spinal fusion or refusion (code/@code is either FUSN or RFUSN), an entry element shall be present for each of the following: Diabetes Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.7).
In a procedure denominator report, if the procedure was a Cesarean (code/@code is CSEC), an entry element shall be present for each of the following: Height Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.9), Weight Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.10), Duration of Labor Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.11), and Blood Loss Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.12).
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Figure SEQ Figure \* ARABIC 12: Risk Factors in a Procedure Report
Details Section
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.
A code element shall be present where the value of @codeSystem is 2.16.840.1.113883.6.1, and the value of @code is x-DETAILS.
Event Details
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Figure SEQ Figure \* ARABIC 13: Details Section
The information recorded in the Details section varies according to Report type. The charts below summarize the differences.
Whether the patient was an outpatient is recorded in the CDA Header. Procedure-related details that are risk factors rather than aspects of the procedure itself are recorded separately in the Risk Factors section.
Details Section in BSI, SSI, and Procedure Reports:BSI ReportSSI ReportProcedure ReportBSI Type
If patient died
Death (+ Contributed to Death)Procedure Details Entry
SSI Detected
If patient died
Death (+ Contributed to Death)Procedure Details Entry
Procedure Details Entries in Procedure and SSI Reports:All VariantsA procedure element with templateId 2.16.840.1.113883.3.117.1.1.2.2.7
a code element recording the NHSN Procedure Category code
effectiveTime
low = procedure date
width = procedure durationIn SSI ReportIn Procedure ReportA second templateId (2.16.840.1.113883.3.117.1.1.2.2.7.2)
SSI Location Type
If SSI Location Type is Organ/System (OS):
SSI Anatomic Site
Secondary Bloodstream Infection
A second templateId (2.16.840.1.113883.3.117.1.1.2.2.7.1)
A procedure id
General anesthesia
If spinal fusion or refusion:
Spinal fusion level
Spinal fusion approach
If hip replacement or knee replacement:
TypeDetails Entries in a BSI Numerator Report
In a BSI numerator report, an entry element shall be present containing a Bloodstream Infection Type Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.3).
If the patient died, an entry element shall be present containing a Death Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.4); if the patient did not die, an entry element may be present containing a Death Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.4) where @negationInd is true.
Details Entries in a Procedure Denominator Report
In an Procedure denominator report, an entry element shall be present containing Procedure Details (templateId 2.16.840.1.113883.3.117.1.1.2.2.7).
Details Entries in an SSI Numerator Report
In an SSI numerator report, an entry element shall be present containing Procedure Details (templateId 2.16.840.1.113883.3.117.1.1.2.2.7).
An entry element shall be present containing an SSI Detected Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.5).
If the patient died, an entry element containing a Death Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.4) shall be present to record this; if the patient did not die, an entry element may be present containing a Death Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.4) where @negationInd is true.
Procedure Details in an SSI Report
A Procedure Details clinical statement conforming to SSI report constraints shall contain a second templateId where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.2.
In an SSI report, the Procedure Details shall include a methodCode element representing the SSI Location Type. The value for code/@code shall be selected from ValueSet NHSNSSILocationTypeCode 2.16.840.1.113883.3.117.1.1.6.3.21 STATIC 20080130 and shall be a code appropriate to the procedure category code.
Value Set: NHSNSSILocationTypeCode 2.16.840.1.113883.3.117.1.1.6.3.21
Code system: NHSN SSI Location Type 2.16.840.1.113883.3.117.1.1.4.3.21SSI Location Type CodeMeaningDIPDeep Incisional PrimaryDISDeep Incisional SecondarySIPSuperficial Incisional Primary SISSuperficial Incisional SecondaryOSOrgan/SpaceTable SEQ Table \* ARABIC 5: Surgical Site Infection Location Type Value Set
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Figure SEQ Figure \* ARABIC 17: SSI Location Type methodCode
In an SSI report, if the Surgical Site Infection Location value represents Organ/Space (@code="OS"), the Procedure Details shall include an entryRelationship element where the value of @typeCode is REFR that contains an SSI Anatomic Site Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.13).
In an SSI report, the Procedure Details SHALL include an entryRelationship element where the value of @typeCode is REFR that contains a Secondary Bloodstream Infection Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.15).
Procedure Details in a Procedure Report
A Procedure Details clinical statement conforming to Procedure report constraints shall contain a second templateId where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.1
A Procedure Details clinical statement conforming to Procedure report constraints shall contain an id element where the value of @root is the same as the id of the procedure element in the Risk Factors section that records risk factors for the procedure.
The Procedure Details shall include an entryRelationship element where @typeCode is COMP to record whether anesthesia was administered, as an Anesthesia Administration (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.3).
If the procedure is a fusion or refusion (code/@code is either FUSN or RFUSN), the Procedure Details shall include an approachSiteCode element where the value of @code shall be selected from ValueSet 2.16.840.1.113883.3.117.1.1.6.17 NHSNSpinalFusionApproachCode STATIC, and SHALL also contain an entryRelationship element where the value of @typeCode is COMP, containing a Spinal Fusion Level Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.8).
Value Set: NHSNSpinalFusionApproachCode 2.16.840.1.113883.3.117.1.1.6.17
Code System: NHSN Spinal Fusion Approach 2.16.840.1.113883.3.117.1.1.4.17CodeMeaningAanteriorPposteriorAPanterior posteriorLTlateral transverseTable SEQ Table \* ARABIC 2: Spinal Fusion Approach Value Set
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Figure SEQ Figure \* ARABIC 14: Spinal Fusion Approach
If the procedure category code represents a hip replacement, the Procedure Details shall include a methodCode element. The value for methodCode/@code shall be selected from Value Set NHSNHipReplacementCode 2.16.840.1.113883.3.117.1.1.6.18 static 20080130.
Value Set: NHSNHipReplacementCode 2.16.840.1.113883.3.117.1.1.6.18
Code System: NHSN Hip Replacement 2.16.840.1.113883.3.117.1.1.4.18CodeMeaningTPtotal primaryPPpartial primaryTRtotal revisionPRpartial revisionTable SEQ Table \* ARABIC 3: Hip Replacement Value Set
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Figure SEQ Figure \* ARABIC 15: NHSN Hip Replacement methodCode
If the procedure category code represents a knee replacement, the Procedure Details shall include a methodCode element. The value for methodCode/@code shall be selected from Value Set NHSNKneeReplacementCode 2.16.840.1.113883.3.117.1.1.6.19 STATIC 20080130.
Value Set: NHSNKneeReplacementCode 2.16.840.1.113883.3.117.1.1.6.19
Code System: NHSN Knee Replacement 2.16.840.1.113883.3.117.1.1.4.19CodeMeaningTprimary (total)Rrevision (total or partial)Table SEQ Table \* ARABIC 4: Knee Replacement Value Set
...
Figure SEQ Figure \* ARABIC 16: NHSN Knee Replacement methodCode
Findings Section
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.5.
A code element shall be present where the value of @codeSystem is 2.16.840.1.113883.6.1 and the value of @code is 18769-0.
If pathogens were identified, the Findings section shall contain at least one and no more than three entry elements, each containing a single Findings Organizer 2.16.840.1.113883.3.117.1.1.2.5.0) reporting a pathogen identified.
If no pathogens were identified, the Findings section SHALL contain a single entry containing a Pathogens Identified Observation (templateId 2.16.840.1.113883.3.117.1.1.2.5.2) where the value of @negationInd is true, showing that no pathogens were identified.
Findings
...
Figure SEQ Figure \* ARABIC 18: Findings Section
Summary Section
The specific data to be reported in the Summary section vary according to report type. The report type can be inferred from ClinicalDocument/templateId.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.6.
A code element shall be present where the value of @codeSystem is 2.16.840.1.113883.6.1 and the value of @code is x-SUMMARY.
A single entry element shall be present containing a Summary Encounter (templateId 2.16.840.1.113883.3.117.1.1.2.6.1).
Summary - ICU - June 2006
...
Figure SEQ Figure \* ARABIC 19: Summary Section
Summary Encounter
At present, this DSTU has in scope only one summary report, the ICU denominator.
A Summary Encounter shall be represented by an encounter element where the value of @classCode is ENC and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.6.1.
An entryRelationship element where the value of @typeCode is COMP shall be present for each Summary Data Observation (templateId 2.16.840.1.113883.3.117.1.1.2.6.1.1) required by the report type.
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Figure SEQ Figure \* ARABIC 20: Summary Encounter
Summary Encounter in an ICU Denominator Report
An Summary Encounter conforming to ICU Denominator Report constraints SHALL contain a second templateId where the value of @root is 2.16.840.1.113883.3.117.1.1.2.6.1.2.
A Summary Encounter in an ICU Denominator report shall contain four Summary Data Observations (templateId 2.16.840.1.113883.3.117.1.1.2.6.1.1)representing patient days, central line days, urinary catheter days, and ventilator days.
Clinical Statement Library (Non-normative)
Risks Organizer
The Risks Organizer SHALL be represented with an organizer element where the value of @classCode is CLUSTER and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.1.1.
A statusCode element shall be present where the value of @code is completed.
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Figure SEQ Figure \* ARABIC 21: Risks Entry and Organizer
The content of the Risk Factors Organizer is one or more component/observation elements. The particular observations required depend on the location type, specified by ClinicalDocument/componentOf/encompassingEncounter/location/ healthcareFacility/code.
If the location type represents an ICU/Other Location (ICU or any other location except for SCA or NICU), the organizer element shall contain a single component element containing a Risk Factors Observation (templateId 2.16.840.1.113883.3.117.1.1.2.1.1.1) representing whether a central line was present.
If the location type represents an SCA, the organizer element shall contain a component element containing a Risk Factors Observation (templateId 2.16.840.1.113883.3.117.1.1.2.1.1.1) representing whether a permanent central line was present, and a component element containing a Risk Factors Observation (templateId 2.16.840.1.113883.3.117.1.1.2.1.1.1) representing whether a Temporary Central Line was present.
If the location type represents an NICU, the organizer element shall contain a component element containing a Risk Factors Observation (templateId 2.16.840.1.113883.3.117.1.1.2.1.1.1) representing whether a (non-umbilical) central line was present, a component element containing a Risk Factors Observation (templateId 2.16.840.1.113883.3.117.1.1.2.1.1.1) representing whether an umbilical catheter was present, and a component element containing a Risk Factors Measurement Observation (templateId 2.16.840.1.113883.3.117.1.1.2.1.1.2) representing the birth weight.
Note that there are three distinct component/observations related to central line: an unspecified central line, used when the location type represents an ICU or an NICU, and a permanent central line and temporary central line, used when the location type represents an SCA.
BSI Risk Factors Observation
A BSI Risk Factors Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element SHALL be present where @root is 2.16.840.1.113883.3.117.1.1.2.1.1.1.
The value for code/@code SHALL be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@code shall be selected from Value Set 2.16.840.1.113883.3.117.1.1.6.7 NHSNBSIRiskFactorsCode static 20080130.
Value Set: NHSNBSIRiskFactorsCode 2.16.840.1.113883.3.117.1.1.6.7
Code system: NHSN BSI Risk Factors 2.16.840.1.113883.3.117.1.1.4.7CodeMeaningcentralLine(unspecified) central linepermCentralLinepermanent central linetempCentralLinetemporary central lineumbCatheterumbilical catheterbirthwtbirth weightTable SEQ Table \* ARABIC 6: BSI Risk Factors Value Set
Figure SEQ Figure \* ARABIC 22: Risk Factor Observation
Risk Factors Measurement Observation
This observation records a risk factor that reports a value, such as birth weight.
A Risk Factors Measurement Observation SHALL be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.1.1.2.
A code element shall be present where the value of @codeSystem is 2.16.840.1.113883.3.117.1.1.4.7 and the value of @code is selected from Value Set NHSNBSIRiskFactorsCode 2.16.840.1.113883.3.117.1.1.6.7 STATIC 20080130.
A statusCode element SHALL be present where the value of @code is completed.
A value element SHALL be present where the value of @xsi:type is PQ and the value represents the measurement observed.
Bloodstream Infection Type Observation
This observation records whether the bloodstream infection being reported was confirmed by a positive blood culture or inferred from clinical symptoms.
A Bloodstream Infection Type Observation SHALL be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.3.
The value for code/@code SHALL be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element SHALL be present where the value of @code is completed.
The value for value/@code shall be selected from ValueSet 2.16.840.1.113883.3.117.1.1.6.3.1 NHSNBloodStreamInfectionTypeCode STATIC 20080130.
An effectiveTime element shall be present representing the event date.
Value Set: NHSNBloodStreamInfectionTypeCode 2.16.840.1.113883.3.117.1.1.6.3.1
Code System: SNOMED CT 2.16.840.1.113883.6.96MeaningSNOMED CTClinical sepsis =
>= 1 clinical symptom
+ blood culture not done or negative
+ no infection at another site
+ antimicrobial therapy238149007
abacteremic sepsis syn: culture negative sepsisLaboratory confirmed: =
No infection at another site
+ 1 choice of pathways (next table)Sepsis: 91302008Table SEQ Table \* ARABIC 7: Blood Stream Infection Value Set
Figure SEQ Figure \* ARABIC 23: Bloodstream Infection Type Observation
If the event type is laboratory-confirmed (LCBI), the Bloodstream Infection Type Observation shall contain an entryRelationship element where the value of @typeCode is SUBJ and the element contains an LCBI Pathway Observation (templateID 2.16.840.1.113883.3.117.1.1.2.2.3.1).
LCBI Pathway Observation
NHSN will maintain the code set for LCBI Pathways because the definitions are specific to their data-gathering and do undergo change.
An LCBI Pathway Observation SHALL be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element SHALL be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.3.1.
The value for code/@code SHALL be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element SHALL be present where the value of @code is completed.
The value for value/@code SHALL be selected from Value Set 2.16.840.1.113883.3.117.1.1.6.3.2 NHSNLCBIPathwaysCode STATIC 20080130.
Value Set: NHSNLCBIPathwaysCode 2.16.840.1.113883.3.117.1.1.6.3.2
Code System: NHSN LCBI Pathways 2.16.840.1.113883.3.117.1.1.4.3.2CodeMeaningARecognized pathogens >=1 blood culture positive
BOther organisms: >= 2 blood cultures from separate sites positive w/same organism + clinical sxCOther organisms: >= 1 blood culture positive in pt with IV + clinical sx + antimicrobial therapyTable SEQ Table \* ARABIC 8: LCBI Pathways Value Set
Figure SEQ Figure \* ARABIC 24: LCBI Pathway Observation
Procedure Risk Factors
Procedure Risk Factors shall be represented with a procedure element where the value of @classCode is PROC and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.17.
The procedure element shall contain an id element whose value is the same as the value of the procedure/id element that appears in the Details section of the report.
If the procedure was an emergency, the procedure element shall contain a methodCode element where the value of @codeSystem is 2.16.840.1.113883.6.96 SNOMED CT and the value of @code is 373110003 Emergency.
The procedure element shall also contain an entryRelationship element for each of the following: Wound Class Observation (templateId 2.16.840.1.113883.3.117.1.1.2.1.2), and Endoscope Used Procedure (templateId 2.16.840.1.113883.3.117.1.1.2.1.3).
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Figure SEQ Figure \* ARABIC 25: Procedure Risk Factors
Procedure Details
Procedure Details shall be represented with a procedure element where the value of @classCode is PROC and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.
An id element SHALL be present.
The value for code/@code shall be selected from Value Set NHSNProcedureCategoryCode 2.16.840.1.113883.3.117.1.1.6.4 DYNAMIC.
An effectiveTime element shall be present where the low element represents the date of the procedure and the width element represents the duration of the procedure.
The procedure element shall contain additional elements as required by the specific Report type and procedure category.
Value Set: NHSNProcedureCategoryCode 2.16.840.1.113883.3.117.1.1.6.4
Code System: NHSN Procedure Category 2.16.840.1.113883.3.117.1.1.4.4CodeMeaningAAAAbdominal aortic aneurysm repairAMPLimb amputationAPPYAppendix surgeryAVSDArteriovenous (AV) shunt for dialysis........Table SEQ Table \* ARABIC 9: Procedure Category Code (excerpt)
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Figure SEQ Figure \* ARABIC 26: Procedure Details
Death Observation
This observation records whether the patient died and if so, whether the infection being recorded contributed to that death.
A Death Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN. If the patient died, @negationInd shall be false. If the patient did not die, @negationInd shall be true.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.4.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
A value element shall be present where the value of @xsi:type is CD, the value of @codeSystem is 2.16.840.1.113883.6.96, and the value of @code is 419099009.
If the patient died, submitters should indicate whether or not the BSI contributed to the death using an entryRelationship on the observation of death. The inversionInd attribute indicates that the relationship should be interpreted as if the roles of the source and target entries were reversed. Thus, that observation reports whether the infection supported (contributed to) the death.
If the patient died, the observation shall contain an entryRelationship element where the value of @typeCode is SPRT (support) and the value of @inversionInd is true. The entryRelationship element shall contain an Infection Contributed to Death Observation (templateId 2.16.840.1.113883.3.117.1.1.2.2.7.16).
Figure SEQ Figure \* ARABIC 27: Death Observation
Infection Contributed to Death Observation
An Infection Contributed to Death Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN. If the infection contributed to death, @negationInd shall be false. If the infection did not contribute to the death, @negationInd shall be true.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.16.
The value for code/@code SHALL be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed
The value for code/@code shall be selected from Value Set NHSNInfectionTypeCode 2.16.840.1.113883.3.117.1.1.6.3.22 DYNAMIC.
Value Set: NHSNInfectionTypeCode 2.16.840.1.113883.3.117.1.1.6.3.22
Code System: NHSN Infection Type 2.16.840.1.113883.3.117.1.1.4.3.22CodeMeaningBSIblood stream infectionSSIsurgical site infectionTable SEQ Table \* ARABIC 10: Infection Type Value Set
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Figure SEQ Figure \* ARABIC 29: SSI Anatomic Site Observation
Wound Class Observation
NHSN patient safety protocol on this topic is an adaptation of (not a change to) the American College of Surgeons (ACoS) definitions, which are the definitions used by SNOMED. Thus SNOMED wound-class codes are appropriate for use with this observation. A Wound Class Observation shall be represented with an observation element.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.1.2.
A code element shall be present where the value of @codeSystem is 2.16.840.1.113883.6.96 and the value of @code is 420089007 CDC Wound Classification Category.
A statusCode element shall be present where the value of @code is completed.
If the wound classification is known, the value for value/@code shall be a SNOMED code selected from ValueSet 2.16.840.1.113883.3.117.1.1.6.13 NHSNWoundClassCode STATIC 20080130. If the wound classification is not known, the value for value/@nullFlavor shall be UNK.
Value Set: NHSNWoundClassCode 2.16.840.1.113883.3.117.1.1.6.13
Code System: SNOMED CT 2.16.840.1.113883.6.96NHSN MeaningSNOMED CT420089007 CDC Wound Classification CategoryClean418780004
CDC Class I/Clean Clean-contaminated418115006
CDC [wound] Class II/Clean Contaminated Contaminated419877002
CDC [wound] Class III/Contaminated Dirty418422005
CDC Class IV/Dirty Infected Table SEQ Table \* ARABIC 12: Wound Class Value Set
If the wound class is unknown:
Figure SEQ Figure \* ARABIC 30: Wound Class Observation
Anesthesia Administration
An Anesthesia Administration shall be represented with a substanceAdministration element where the value of @classCode is SBADM and the value of @moodCode is EVN.
A templateId element shall be present where @root is 2.16.840.1.113883.3.117.1.1.2.2.7.3.
A single consumable/manufacturedProduct/manufacturedLabeledDrug element shall be present and shall contain a code element where the value of @codeSystem is 2.16.840.1.113883.6.96 SNOMED and the value of @code is 84451006 General Anesthesia. If anesthesia was not administered, the value for substanceAdministration/@negationInd shall be true. If anesthesia was administered, the value for substanceAdministration/@negationInd shall be false.
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Figure SEQ Figure \* ARABIC 31: General Anesthesia Observation
ASA Class Observation
The SNOMED CT representation of ASA Class Codes includes a sixth value (413500003 ASA physical status class 6 for brain-dead patients taken to the operating room to remove organs for transplant). This sixth value is not part of the value set allowed in a CDA document submitted to NHSN.
An ASA Class Observation shall be represented with an observation element.
A templateId element shall be present where @root is 2.16.840.1.113883.3.117.1.1.2.2.7.4.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@code shall be selected from ValueSet 2.16.840.1.113883.3.117.1.1.6.14 NHSNASAClassCode STATIC 20080130.
Value Set: NHSNASAClassCode 2.16.840.1.113883.3.117.1.1.6.14
Code System: SNOMED CT 2.16.840.1.113883.6.96MeaningSNOMED CTNormally healthy patient413495001
ASA physical status class 1Patient with mild systemic disease413496000
ASA physical status class 2Patient with severe systemic disease, not incapacitating413497009
ASA physical status class 3Patient with incapacitating systemic disease, constant threat to life413498004
ASA physical status class 4Moribund patient, < 24-hour life expectancy413499007
ASA physical status class 5Table SEQ Table \* ARABIC 13: ASA Class Value Set
Figure SEQ Figure \* ARABIC 32: ASA Class Observation
Trauma Observation
A Trauma Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN. If trauma was involved, the value for @negationInd shall be false. If trauma was not involved, the value for @negationInd shall be true.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.5.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@xsi:type shall be CD. The value for value/@code shall be 417746004 from 2.16.840.1.113883.6.96 SNOMED CT static 20080130.
Figure SEQ Figure \* ARABIC 33: Trauma Observation
Endoscope Used Procedure
An Endoscope Used Procedure shall be represented with a procedure element where the value of @classCode is PROC and the value of @moodCode is EVN. If an endoscope was not used, the value of @negationInd shall be true. If an endoscope was used, the value of @negationInd shall be false.
A templateId element shall be present where @root is 2.16.840.1.113883.3.117.1.1.2.1.3.
The value for code/@code shall be 423827005 from code system 2.16.840.1.113883.6.96 SNOMED CT STATIC 20080130.
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Figure SEQ Figure \* ARABIC 34: Endoscope Used Procedure
Multiple Procedure Observation
A Multiple Procedure Observation shall be represented with an observation element. If multiple procedures were performed, the value of @negationInd shall be false. If multiple procedures were not performed, the value of @negationInd shall be true.
A templateId element shall be present where @root is 2.16.840.1.113883.3.117.1.1.2.2.7.6.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@xsi:type SHALL be CD. The value for value/@code SHALL be multProc from code system NHSN Vocabulary (2.16.840.1.113883.3.117.1.1.4.2) STATIC.
Figure SEQ Figure \* ARABIC 35: Multiple Procedure Observation
Diabetes Observation
A Diabetes Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN. If the patient did not have diabetes, the value of @negationInd shall be true. If the patient did have diabetes, the value of @negationInd shall be false.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.7.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@xsi:type shall be CD. The value for value/@code shall be 73211009 from 2.16.840.1.113883.6.96 SNOMED.
Figure SEQ Figure \* ARABIC 36: Diabetes Observation
Spinal Fusion Level Observation
A Spinal Fusion Level Observation shall be represented with an observation element.
A templateId element shall be present where @root is 2.16.840.1.113883.3.117.1.1.2.2.7.8.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@xsi:type shall be CD. If the spinal fusion level is known, the value for value/@code shall be selected from Value Set NHSNSpinalFusionLevelCode 2.16.840.1.113883.3.117.1.1.6.16 STATIC 20080130. If the spinal fusion level is not known, the value of value/@nullFlavor shall be NI.
Value Set: NHSNSpinalFusionLevelCode 2.16.840.1.113883.3.117.1.1.6.16
Code System: NHSN SpinalFusion Level 2.16.840.1.113883.3.117.1.1.4.16CodeNHSN PhraseDefined Asataxatlas-axisC1-C2 onlyataxCatlas-axis/cervicalC1-C7 (any combination)CcervicalC3-C7 (any combination)CDDcervical/dorsal/dorsolumbarExtends from any cervical through any lumbar levels DDdorsal/dorsolumbarT1-L5 (any combination)LLlumbar/lumbosacralL1-S5 (any combination)Table SEQ Table \* ARABIC 14: Spinal Fusion Level Value Set
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Figure SEQ Figure \* ARABIC 37: Spinal Fusion Level Observation
Height Observation
A Height Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.9.
The value for code/@code shall be 50373000 (Body Height) from SNOMED CT STATIC. The value for code/@codeSystem shall be 2.16.840.1.113883.6.96.
The value for value/@xsi:type shall be PQ (Physical Quantity). The value for value/@value shall be a non-negative real number representing the body height.
Figure SEQ Figure \* ARABIC 38: Height Observation
Weight Observation
A Weight Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.10.
The value for code/@code shall be 27113001 (Body Weight) from SNOMED CT STATIC. The value for code/@codeSystem SHALL be 2.16.840.1.113883.6.96.
The value for value/@xsi:type shall be PQ (Physical Quantity). The value for value/@value shall be a non-negative real number representing the body weight.
Figure SEQ Figure \* ARABIC 39: Weight Observation
Duration of Labor Observation
A Duration of Labor Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.11.
The value for code/@code shall be 289248003 (Duration of Labor) from SNOMED CT STATIC. The value for code/@codeSystem SHALL be 2.16.840.1.113883.6.96.
The value for value/@xsi:type shall be IVS TS (Interval of Point in Time). The value for value/@value shall be a non-negative real number representing the duration of labor in terms of the unit specified in @unit.
Figure SEQ Figure \* ARABIC 40: Duration of Labor Observation
Estimated Blood Loss Observation
An Estimated Blood Loss Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.12.
The value for code/@code shall be 409086003 (Estimated Maternal Blood Loss) from SNOMED CT STATIC. The value for code/@codeSystem shall be 2.16.840.1.113883.6.96.
The value for value/@xsi:type shall be PQ (Physical Quantity). The value for value/@value shall be a non-negative real number representing the estimated blood loss in terms of the units specified in @unit.
Figure SEQ Figure \* ARABIC 41: Estimated Blood Loss Observation
SSI Detected Observation
An SSI Detected Observation shall be represented by an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.5.
The value for code/@code SHALL be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
An effectiveTime element shall be present representing the date of the SSI event.
The value for value/@code shall be selected from Value Set NHSNOccasionOfHAIDetectionCode 2.16.840.1.113883.3.117.1.1.6.20 STATIC 20071130.
Value Set:NHSNOccasionOfHAIDetectionCode 2.16.840.1.113883.3.117.1.1.6.20
Code System: NHSN Occasion Of HAI Detection 2.16.840.1.113883.3.117.1.1.4.20CodeMeaningAAdmission (during the stay in which the surgery was performed)PPost Discharge SurveillanceRRe-admission (during a stay that is subsequent to the stay in which the surgery was performed)Table SEQ Table \* ARABIC 15: Occasion of Detection Value Set
Figure SEQ Figure \* ARABIC 42: SSI Detected Observation
Secondary Bloodstream Infection Observation
A Secondary Bloodstream Infection Observation shall be represented by an observation element where the value of @classCode is OBS and the value of @moodCode is EVN. If a secondary bloodstream infection was not present, the value for observation/@negationInd SHALL be true. If a secondary bloodstream infection was present, the value for observation/@negationInd SHALL be false.
A templateId element SHALL be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.2.7.15.
The value for code/@code SHALL be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@xsi:type SHALL be CD. The value for value/@code SHALL be secondaryBSI from code system NHSN Vocabulary (2.16.840.1.113883.3.117.1.1.4.2) STATIC.
Figure SEQ Figure \* ARABIC 43: SSI Secondary Bloodstream Infection Observation
Findings Organizer
Each Findings Organizer represents a single pathogen identified. The organizer contains two entryRelationships that record the pathogen and its rank in regard to the other pathogens identified and can contain additional entryRelationships recording drug-susceptibility test findings.
A Findings Organizer SHALL be represented with an organizer element where the value of @classCode is CLUSTER and the value of @moodCode is EVN.
A templateId element SHALL be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.5.0.
An entryRelationship element SHALL be present where the value of @typeCode is COMP, containing a Pathogen Identified Observation (templateId 2.16.840.1.113883.3.117.1.1.2.5.1).
An entryRelationship element SHALL be present where the value of @typeCode is COMP, containing a Pathogen Ranking Observation (templateId 2.16.840.1.113883.3.117.1.1.2.5.1.1).
For some pathogens, NHSN requires that specific drug-susceptibility tests be recorded. These pathogens are listed, with the required tests, in REF _Ref184375733 \h \* MERGEFORMAT Table 20: Required Pathogen-specific Drug-susceptibility Tests. For all other bacterial pathogens, at least one drug-susceptibility test result is required. For nonbacterial pathogens, drug-susceptibility test results are not required.
If the pathogen is listed in REF _Ref184375752 \h \* MERGEFORMAT Table 20: Required Pathogen-specific Drug-susceptibility Tests, an entryRelationship element where @typeCode is COMP shall be present containing a Drug Susceptibility Test Observation (templateId 2.16.840.1.113883.3.117.1.1.2.5.1.2) for each drug-susceptibility test shown for that pathogen. If the pathogen is not listed in REF _Ref184375769 \h \* MERGEFORMAT Table 20: Required Pathogen-specific Drug-susceptibility Tests and is a bacterial pathogen, at least one entryRelationship element where @typeCode is COMP shall be present containing a Drug Susceptibility Test Observation (templateId 2.16.840.1.113883.3.117.1.1.2.5.1.2).
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Figure SEQ Figure \* ARABIC 44: Findings Organizer
Pathogen Identified Observation
Each Pathogen Identified Observation represents a pathogen identified.
Pathogens are identified with SNOMED CT codes. NHSN requires that HAI CDA documents submitted record only pathogens listed in REF _Ref184375646 \h \* MERGEFORMAT Table 19: Pathogens . Note that in many cases, the table provides a code for an unspecified species, for example, Acidaminococcus species (SNOMED CT 131202007, NHSN ACISP), for use when a more precise code is not available. This code for an unspecified species is preferred to a genus-level code.
A Pathogen Identified Observation SHALL be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element SHALL be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.5.1.
The value of code/@code SHALL be 41852-5 Microorganism Identified from 2.16.840.1.113883.6.1 LOINC.
A value element SHALL be present where the value of @xsi:type is CD and the value is selected from Value Set NHSNPathogensCode 2.16.840.1.113883.3.117.1.1.6.8 DYNAMIC.
Figure SEQ Figure \* ARABIC 45: Microorganism Identified Observation
Pathogen Ranking Observation
A Pathogen Ranking Observation SHALL be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element SHALL be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.5.1.1.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element SHALL be present where the value of @code is completed.
A value element SHALL be present where the value of @xsi:type is CO (coded ordinal) and the value of @value is the number 1 or 2 or 3, where 1 represents the highest-ranked pathogen of up to 3 pathogens recorded.
Figure SEQ Figure \* ARABIC 46: Pathogen Ranking Observation
Drug-susceptibility Test Observation
A drug-susceptibility test finding is represented by a LOINC code representing a methodless isolate drug-susceptibility test, together with an HL7 ObservationInterpretationSusceptibility code representing the finding.
The drug-susceptibility test value set is given in REF _Ref184362179 \h \* MERGEFORMAT Table 18: Drug-susceptibility Tests Value Set.
A Drug Susceptibility Test Observation SHALL be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element SHALL be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.5.1.2.
The value of code/@code SHALL be selected from Value Set NHSNDrugSusceptibilityTestCode 2.16.840.1.113883.3.117.1.1.6.9 DYNAMIC.
An interpretationCode element SHALL be present. If the interpretation result is known, the value of code/@code shall be selected from Value Set NHSNDrugSusceptibilityFindingCode 2.16.840.1.113883.3.117.1.1.6.21 STATIC 20080130. ( If the interpretation result is not known, @nullFlavor with the value NASK meaning not tested SHALL be present.
Value Set: NHSNDrugSusceptibilityFindingCode 2.16.840.1.113883.3.117.1.1.6.21
Code System: HL7 ObservationInterpretationSusceptibility 2.16.840.1.113883.5.83CodeMeaningSSusceptibleIIntermediateRResistantTable SEQ Table \* ARABIC 16: Drug-susceptibility Finding Value Set
Figure SEQ Figure \* ARABIC 47: Drug-susceptibility Test Observation
Pathogens Identified Observation (Negated)
The Findings section must either contain at least one Findings Organizer or report that pathogens were not identified. The report that no pathogens were identified is accomplished by negating a Pathogens Identified observation. Note that a positive assertion of pathogens identified will never be present; an identified pathogen is represented by a Findings Organizer.
A Pathogens Identified Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN. The value for @negationInd shall be true.
A templateId element shall be present where @root is 2.16.840.1.113883.3.117.1.1.2.5.2.
The value for code/@code shall be ASSERTION 2.16.840.1.113883.5.4 ActCode Complete STATIC 20080130.
A statusCode element shall be present where the value of @code is completed.
The value for value/@xsi:type shall be CD. The value for value/@code shall be pathIdentified from code system 2.16.840.1.113883.3.117.1.1.4.2 NHSN Vocabulary STATIC 20080130.
Figure SEQ Figure \* ARABIC 48: Pathogens Identified Observation
Summary Data Observation
A Summary Data Observation shall be represented with an observation element where the value of @classCode is OBS and the value of @moodCode is EVN.
A templateId element shall be present where the value of @root is 2.16.840.1.113883.3.117.1.1.2.6.1.1.
The value of code/@code shall be selected from Value Set NHSNSummaryDataCode 2.16.840.1.113883.3.117.1.1.6.12 DYNAMIC.
A value element shall be present where the value of @xsi:type is PQ, the value of @unit is d, and @value is present..
Value Set: NHSNSummaryDataCode 2.16.840.1.113883.3.117.1.1.6.12
Code System: NHSNSummaryData 2.16.840.1.113883.3.117.1.1.4.12CodeMeaningnumPtDaysPatient DaysnumPtCLDaysCentral Line DaysnumPtUCathDaysUrinary Catheter DaysnumPtVentDaysVentilator DaysTable SEQ Table \* ARABIC 17: Summary Data Value Set
...
Figure SEQ Figure \* ARABIC 49: Summary Data Observation
Large Vocabularies (Non-normative)
Drug-susceptibility Test Codes
This is a DYNAMIC value set. See REF _Ref184188172 \r \h \* MERGEFORMAT 1.3.3 REF _Ref184188172 \h \* MERGEFORMAT Change Notification Process to obtain any changes made since issuance of this IG.
Table SEQ Table \* ARABIC 18: Drug-susceptibility Tests Value Set
Value Set: NHSNDrugSusceptibilityTestsCode 2.16.840.1.113883.3.117.1.1.6.9
Code System: LOINC 2.16.840.1.113883.6.1LOINC CodeLOINC Short Name18860-7Amikacin Susc Islt18862-3Amoxicillin+Clav Susc Islt18864-9Ampicillin Susc Islt18865-6Ampicillin+Sulbac Susc Islt18866-4Azithromycin Susc Islt18868-0Aztreonam Susc Islt18878-9Cefazolin Susc Islt18879-7Cefepime Susc Islt18886-2Cefotaxime Susc Islt18887-0Cefotetan Susc Islt18888-8Cefoxitin Susc Islt18893-8Ceftazidime Susc Islt18895-3Ceftriaxone Susc Islt35783-0Cefuroxime Oral Susc Islt18900-1Cephalothin Susc Islt18906-8Ciprofloxacin Susc Islt18907-6Clarithro Susc Islt18908-4Clindamycin Susc Islt35789-7Daptomycin Susc Islt35802-8Ertapenem Susc Islt18919-1Erythromycin Susc Islt31038-3Gatifloxacin Susc Islt18928-2Gentamicin Susc Islt18932-4Imipenem Susc Islt20629-2L-Floxacin Susc Islt29258-1Linezolid Susc Islt18943-1Meropenem Susc Islt31039-1Moxifloxacin Susc Islt18959-7Ofloxacin Susc Islt18961-3Oxacillin Susc Islt18965-4Penicillin G Susc Islt18970-4Piperacillin+Tazobac Susc Islt18969-6Piperacillin Susc Islt23640-6Quinupristin+Dalfoprist Susc Islt18974-6Rifampin Susc Islt18993-6Tetracycline Susc Islt18995-1Ticarcillin+Clav Susc Islt18994-4Ticarcillin Susc Islt18996-9Tobramycin Susc Islt18998-5TMP SMX Susc Islt19000-9Vancomycin Susc IsltPathogen Codes
In this table of pathogen codes, the first column categorizes the type of organism. For bacteria only, in a Findings section, NHSN requires at least one drug-susceptibility test.
Note that if the pathogen also appears in REF _Ref184362278 \h \* MERGEFORMAT Table 20: Required Pathogen-specific Drug-susceptibility Tests, all the drug-susceptibility tests listed with that pathogen in that table must be reported.
This is a DYNAMIC value set. See REF _Ref184188172 \r \h \* MERGEFORMAT 1.3.3 REF _Ref184188172 \h \* MERGEFORMAT Change Notification Process to obtain any changes made since issuance of this IG.
Table SEQ Table \* ARABIC 19: Pathogens Value Set
Value Set: NHSNPathogenCode 2.16.840.1.113883.3.117.1.1.6.8
Code System: SNOMED CT 2.16.840.1.113883.6.96CategorySNOMED CT
Concept IDSNOMED CT
Fully Specified NamePARASITE50875003Acanthamoeba (organism)BACTERIUM91288006Acinetobacter baumannii (organism)BACTERIUM29822006Actinobacillus actinomycetem comitans (organism)BACTERIUM27165004Actinobacillus equuli (organism)BACTERIUM78043002Actinobacillus lignieresii (organism)BACTERIUM116383006Actinobacillus species (organism)BACTERIUM112272003Actinobacillus suis (organism)BACTERIUM113376007Acinetobacter calcoaceticus-Acinetobacter baumanni complex (organism)BACTERIUM77045006Acinetobacter haemolyticus (organism)BACTERIUM91620006Achromobacter (organism)BACTERIUM63005002Acidaminococcus fermentans (organism)BACTERIUM131202007Acidaminococcus species (organism)BACTERIUM252000Acinetobacter johnsonii (organism)BACTERIUM13879009Acinetobacter junii (organism)BACTERIUM83088009Acinetobacter lwoffi (organism)BACTERIUM7858008Campylobacter cryaerophila (organism)BACTERIUM408629003Arcobacter nitrofigilis (organism)BACTERIUM131407003Arcobacter species (organism)FUNGUS63996006Acremonium (organism)BACTERIUM116456006Acinetobacter species (organism)BACTERIUM59806008Actinomyces bovis (organism)BACTERIUM113415003Actinomyces georgiae (organism)BACTERIUM113416002Actinomyces gerencseriae (organism)BACTERIUM46369004Actinomyces israelii (organism)BACTERIUM3174002Actinomyces meyeri (organism)BACTERIUM8940004Actinomyces naeslundii (organism)BACTERIUM12069003Actinomyces odontolyticus (organism)BACTERIUM48773009Actinomyces pyogenes (organism)BACTERIUM131204008Actinomyces species (organism)BACTERIUM33529006Actinomyces viscosus (organism)BACTERIUM1839009Actinobacillus ureae (organism)VIRUS17303003AdenoV (organism)BACTERIUM78230006Aeromonas caviae (organism)BACTERIUM115034008Aeromonas jandei (organism)BACTERIUM65192005Aeromonas media (organism)BACTERIUM30334005Aeromonas salmonicida (organism)BACTERIUM115039003Aeromonas schubertii (organism)BACTERIUM243317004Aeromonas veronii subsp sobria (organism)BACTERIUM243316008Aeromonas trota (organism)BACTERIUM243318009Aeromonas veronii subsp veronii (organism)BACTERIUM131207001Aeromonas species (organism)BACTERIUM131206005Aerococcus species (organism)BACTERIUM243230001Aerococcus urinae (organism)BACTERIUM78803006Aerococcus viridans (organism)FUNGUS66821001Aspergillus flavus (organism)BACTERIUM131208006Agrobacterium species (organism)BACTERIUM113423001Agrobacterium tumefaciens (organism)BACTERIUM85823000Aeromonas hydrophila (organism)BACTERIUM42947002Alcaligenes xylosoxidans ss. denitrificans (organism)BACTERIUM25223004Alcaligenes fecalis (organism)BACTERIUM58251005Alcaligenes piechaudii (organism)BACTERIUM131201000Alcaligenes species (organism)FUNGUS75059003Alternaria (organism)BACTERIUM53735001Alcaligenes xylosoxidans ss. xylosoxidans (organism)PARASITE17113000Ancylostoma (organism)PARASITE7153002Angiostrongylus (organism)BACTERIUM24716009Anaerorhabdus furcosus (organism)BACTERIUM131213005Anaerorhabdus species (organism)BACTERIUM59343002Anaerobic bacteria (organism)BACTERIUM131212000Anaerobiospirillum species (organism)BACTERIUM46934005Anaerobiospirillum succinoproducens (organism)BACTERIUM44723000Arcanobacterium haemolyticum (organism)BACTERIUM131216002Arcanobacterium species (organism)VIRUS58234003ArenaV (organism)BACTERIUM60631002Alpha-hemolytic streptococcus (organism)PARASITE66953006Ascaris (organism)FUNGUS32684000Aspergillus fumigatus (organism)FUNGUS89354002Aspergillus niger (organism)FUNGUS35805009Aspergillus oryzae (organism)VIRUS65195007AstroV (organism)FUNGUS115994009Aspergillus species (organism)BACTERIUM21927003Bacillus anthracis (organism)PARASITE35029001Babesia (organism)BACTERIUM48496008Bacteroides capillosus (organism)BACTERIUM14342006Bacteroides caccae (organism)BACTERIUM86193002Bacteroides coagulans (organism)BACTERIUM45863003Bacteroides distasonis (organism)BACTERIUM90072006Bacteroides eggerthii (organism)BACTERIUM86930002Bacteroides forsythus (organism)BACTERIUM72536005Bacteroides gracilis (organism)BACTERIUM37974009Bacteroides levii (organism)BACTERIUM38895000Bacteroides merdae (organism)BACTERIUM86936008Bacteroides ovatus (organism)BACTERIUM11169004Bacteroides pneumosintes (organism)BACTERIUM66172007Bacteroides putredinis (organism)BACTERIUM59313004Bacteroides splanchnicus (organism)BACTERIUM163009Bacteroides stercoris (organism)BACTERIUM85541000Bacteroides tectum (organism)BACTERIUM34236001Bacteroides thetaiotaomicron (organism)BACTERIUM59604009Bacteroides uniformis (organism)BACTERIUM36392001Bacteroides ureolyticus (organism)BACTERIUM52798008Bacteroides vulgatus (organism)PARASITE14479005Balantidium (organism)BACTERIUM243352007Bartonella bacilliformis (organism)BACTERIUM131413007Bartonella species (organism)BACTERIUM131218001Bacteroides species (organism)FUNGUS26217004Basidiobolus (organism)BACTERIUM84408007Bacillus cereus (organism)FUNGUS66193005Beauveria (organism)BACTERIUM55247009Bacteroides fragilis (organism)BACTERIUM27108000Bifidobacterium bifidum (organism)BACTERIUM35011006Bifidobacterium breve (organism)BACTERIUM36623007Bifidobacterium dentium (organism)BACTERIUM19464000Bifidobacterium longum (organism)BACTERIUM116384000Bifidobacterium species (organism)BACTERIUM131425005Bilophila species (organism)BACTERIUM114243003Bilophia wadsworhthia (organism)VIRUS83397001BK V (organism)FUNGUS65615007Blastomyces dermatitidis (organism)FUNGUS115995005Blastomyces species (organism)BACTERIUM76327009Borrelia burgdorferi (organism)BACTERIUM113497007Borrelia garinii (organism)BACTERIUM62748005Borrelia hermsii (organism)BACTERIUM41704008Borrelia parkeri (organism)BACTERIUM10620008Bordetella bronchiseptica (organism)BACTERIUM34726005Borrelia recurrentis (organism)BACTERIUM26183002Bordetella parapertussis (organism)BACTERIUM5247005Bordetella pertussis (organism)BACTERIUM131220003Bordetella species (organism)BACTERIUM131221004Borrelia species (organism)BACTERIUM24986006Borrelia turicatae (organism)BACTERIUM24224000Brucella abortus (organism)BACTERIUM38025008Brucella canis (organism)BACTERIUM72829003Brucella melitensis (organism)BACTERIUM116505000Brucella species (organism)BACTERIUM48317004Brucella suis (organism)BACTERIUM53490009Beta-hemolytic streptococcus (organism)BACTERIUM372377007Bacillus species (organism)BACTERIUM83512007Bacillus subtilis (organism)BACTERIUM75464008Budvicia aquatica (organism)BACTERIUM131253008Budvicia species (organism)VIRUS79875007Crimean-Congo hemorrhagic fever V (organism)VIRUS64979004California encephalitis V (organism)VIRUS28335002Rift Valley fever V (organism)VIRUS243615000Family Bunyaviridae (organism)BACTERIUM113669008Burkholderia cepacia (organism)BACTERIUM113671008Burkholderia gladioli (organism)BACTERIUM113674000Burkholderia mallei (organism)BACTERIUM79312008Pseudomonas pickettii (organism)BACTERIUM116399000Burkholderia pseudomallei (organism)BACTERIUM116201008Burkholderia species (organism)BACTERIUM10969007Buttiauxella agrestis (organism)BACTERIUM131254002Buttiauxella species (organism)FUNGUS53326005Candida albicans (organism)BACTERIUM28169008Calymmatobacterium granulomatis (organism)VIRUS243627002Family Caliciviridae (organism)BACTERIUM131231006Calymmatobacterium species (organism)BACTERIUM40614002Campylobacter coli (organism)BACTERIUM40614002Campylobacter coli (organism)BACTERIUM116037008Campylobacter curvus (organism)BACTERIUM64589009Campylobacter fetus ss. fetus (organism)BACTERIUM84210007Campylobacter fetus (organism)BACTERIUM60817000Campylobacter fetus ss. venerealis (organism)BACTERIUM9041007Campylobacter hyointestinalis (organism)BACTERIUM113523003Campylobacter jejuni ss doylei (organism)BACTERIUM66543000Campylobacter jejuni (organism)BACTERIUM113524009Campylobacter jejuni ss jejuni (organism)BACTERIUM116386003Campylobacter lari (organism)BACTERIUM113525005Campylobacter rectus (organism)BACTERIUM19552006Campylobacter sputorum ss. bubulus (organism)BACTERIUM87402003Campylobacter mucosalis (organism)BACTERIUM116457002Campylobacter species (organism)BACTERIUM58928003Campylobacter sputorum ss. sputorum (organism)FUNGUS16557001Candida guilliermondii (organism)FUNGUS31770002candida pseudotropicalis (organism)FUNGUS47608006Candida lusitaniae (organism)FUNGUS31770002Candida pseudotropicalis (organism)FUNGUS20849004Candida stellatoidea (organism)BACTERIUM113529004Capnocytophaga canimorsus (organism)BACTERIUM66463009Capnocytophaga gingivalis (organism)BACTERIUM4256006Capnocytophaga ochracea (organism)BACTERIUM116387007Capnocytophaga species (organism)BACTERIUM89892005Capnocytophaga sputigena (organism)BACTERIUM7333005Cardiobacterium hominis (organism)BACTERIUM131232004Cardiobacterium species (organism)FUNGUS372381007Candida species (organism)BACTERIUM5933001Clostridium difficile (organism)BACTERIUM30854004Cedecea davisae (organism)BACTERIUM2345009Cedecea lapagei (organism)BACTERIUM83767006Cedecea neteri (organism)BACTERIUM243292007Cedecea species 3 (organism)BACTERIUM243293002Cedecea species 5 (organism)BACTERIUM131255001Cedecea species (organism)BACTERIUM72002007Centipeda periodontii (organism)BACTERIUM131239008Centipeda species (organism)BACTERIUM6265002Citrobacter freundii (organism)BACTERIUM103514009Chlamydia pneumoniae (organism)BACTERIUM14590003Chlamydia psittaci (organism)BACTERIUM131418003Chlamydia species (organism)BACTERIUM63938009Chlamydia trachomatis (organism)BACTERIUM116459004Chromobacterium species (organism)BACTERIUM11042002Chromobacterium violaceum (organism)BACTERIUM33919008Chryseomonas luteola (organism)BACTERIUM131233009Chryseomonas species (organism)BACTERIUM60532000Citrobacter diversus (organism)BACTERIUM114263005Citrobacter farmeri (organism)BACTERIUM55744003Citrobacter amalonaticus (organism)BACTERIUM114264004Citrobacter koseri (organism)PARASITEn88520007Creutzfeldt-Jakob agent (organism)FUNGUS76995003Candida krusei (organism)FUNGUS32043002Cladosporium (organism)BACTERIUM24918000Clostridium absonum (organism)BACTERIUM113565009Clostridium argentiense (organism)BACTERIUM31169007Clostridium baratii (organism)BACTERIUM8208007Clostridium bifermentans (organism)BACTERIUM13080008Clostridium botulinum (organism)BACTERIUM19084008Clostridium butyricum (organism)BACTERIUM16616000Clostridium cadaveris (organism)BACTERIUM243407005Clostridium clostridioforme (organism)BACTERIUM7889007Clostridium carnis (organism)BACTERIUM76955000Clostridium cochlearium (organism)BACTERIUM14264000Clostridium fallax (organism)BACTERIUM10467001Clostridium ghonii (organism)BACTERIUM112279007Clostridium glycolicum (organism)BACTERIUM45724004Clostridium haemolyticum (organism)BACTERIUM87443003Clostridium histolyticum (organism)BACTERIUM19185007Clostridium hastiforme (organism)BACTERIUM50884003Clostridium indolis (organism)BACTERIUM19415008Clostridium innocuum (organism)BACTERIUM40423006Clostridium irregulare (organism)BACTERIUM48305001Clostridium limosum (organism)BACTERIUM12948002Clostridium malenominatum (organism)BACTERIUM53591005Clostridium novyi, type A (organism)BACTERIUM29280008Clostridium oroticum (organism)BACTERIUM41531009Clostridium putrificum (organism)BACTERIUM22321006Clostridium putrefaciens (organism)BACTERIUM41966004Clostridium paraputrificum (organism)BACTERIUM42706008Clostridium ramosum (organism)BACTERIUM33101000Clostridium septicum (organism)BACTERIUM65891000Clostridium sphenoides (organism)BACTERIUM89313005Clostridium sordellii (organism)BACTERIUM41468005Clostridium sporogenes (organism)BACTERIUM58838009Clostridium subterminale (organism)BACTERIUM48321006Clostridium symbiosum (organism)BACTERIUM81909005Clostridium tertium (organism)BACTERIUM30917009Clostridium tetani (organism)BACTERIUM86412003Clostridium villosum (organism)BACTERIUM8331005Clostridium perfringens (organism)BACTERIUM116460009Clostridium species (organism)VIRUS243579005Human cytomegaloV 5 (organism)BACTERIUM116197008Staphylococcus, coagulase negative (organism)FUNGUS23439005Coccidioides immitis (organism)FUNGUS115996006Coccidioides species (organism)BACTERIUM20432002Comamonas acidovorans (organism)BACTERIUM131240005Comamonas species (organism)BACTERIUM43721005Comamonas testosteroni (organism)BACTERIUM81829007Comamonas terrigena (organism)FUNGUS42178002Conidiobolus (organism)BACTERIUM65736001Corynebacterium aquaticum (organism)BACTERIUM44885001Corynebacterium bovis (organism)BACTERIUM50169005Corynebacterium cystitidis (organism)BACTERIUM5851001Corynebacterium diphtheriae (organism)BACTERIUM243280007CDC Corynebacterium group G-2 (organism)BACTERIUM89651003Corynebacterium glutamicum (organism)BACTERIUM63410006Corynebacterium jeikeium (organism)BACTERIUM88575000Corynebacterium kutscheri (organism)BACTERIUM89922004Corynebacterium matruchotii (organism)BACTERIUM83594007Corynebacterium minutissimum (organism)BACTERIUM58879005Corynebacterium mycetoides (organism)BACTERIUM12050008Corynebacterium pseudodiphtheriticum (organism)BACTERIUM81368007Corynebacterium pilosum (organism)BACTERIUM55084001Corynebacterium pseudotuberculosis (organism)BACTERIUM62000003Corynebacterium renale (organism)BACTERIUM63815007Corynebacterium striatum (organism)VIRUS243608008Genus CoronaV (organism)BACTERIUM103428000Corynebacterium ulcerans (organism)BACTERIUM113613004Corynebacterium urealyticum (organism)BACTERIUM27101006Corynebacterium xerosis (organism)BACTERIUM116463006Corynebacterium species (organism)BACTERIUM77309002Coliform bacteria (organism)VIRUS53744000Human coxsackieV A (organism)VIRUS49018005Human coxsackieV B (organism)FUNGUS61302002Candida parapsilosis (organism)BACTERIUM127535004Staphylococcus, coagulase positive (organism)FUNGUS67168003Cryptococcus neoformans (organism)FUNGUS17579001Cryptococcus (organism)BACTERIUM131256000Citrobacter species (organism)PARASITE83821001Cryptosporidium (organism)FUNGUS47885008Candida tropicalis (organism)FUNGUS5214001Curvularia (organism)BACTERIUM22533000Coxiella burnetii (organism)BACTERIUM131412002Coxiella species (organism)HELMINTHIC LIFE-CYCLE FORM78167007Cysticercus (organism)VIRUS34348001Dengue V (organism)PARASITE48262003Diphyllobothrium (organism)BACTERIUM114168007Dichelobacter nodosus (organism)BACTERIUM131400001Dichelobacter species (organism)BACTERIUM54642001diphtheroids (organism)PARASITE21041005Dipylidium (organism)FUNGUS73185003Drechslera (organism)BACTERIUM43560009Desulfomonas pigra (organism)BACTERIUM131245000Desulfomonas species (organism)BACTERIUM243394005Desulfovibrio desulfuricans (organism)BACTERIUM243393004Desulfovibrio (organism)BACTERIUM62592009Enterobacter aerogenes (organism)VIRUS56431000Ebola V (organism)VIRUS40168006Human herpesV 4 (organism)BACTERIUM112283007Escherichia coli (organism)BACTERIUM83285000Enteropathogenic Escherichia coli (organism)PARASITE47622006Echinococcus (organism)VIRUS39164004Human echoV (organism)BACTERIUM4280005Edwardsiella hoshinae (organism)BACTERIUM68227003Edwardsiella ictaluri (organism)BACTERIUM131257009Edwardsiella species (organism)BACTERIUM114447000Edwardsiella tarda, biogroup 1 (organism)BACTERIUM74672006Edwardsiella tarda (organism)VIRUS243601002Eastern equine encephalitis V (organism)BACTERIUM116403009CDC group EF-4 (organism)BACTERIUM52591004Eikenella corrodens (organism)BACTERIUM131247008Eikenella species (organism)BACTERIUM14385002Enterobacter cloacae (organism)BACTERIUM114261007Buttiauxella noackiae (organism)BACTERIUM106544002Enterobacteriaceae (organism)BACTERIUM87875008Enterococcus avium (organism)BACTERIUM114452005Enterobacter amnigenus biogroup I (organism)BACTERIUM114453000Enterobacter amnigenus biogroup II (organism)BACTERIUM33115003Enterobacter asburiae (organism)BACTERIUM51494007Enterobacter agglomerans (organism)PARASITE372407009Entamoeba species (organism)BACTERIUM84221003Enterobacter amnigenus (organism)BACTERIUM30949009Enterococcus casseliflavus (organism)PARASITE79235009Entamoeba coli (organism)BACTERIUM46464008Enterococcus durans (organism)BACTERIUM113724006Enterococcus dispar (organism)PARASITE88569009Enterobius (organism)BACTERIUM113725007Enterococcus flavescens (organism)BACTERIUM90272000Enterococcus faecium (organism)BACTERIUM78065002Enterococcus faecalis (organism)BACTERIUM53233007Enterococcus gallinarum (organism)BACTERIUM5381002Enterobacter gergoviae (organism)PARASITE4716008Entamoeba histolytica (organism)BACTERIUM114454006Enterobacter hormaechei (organism)BACTERIUM73852008Enterococcus hirae (organism)BACTERIUM35165009Enterobacter intermedium (organism)BACTERIUM10262005Enterococcus malodoratus (organism)BACTERIUM38004008Enterococcus mundtii (organism)BACTERIUM103436009Enterococcus pseudoavium (organism)BACTERIUM103437000Enterococcus raffinosus (organism)VIRUS243633006Genus EnteroV (organism)BACTERIUM77614008Enterobacter sakazakii (organism)BACTERIUM103440000Enterococcus solitarius (organism)BACTERIUM131297007Enterococcus species (organism)BACTERIUM88127002Enterobacter taylorae (organism)FUNGUS112403007Epidermophyton (organism)BACTERIUM131258004Erwinia species (organism)BACTERIUM48666005Erysipelothrix rhusiopathiae (organism)BACTERIUM131298002Erysipelothrix species (organism)BACTERIUM91550008Escherichia blattae (organism)BACTERIUM72461005Escherichia fergusonii (organism)BACTERIUM85786000Escherichia hermannii (organism)BACTERIUM131259007Escherichia species (organism)BACTERIUM53013003Escherichia vulneris (organism)BACTERIUM131263000Enterobacter species (organism)BACTERIUM35307005Eubacterium aerofaciens (organism)BACTERIUM53780000Eubacterium alactolyticum (organism)BACTERIUM12734008Eubacterium brachy (organism)BACTERIUM13257008Eubacterium combesii (organism)BACTERIUM59949005Eubacterium contortum (organism)BACTERIUM43435006Eubacterium lentum (organism)BACTERIUM87632000Eubacterium limosum (organism)BACTERIUM46192006Eubacterium moniliforme (organism)BACTERIUM22777005Eubacterium nitrogenes (organism)BACTERIUM48215005Eubacterium nodatum (organism)BACTERIUM41543005Eubacterium saburreum (organism)BACTERIUM116465004Eubacterium species (organism)BACTERIUM29575000Eubacterium tenue (organism)BACTERIUM79679004Eubacterium timidum (organism)BACTERIUM4791002Eubacterium yurii (organism)BACTERIUM19027003Ewingella americana (organism)BACTERIUM131262005Ewingella species (organism)BACTERIUM113549008Chryseobacterium indologenes (organism)BACTERIUM127530009CDC group IIe (organism)BACTERIUM127532001CDC group IIh (organism)BACTERIUM127533006CDC group IIi (organism)BACTERIUM66711003Flavobacterium breve (organism)BACTERIUM113551007Chryseobacterium meningosepticum (organism)BACTERIUM87157009Flavobacterium odoratum (organism)BACTERIUM125037002Flavobacterium species (organism)BACTERIUM49037001Helicobacter rappini (organism)VIRUS407479009Influenza A V (organism)VIRUS407480007Influenza B V (organism)VIRUS407482004Influenza C V (organism)BACTERIUM179568002Flavimonas oryzihabitans (organism)BACTERIUM131307004Flavimonas species (organism)FUNGUS23639003Fonsecaea (organism)BACTERIUM131308009Francisella species (organism)BACTERIUM51526001Francisella tularensis (organism)BACTERIUM116467007Fusobacterium species (organism)FUNGUS23496000F (organism)BACTERIUM112331002Fusobacterium alocis (organism)FUNGUS35238009Fusarium (organism)BACTERIUM84644009Fusobacterium gonidiaformans (organism)BACTERIUM112330001Fusobacterium mortiferum (organism)BACTERIUM33311002Fusobacterium naviforme (organism)BACTERIUM17304009Fusobacterium necrogenes (organism)BACTERIUM113757008Fusobacterium necrophorum ss fundiliforme (organism)BACTERIUM27274008Fusobacterium necrophorum (organism)BACTERIUM113761002Fusobacterium nucleatum ss nucleatum (organism)BACTERIUM113758003Fusobacterium necrophorum ss necrophorum (organism)BACTERIUM113762009Fusobacterium nucleatum ss polymorphum (organism)BACTERIUM113760001Fusobacterium nucleatum ss fusiforme (organism)BACTERIUM32763000Fusobacterium nucleatum (organism)BACTERIUM69601004Fusobacterium periodonticum (organism)BACTERIUM85226004Fusobacterium russii (organism)BACTERIUM19435009Fusobacterium sulci (organism)BACTERIUM113764005Fusobacterium ulcerans (organism)BACTERIUM1972005Fusobacterium varium (organism)BACTERIUM131309001Gardnerella species (organism)BACTERIUM80166006Streptococcus pyogenes (organism)BACTERIUM43492007Streptococcus agalactiae (organism)BACTERIUM68704007Neisseria gonorrhoeae (organism)BACTERIUM55547008Streptococcus, group D (organism)BACTERIUM37511002Gemella haemolysans (organism)BACTERIUM113765006Gemella morbillorum (organism)BACTERIUM131311005Gemella species (organism)FUNGUS34324005Geotrichum (organism)BACTERIUM83503005Streptococcus, group F (organism)BACTERIUM75012005Streptococcus, group G (organism)PARASITE61419001Giardia (organism)BACTERIUM18383003Gram-negative coccus (organism)BACTERIUM87172008Gram-negative bacillus (organism)BACTERIUM59206002Gram-positive coccus (organism)BACTERIUM83514008Gram-positive bacillus (organism)BACTERIUM22339002Gamma-hemolytic streptococcus (organism)BACTERIUM64071004Gardnerella vaginalis (organism)BACTERIUM76694001Hafnia alvei (organism)BACTERIUM46143000Haemophilus aphrophilus (organism)BACTERIUM64889004Haemophilus ducreyi (organism)BACTERIUM54950008Haemophilus haemolyticus (organism)BACTERIUM34902001Haemophilus paraphrophilus (organism)BACTERIUM116046002Hafnia alvei biogroup I (organism)BACTERIUM116047006Hafnia species (organism)VIRUS81665004Hepatitis B V (organism)FUNGUS56596006Histoplasma capsulatum (organism)BACTERIUM29258005Helicobacter cinaedi (organism)BACTERIUM58177005Helicobacter fennelliae (organism)BACTERIUM10402009Helicobacter mustelae (organism)BACTERIUM80774000Helicobacter pylori (organism)BACTERIUM131234003Helicobacter species (organism)VIRUS32452004Human enteroV 72 (organism)VIRUS62944002Hepatitis C V (organism)VIRUS128377001Family Herpesviridae (organism)BACTERIUM115407004Haemophilus influenzae, not B (organism)BACTERIUM103441001Haemophilus influenzae type A (organism)BACTERIUM103442008Haemophilus influenzae type B (organism)FUNGUS115997002Histoplasma species (organism)BACTERIUM44470000Haemophilus influenzae (organism)BACTERIUM51593004Haemophilus parainfluenzae (organism)VIRUS112386001Non-A, non-B hepatitis V (organism)BACTERIUM116469005Haemophilus species (organism)VIRUS19965007Human herpes simplex V (organism)VIRUS15302007Human herpes simplex V type 1 (organism)VIRUS13687007Human herpes simplex V type 2 (organism)PARASITE76403008Hymenolepis (organism)PARASITE26704001Isospora (organism)VIRUS36319009JC V (organism)BACTERIUM113769000Jonesia denitrificans (organism)BACTERIUM131314002Jonesia species (organism)BACTERIUM78676004Kingella denitrificans (organism)BACTERIUM116392009Suttonella indologenes (organism)BACTERIUM90422000Kingella kingae (organism)BACTERIUM131313008Kingella species (organism)BACTERIUM114457004Klebsiella ornithinolytica (organism)BACTERIUM65186004Klebsiella pneumoniae ss. ozaenae (organism)BACTERIUM3615007Klebsiella planticola (organism)BACTERIUM17688001Klebsiella pneumoniae ss. rhinoscleromatis (organism)BACTERIUM5231008Klebsiella terrigena (organism)BACTERIUM58493008Kluyvera ascorbata (organism)BACTERIUM32547006Kluyvera cryocrescens (organism)BACTERIUM131270000Kluyvera species (organism)BACTERIUM40886007Klebsiella oxytoca (organism)BACTERIUM56415008Klebsiella pneumoniae (organism)BACTERIUM131269001Klebsiella species (organism)BACTERIUM243283009Kurthia bessoni (organism)BACTERIUM69512006Kurthia (organism)BACTERIUM45707005Lactobacillus acidophilus (organism)BACTERIUM9534006Lactobacillus amylovorus (organism)BACTERIUM59836004Lactobacillus catenaformis (organism)BACTERIUM89237007Lactobacillus crispatus (organism)BACTERIUM1017006Lactobacillus casei (organism)BACTERIUM71158000Lactobacillus gasseri (organism)BACTERIUM113786006Lactobacillus johnsonii (organism)BACTERIUM5377002Lactobacillus minutus (organism)BACTERIUM87480009Lactobacillus oris (organism)BACTERIUM113632005Atopobium rimae (organism)BACTERIUM113829005Lactobacillus uli (organism)BACTERIUM113803005Lactobacillus vaginalis (organism)VIRUS85944001Lassa V (organism)VIRUS82518003Lymphocytic choriomeningitis V (organism)BACTERIUM57459006Leclercia adecarboxylata (organism)BACTERIUM43590002Leclercia (organism)BACTERIUM18214000Legionella anisa (organism)BACTERIUM22592008Legionella birminghamensis (organism)BACTERIUM37835001Legionella bozemanii (organism)BACTERIUM103448007Legionella brunensis (organism)BACTERIUM52462004Legionella cherrii (organism)BACTERIUM58923007Legionella cincinnatiensis (organism)BACTERIUM113720002Fluoribacter dumoffii (organism)BACTERIUM28109006Legionella erythra (organism)BACTERIUM17083009Legionella feeleii (organism)BACTERIUM103450004Legionella geestiana (organism)BACTERIUM113721003Fluoribacter gormanii (organism)BACTERIUM58939000Legionella hackeliae (organism)BACTERIUM3128001Legionella israelensis (organism)BACTERIUM89709001Legionella janestowniensis (organism)BACTERIUM39739007Legionella jordanis (organism)BACTERIUM89605004Legionella longbeachae (organism)BACTERIUM103453002Legionella londiniensis (organism)BACTERIUM116379006Tatlockia macaechernii (organism)BACTERIUM116380009Tatlockia micdadei (organism)BACTERIUM103454008Legionella moravica (organism)BACTERIUM103455009Legionella nautarum (organism)BACTERIUM638008Legionella oakridgensis (organism)BACTERIUM38322001Legionella parisiensis (organism)BACTERIUM113807006Legionella quateirensis (organism)BACTERIUM103459003Legionella quinlivanii (organism)BACTERIUM17298000Legionella rubilucens (organism)BACTERIUM115514004Legionella species (organism)BACTERIUM72814000Legionella santicrucis (organism)BACTERIUM87271006Legionella sainthelens (organism)BACTERIUM103460008Legionella shakespearei (organism)BACTERIUM64930007Legionella spiritensis (organism)BACTERIUM14121003Legionella steigerwaltii (organism)BACTERIUM103461007Legionella tucsonensis (organism)BACTERIUM8147000Legionella wadsworthii (organism)BACTERIUM103462000Legionella worsleiensis (organism)PARASITE79357004Leishmania (organism)BACTERIUM74357002Leminorella grimontii (organism)BACTERIUM45354007Leminorella richardii (organism)BACTERIUM131273003Leminorella species (organism)BACTERIUM45882007Leptospira interrogans, serogroup autumnalis (organism)BACTERIUM59217001Leptospira interrogans, serogroup balhum (organism)BACTERIUM26870001Leptospira interrogans, serogroup bataviae (organism)BACTERIUM54933006Leptospira interrogans, serogroup canicola (organism)BACTERIUM26615002Leptospira interrogans, serogroup grippotyphosa (organism)BACTERIUM19251003Leptospira interrogans, serogroup icterohaemorrhagiae (organism)BACTERIUM116401006Leptospira interrogans (organism)BACTERIUM47840007Leptospira interrogans, serogroup pomona (organism)BACTERIUM83409006Leptospira interrogans, serogroup pyrogenes (organism)BACTERIUM116200009Leptospira species (organism)BACTERIUM85744006Leptotrichia buccalis (organism)BACTERIUM131328008Leptotrichia species (organism)BACTERIUM131329000Leuconostoc species (organism)BACTERIUM113821008Leuconostoc citreum (organism)BACTERIUM70285009Leuconostoc lactis (organism)BACTERIUM71403009Leuconostoc mesenteroides (organism)BACTERIUM243235006Leuconostoc pseudomesenteroides (organism)artHelminthic Life-cycle formroParasiteod89756003Louse (organism)BACTERIUM67816007Listeria grayi (organism)BACTERIUM67863009Listeria murrayi (organism)BACTERIUM131330005Listeria species (organism)BACTERIUM36094007Listeria monocytogenes (organism)FUNGUS90959007Loboa (organism)BACTERIUM80897008Legionella pneumophila (organism)BACTERIUM116472003Lactobacillus species (organism)FUNGUS23009007Madurella (organism)FUNGUS18097004Malassezia (organism)FUNGUS29619007Malassezia furfur (organism)VIRUS2963004Marburg V (organism)VIRUS52584002Measles V (organism)BACTERIUM26044001Megasphaera elsdenii (organism)BACTERIUM131334001Megasphaera species (organism)BACTERIUM103486003Methylobacterium mesophilicum (organism)BACTERIUM116476000Methylobacterium species (organism)FUNGUS11983001Microsporum (organism)BACTERIUM114137008Prevotella dentalis (organism)BACTERIUM55553008Mitsuokella multiacidus (organism)BACTERIUM131336004Mitsuokella species (organism)BACTERIUM30224004Mobiluncus curtisii (organism)BACTERIUM13716002Mobiluncus mulieris (organism)BACTERIUM131335000Mobiluncus species (organism)BACTERIUM131272008Moellerella species (organism)BACTERIUM37107002Moellerella wisconsensis (organism)BACTERIUM47491001Moraxella (Moraxella) atlantae (organism)BACTERIUM19425003Moraxella (Moraxella) bovis (organism)BACTERIUM24226003Moraxella (Branhamella) catarrhalis (organism)BACTERIUM84066001Moraxella (Moraxella) lacunata (organism)BACTERIUM114460006Morganella morganii, biogroup1 (organism)BACTERIUM243301005Morganella morganii (organism)BACTERIUM46455003Moraxella (Moraxella) nonliquefaciens (organism)BACTERIUM72401008Moraxella (Moraxella) osloensis (organism)BACTERIUM113941002Psychrobacter phenylpyruvicus (organism)BACTERIUM243303008Morganella morganii subsp sibonii (organism)BACTERIUM372316007Morganella species (organism)BACTERIUM131337008Moraxella species (organism)BACTERIUM58720004Mycoplasma pneumoniae (organism)BACTERIUM116486004Micrococcus species (organism)FUNGUS79297004Mucor ramosissimus (organism)FUNGUS372317003Mucor species (organism)VIRUS50384007Mumps V (organism)BACTERIUM113838007Mycobacterium abscessus (organism)BACTERIUM51320008Mycobacterium africanum (organism)BACTERIUM113839004Mycobacterium alvei (organism)BACTERIUM44760001Mycobacterium asiaticum (organism)BACTERIUM48134004Mycobacterium aurum (organism)BACTERIUM58503001Mycobacterium, avium-intracellulare group (organism)BACTERIUM27142009Mycobacterium bovis (organism)BACTERIUM112338008Mycoplasma buccale (organism)BACTERIUM74349000Mycobacterium chelonae ss. chelonae (organism)BACTERIUM113845007Mycobacterium confluentis (organism)BACTERIUM76010005Mycoplasma faucium (organism)BACTERIUM103474001Mycobacterium fortuitum complex (organism)BACTERIUM88263009Mycoplasma fermentans (organism)BACTERIUM333873003Mycobacterium fortuitum subsp fortuitum (organism)BACTERIUM5885000Mycobacterium flavescens (organism)BACTERIUM112333004Mycobacterium fortuitum biovar. peregrinum (organism)BACTERIUM70463000Mycobacterium gastri (organism)BACTERIUM5056007Mycoplasma genitalium (organism)BACTERIUM103476004Mycobacterium genavense (organism)BACTERIUM24871004Mycobacterium gordonae (organism)BACTERIUM21996001Mycobacterium haemophilum (organism)BACTERIUM1290001Mycoplasma hominis (organism)BACTERIUM83841006Mycobacterium intracellulare (organism)BACTERIUM1507005Mycobacterium kansasii (organism)BACTERIUM58242002Mycobacterium leprae (organism)BACTERIUM11412008Mycoplasma lipophilum (organism)BACTERIUM58869008Mycobacterium marinum (organism)BACTERIUM73576007Mycobacterium malmoense (organism)BACTERIUM21433000Mycobacterium nonchromogenicum (organism)BACTERIUM46705005Mycoplasma orale (organism)BACTERIUM113884002Mycoplasma penetrans (organism)BACTERIUM78112006Mycobacterium phlei (organism)BACTERIUM112337003Mycoplasma primatum (organism)BACTERIUM116487008Mycoplasma species (organism)BACTERIUM2654003Mycoplasma salivarium (organism)BACTERIUM20141004Mycobacterium scrofulaceum (organism)BACTERIUM79817008Mycobacterium shimoidei (organism)BACTERIUM84180005Mycobacterium simiae (organism)BACTERIUM53114006Mycobacterium smegmatis (organism)BACTERIUM131339006Mycobacterium species (organism)BACTERIUM113890003Mycoplasma spermatophilum (organism)BACTERIUM65613000Mycobacterium szulgai (organism)BACTERIUM45662006Mycobacterium terrae (organism)BACTERIUM20973006Mycobacterium thermoresistibile (organism)BACTERIUM40333002Mycobacterium triviale (organism)BACTERIUM40713003Mycobacterium ulcerans (organism)BACTERIUM54925005Mycobacterium vaccae (organism)BACTERIUM58663006Mycobacterium xenopi (organism)BACTERIUM83723009Mycobacterium avium (organism)VIRUS55014007Family Orthomyxoviridae (organism)PARASITE18441007Naegleria (organism)PARASITE46112007Necator (organism)BACTERIUM54978009Neisseria canis (organism)BACTERIUM69312007Neisseria cinerea (organism)BACTERIUM12638001Neisseria elongata (organism)BACTERIUM75566007Neisseria flavescens (organism)BACTERIUM54915000Neisseria lactamica (organism)BACTERIUM81795000Neisseria mucosa (organism)BACTERIUM113894007Neisseria weaveri (organism)BACTERIUM66768001Neisseria polysaccharea (organism)BACTERIUM49074002Neisseria sicca (organism)BACTERIUM77700001Neisseria subflava (organism)BACTERIUM17872004Neisseria meningitidis (organism)BACTERIUM30092002Nocardia asteroides (organism)BACTERIUM58970008Nocardia brasiliensis (organism)BACTERIUM63087008Nocardia otitidis caviarum (organism)BACTERIUM127524009Nocardia species (organism)BACTERIUM131340008Neisseria species (organism)BACTERIUM28501001Obesumbacterium proteus (organism)BACTERIUM131274009Obesumbacterium species (organism)BACTERIUM116490002Ochrobactrum anthropi (organism)BACTERIUM116489006Ochrobactrum species (organism)BACTERIUM113900007Oerskovia species (organism)BACTERIUM10459009Oerskovia turbata (organism)BACTERIUM114191006Cellulomonas cellulans (organism)BACTERIUM131344004Oligella species (organism)BACTERIUM11309009Oligella ureolytica (organism)BACTERIUM90341001Oligella urethralis (organism)VIRUS44725007Genus OrbiV (organism)BACTERIUM52499004Pseudomonas aeruginosa (organism)BACTERIUM115015008Pantoea agglomerans (organism)BACTERIUM115017000Pantoea dispersa (organism)BACTERIUM131301003Panteoa species (organism)VIRUS9482002Human papillomaV (organism)VIRUS407453000Family Papillomaviridae (organism)VIRUS407455007Family Polyomaviridae (organism)FUNGUS112405000Paracoccidioides (organism)VIRUS10514003Norwalk V (organism)VIRUS11970002Genus ParvoV (organism)BACTERIUM87075007Pasteurella aerogenes (organism)BACTERIUM113902004Pasteurella bettyae (organism)BACTERIUM7784009Pasteurella canis (organism)BACTERIUM80948000Pasteurella dagmatis (organism)BACTERIUM45971000Pasteurella gallinarum (organism)BACTERIUM60643001Pasteurella haemolytica (organism)BACTERIUM1743002Pasteurella multocida ss. gallicida (organism)BACTERIUM71068007Pasteurella multocida ss. multocida (organism)BACTERIUM14298009Pasteurella multocida ss. septica (organism)BACTERIUM10879005Pasteurella multocida (organism)BACTERIUM32562008Pasteurella pneumotropica (organism)BACTERIUM131346002Pasteurella species (organism)FUNGUS639000Pneumocystis carinii (organism)BACTERIUM131258004Erwinia species (organism)BACTERIUM243237003Pediococcus acidilactici (organism)BACTERIUM243242006Pediococcus pentosaceus (organism)BACTERIUM243236007Pediococcus (organism)FUNGUS42993004Penicillium (organism)BACTERIUM112344007Peptococcus niger (organism)FUNGUS91088000Pseudoallescheria boydii (organism)BACTERIUM39289003Pseudomonas fluorescens (organism)VIRUS407498006Human parainfluenza Ves (organism)FUNGUS41402008Phialophora (organism)FUNGUS61019006Phoma (organism)VIRUS407345007Genus PicornaV (organism)FUNGUS50411008Piedraia (organism)PARASITE30020004Plasmodium falciparum (organism)PARASITE56395006Plasmodium malariae (organism)PARASITE18508006Plasmodium ovale (organism)PARASITE372332005Plasmodium species (organism)PARASITE74746009Plasmodium vivax (organism)BACTERIUM38643006Plesiomonas shigelloides (organism)BACTERIUM131347006Plesiomonas species (organism)BACTERIUM73457008Proteus mirabilis (organism)VIRUS407487005Genus RespiroV (organism)VIRUS44172002Human polioV (organism)BACTERIUM115950003Porphyromonas asaccharolyticus (organism)BACTERIUM2401005Bacteroides endodontalis (organism)BACTERIUM114163003Porphyromonas gingivalis (organism)BACTERIUM114166006Porphyromonas macacae (organism)BACTERIUM131398000Porphyromonas species (organism)VIRUS68855006Molluscum contagiosum V (organism)VIRUS59774002Monkeypox V (organism)VIRUS64753004Orf V (organism)VIRUS69683003Tanapox V (organism)VIRUS243567005PoxV group (organism)VIRUS13126002Vaccinia V (organism)VIRUS243568000Variola V (organism)BACTERIUM68608003Pseudomonas putida (organism)BACTERIUM113912006Peptostreptococcus parvulus (organism)BACTERIUM89268006Peptostreptococcus asaccharolyticus (organism)BACTERIUM113914007Peptostreptococcus hydrogenalis (organism)BACTERIUM19204000Peptostreptococcus indolicus (organism)BACTERIUM113909008Peptostreptococcus lacrimalis (organism)BACTERIUM113910003Peptostreptococcus lactolyticus (organism)BACTERIUM31244002Peptostreptococcus magnus (organism)BACTERIUM62890009Peptostreptococcus micros (organism)BACTERIUM78571004Peptostreptococcus productus (organism)BACTERIUM38145003Peptostreptococcus prevotii (organism)BACTERIUM659001Peptostreptococcus tetradius (organism)BACTERIUM113915008Peptostreptococcus vaginalis (organism)BACTERIUM14196002Providencia rettgeri (organism)BACTERIUM115025003Pragia fontium (organism)BACTERIUM131306008Pragia species (organism)BACTERIUM114134001Prevotella buccae (organism)BACTERIUM114131009Prevotella bivia (organism)BACTERIUM114135000Prevotella buccalis (organism)BACTERIUM114136004Prevotella corporis (organism)BACTERIUM114138003Prevotella denticola (organism)BACTERIUM114139006Prevotella disiens (organism)BACTERIUM114141007Prevotella heparinolytica (organism)BACTERIUM114142000Prevotella intermedia (organism)BACTERIUM50654008Bacteroides loescheii (organism)BACTERIUM114144004Prevotella melaninogenica (organism)BACTERIUM114145003Prevotella nigrescens (organism)BACTERIUM114146002Prevotella oralis (organism)BACTERIUM114147006Prevotella oris (organism)BACTERIUM75254002Bacteroides oulorum (organism)BACTERIUM115949003Prevotella ruminicola (organism)BACTERIUM131397005Prevotella species (organism)BACTERIUM114152001Prevotella veroralis (organism)BACTERIUM114153006Prevotella zoogleoformans (organism)BACTERIUM47473006Propionibacterium avidum (organism)BACTERIUM87755005Propionibacterium granulosum (organism)yeast-like alga37563009Prototheca (organism)BACTERIUM39473003Propionibacterium acnes (organism)BACTERIUM26102005Propionibacterium lymphophilum (organism)BACTERIUM17013003Arachnia propionica (organism)BACTERIUM1445008Providencia stuartii (organism)BACTERIUM131348001Propionibacterium species (organism)BACTERIUM86145008Proteus myxofaciens (organism)BACTERIUM45298005Proteus penneri (organism)BACTERIUM131276006Providencia species (organism)BACTERIUM46349009Providencia alcalifaciens (organism)BACTERIUM47300009Providencia heimbachae (organism)BACTERIUM19196004Providencia rustigianii (organism)BACTERIUM19217002Peptostreptococcus anaerobius (organism)BACTERIUM46247008Pseudomonas alcaligenes (organism)BACTERIUM63949003Pseudomonas chlororaphis (organism)BACTERIUM31270001Pseudomonas delafieldii (organism)BACTERIUM14581005Pseudomonas diminuta (organism)BACTERIUM90187004Pseudomonas, group VA-1 (organism)BACTERIUM57032008Genus Pseudomonas (organism)BACTERIUM17191002Pseudomonas pertucinogena (organism)BACTERIUM30955004Pseudomonas pseudoalcaligenes (organism)BACTERIUM243346006Pseudomonas thomasii (organism)BACTERIUM16789008Pseudomonas vesicularis (organism)BACTERIUM116493000Pseudomonas species (organism)BACTERIUM116491003Peptostreptococcus species (organism)BACTERIUM58024003Pseudomonas stutzeri (organism)BACTERIUM20585006Peptococcus (organism)BACTERIUM70465007Psychrobacter immobilis (organism)BACTERIUM131275005Proteus species (organism)BACTERIUM45834001Proteus vulgaris (organism)FUNGUS33478003Pyrenochaeta (organism)VIRUS59881000Rabies V (organism)BACTERIUM10021006Rahnella aquatilis (organism)BACTERIUM48569008Rahnella (organism)VIRUS34212000Colorado tick fever V (organism)VIRUS243592008ReoV (organism)VIRUS243592008ReoV (organism)VIRUS407326003Family Rhabdoviridae (organism)FUNGUS65470001Rhinosporidium (organism)FUNGUS17683005Rhizopus (organism)VIRUS90389005Genus RhinoV (organism)FUNGUS51976007Rhodotorula (organism)BACTERIUM80771008Rhodococcus equi (organism)BACTERIUM131350009Rhodococcus species (organism)BACTERIUM30769009Rickettsia akari (organism)BACTERIUM32691002Rickettsia conorii (organism)BACTERIUM28499009Rickettsia prowazekii (organism)BACTERIUM18054009Rickettsia rickettsii (organism)BACTERIUM131410005Rickettsia species (organism)BACTERIUM114233001Orientia tsutsugamushi (organism)BACTERIUM79284001Rickettsia typhi (organism)BACTERIUM103510000Bartonella henselae (organism)BACTERIUM103511001Bartonella quintana (organism)BACTERIUM103512008Bartonella vinsonii (organism)VIRUS70614005RotaV (organism)BACTERIUM35379007Rothia dentocariosa (organism)BACTERIUM90163001Rothia (organism)VIRUS6415009Human respiratory syncytial V (organism)VIRUS5210005Rubella V (organism)BACTERIUM3092008Staphylococcus aureus (organism)FUNGUS27069008Saccharomyces (organism)BACTERIUM398426003Salmonella group O:2 (organism)BACTERIUM398467008Salmonella group O:4 (organism)BACTERIUM398593004Salmonella group O:7 (organism)BACTERIUM398364000Salmonella group O:8 (organism)BACTERIUM115408009Salmonella, serogroup D (organism)BACTERIUM115409001Salmonella, serogroup E (organism)BACTERIUM398488004Salmonella enterica subsp. salamae (organism)BACTERIUM115411005Salmonella, subgroup 3 (organism)BACTERIUM115411005Salmonella, subgroup 3 (organism)BACTERIUM398371005Salmonella enterica subsp. houtenae (organism)BACTERIUM398393000Salmonella bongori (organism)BACTERIUM80627004Salmonella agona (organism)BACTERIUM397502001Salmonella enterica subsp. arizonae (organism)BACTERIUM110378009Salmonella enterica (organism)BACTERIUM62136003Salmonella Dublin (organism)BACTERIUM73525009Salmonella Enteritidis (organism)BACTERIUM71865006Salmonella heidelberg (organism)BACTERIUM82071007Salmonella infantis (organism)BACTERIUM80268001Salmonella montevideo (organism)BACTERIUM56077000Salmonella newport (organism)BACTERIUM46667007Salmonella oranienburg (organism)BACTERIUM2820001Salmonella Saintpaul (organism)BACTERIUM50136005Salmonella typhimurium (organism)BACTERIUM5595000Salmonella typhi (organism)PARASITE34666003Sarcocystis (organism)BACTERIUM372342007Salmonella species (organism)BACTERIUM89181007Streptococcus, group C (organism)mite67333007Sarcoptes scabiei (organism)BACTERIUM56076009Streptococcus bovis (organism)BACTERIUM60875001Staphylococcus epidermidis (organism)BACTERIUM6754006Selenomonas artemidis (organism)BACTERIUM86435000Selenomonas dianae (organism)BACTERIUM27333006Selenomonas flueggei (organism)BACTERIUM43571005Selenomonas infelix (organism)BACTERIUM70096005Selenomonas noxia (organism)BACTERIUM116415008Selenomonas species (organism)BACTERIUM23595003Selenomonas sputigena (organism)BACTERIUM76656001Serratia entomophila (organism)BACTERIUM802004Serratia ficaria (organism)BACTERIUM112329006Serratia fonticola (organism)BACTERIUM115005002Serratia grimesii (organism)BACTERIUM243385004Serpulina jonesii (organism)BACTERIUM115006001Serratia marcescens, Biogroup I (organism)BACTERIUM397075007Serratia odorifera biogroup 1 (organism)BACTERIUM397076008Serratia odorifera biogroup 2 (organism)BACTERIUM10413007Serratia odorifera (organism)BACTERIUM28955009Serratia plymuthica (organism)BACTERIUM116136002Serratia proteamaculans subsp proteamaculans (organism)BACTERIUM115004003Serratia proteamaculans subsp quinovora (organism)BACTERIUM116135003Serratia proteamaculans (organism)BACTERIUM372348006Serpulina species (organism)BACTERIUM113700003Shewanella putrefaciens (organism)BACTERIUM115158009Shewanella (organism)BACTERIUM43612004Shigella dysenteriae (organism)BACTERIUM85729005Shigella flexneri (organism)BACTERIUM55462008Shigella boydii (organism)BACTERIUM4298009Shigella sonnei (organism)BACTERIUM116498009Shigella species (organism)BACTERIUM23787004Serratia liquefaciens (organism)VIRUS58432001Saint Louis encephalitis V (organism)BACTERIUM33522002Serratia marcescens (organism)BACTERIUM55547008Streptococcus, group D (organism)BACTERIUM9861002Streptococcus pneumoniae (organism)BACTERIUM48962005Sphingobacterium mizutae (organism)BACTERIUM51595006Sphingobacterium multivorum (organism)BACTERIUM131357007Sphingobacterium species (organism)BACTERIUM61675006Sphingobacterium spiritivorum (organism)BACTERIUM113954009Sphingobacterium thalpophilum (organism)BACTERIUM243347002Sphingobacterium yabuuchiae (organism)BACTERIUM35164008Spirillum minus (organism)BACTERIUM131356003Spirillum species (organism)BACTERIUM243350004Sphingomonas paucimobilis (organism)BACTERIUM131235002Sphingomonas species (organism)FUNGUS32662000Sporothrix schenkii (organism)FUNGUS63100009Sporothrix (organism)BACTERIUM55825002Serratia rubidaea (organism)BACTERIUM116499001Staphylococcus species (organism)BACTERIUM116497004Serratia species (organism)BACTERIUM45654003Staphylococcus auricularis (organism)BACTERIUM113962001Staphylococcus capitis ss capitis (organism)BACTERIUM66872005Staphylococcus cohnii (organism)BACTERIUM40347003Staphylococcus capitis (organism)BACTERIUM103492009Staphylococcus capitis ss ureaolyticus (organism)BACTERIUM8056006Staphylococcus gallinarum (organism)BACTERIUM83452006Staphylococcus haemolyticus (organism)BACTERIUM44827007Staphylococcus hominis (organism)BACTERIUM34605002Staphylococcus intermedius (organism)BACTERIUM40253001Staphylococcus lentus (organism)BACTERIUM103494005Staphylococcus lugdunensis (organism)BACTERIUM19743000Staphylococcus saprophyticus (organism)BACTERIUM70806002Staphylococcus sciuri (organism)BACTERIUM131360000Staphylococcus schleiferi (organism)BACTERIUM52122005Staphylococcus simulans (organism)BACTERIUM41103009Staphylococcus saccharolyticus (organism)BACTERIUM63550006Staphylococcus warneri (organism)BACTERIUM32737005Staphylococcus xylosus (organism)BACTERIUM113697002Stenotrophomonas maltophilia (organism)BACTERIUM116400007Stenotrophomonas species (organism)BACTERIUM54037005Stomatococcus mucilaginosus (organism)BACTERIUM26126007Stomatococcus (organism)BACTERIUM116501009Streptococcus species (organism)BACTERIUM113713009Abiotrophia adjacens (organism)BACTERIUM16372003Streptobacillus moniliformis (organism)BACTERIUM29295005Streptobacillus (organism)BACTERIUM113980005Streptococcus cristatus (organism)BACTERIUM72646003Streptococcus equinus (organism)BACTERIUM113714003Abiotrophia defectiva (organism)BACTERIUM37916002Streptococcus, group E (organism)PARASITE10823008Strongyloides (organism)BACTERIUM19870004Streptococcus oralis (organism)BACTERIUM127538002Streptococcus parasanguis (organism)BACTERIUM32134008Streptococcus pleomorphus (organism)BACTERIUM43777007Streptococcus sobrinus (organism)BACTERIUM51182006Streptococcus acidominimus (organism)BACTERIUM76199005Streptococcus constellatus (organism)BACTERIUM113998009Streptococcus vestibularis (organism)BACTERIUM113986004Streptococcus gordonii (organism)BACTERIUM36182000Streptococcus hansenii (organism)BACTERIUM57997003Streptococcus mitis (organism)BACTERIUM44304009Streptococcus anginosus (organism)BACTERIUM39888004Streptococcus salivarius (organism)BACTERIUM214001Streptococcus mutans (organism)BACTERIUM13250005Streptococcus uberis (organism)BACTERIUM62170002Streptococcus intermedius (organism)BACTERIUM77758001Streptococcus sanguis (organism)BACTERIUM31703004Streptococcus, viridans group (organism)PARASITE28625000Taenia (organism)BACTERIUM1546007Tatumella ptyseos (organism)BACTERIUM131294000Tatumella species (organism)BACTERIUM113861009Mycobacterium tuberculosis (organism)VIRUS32323003Tick-borne encephalitis V (organism)FUNGUS40747000Torulopsis glabrata (organism)BACTERIUM75376009Tissierella praeacuta (organism)BACTERIUM131369004Tissierella species (organism)VIRUS129231002Togaviridae (organism)VIRUS26630006Yellow fever V (organism)PARASITE61949005Toxoplasma (organism)PARASITE39091000Toxocara (organism)BACTERIUM243309007Trabulsiella guamensis (organism)BACTERIUM243308004Trabulsiella (organism)BACTERIUM14562002Treponema carateum (organism)BACTERIUM44106000Treponema pallidum ss. endemicum (organism)BACTERIUM43454006Treponema pallidum ss. pallidum (organism)BACTERIUM6246005Treponema pallidum ss. pertenue (organism)BACTERIUM125047004Treponema species (organism)PARASITE3764006Trichomonas (organism)PARASITE37900004Trichinella (organism)FUNGUS88578003Trichophyton (organism)FUNGUS62289009Trichosporon (organism)PARASITE2572000Trichuris (organism)PARASITE243659009Trypanosoma brucei (organism)PARASITE88274000Trypanosoma cruzi (organism)BACTERIUM131371004Ureaplasma species (organism)BACTERIUM12006007Ureaplasma urealyticum (organism)BACTERIUM398506000Vibrio cholerae, non-01 (organism)BACTERIUM62987004Vibrio cholerae, 01 (organism)BACTERIUM75953000Vibrio cholerae (organism)VIRUS62958000Venezuelan equine encephalomyelitis V (organism)BACTERIUM90435009Veillonella parvula (organism)BACTERIUM116420008Veillonella species (organism)BACTERIUM45749000Vibrio alginolyticus (organism)BACTERIUM36764009Vibrio cincinnatiensis (organism)VIRUS183392006Vibrio damsela (organism)BACTERIUM43199008Vibrio fluvialis (organism)BACTERIUM6387008Vibrio furnissii (organism)BACTERIUM7064002Vibrio hollisae (organism)BACTERIUM28382009Vibrio metschnikovii (organism)BACTERIUM11776003Vibrio mimicus (organism)BACTERIUM11736008Vibrio parahaemolyticus (organism)BACTERIUM131373001Vibrio species (organism)BACTERIUM55905000Vibrio vulnificus (organism)VIRUS19551004Human herpesV 3 (organism)VIRUS11428003Western equine encephalomyelitis V (organism)BACTERIUM131374007Weeksella species (organism)BACTERIUM83326004Weeksella virosa (organism)BACTERIUM28833002Weeksella zoohelcum (organism)BACTERIUM131375008Wolinella species (organism)BACTERIUM32360004Wolinella succinogenes (organism)BACTERIUM131376009Xanthomonas species (organism)BACTERIUM115023005Photorhabdus luminescens (organism)BACTERIUM57111002Xenorhabdus nematophilus (organism)BACTERIUM116422000Xenorhabdus species (organism)FUNGUS62093005Yeast (organism)BACTERIUM91246002Yersinia aldovae (organism)BACTERIUM103434007Yersinia bercovieri (organism)BACTERIUM65255000Yersinia enterocolitica (organism)BACTERIUM85159008Yersinia frederiksenii (organism)BACTERIUM10334001Yersinia intermedia (organism)BACTERIUM91042006Yersinia kristensenii (organism)BACTERIUM103435008Yersinia mollaretii (organism)BACTERIUM54365000Yersinia pestis (organism)BACTERIUM90530002Yersinia pseudotuberculosis (organism)BACTERIUM87145000Yersinia rohdei (organism)BACTERIUM64125009Yersinia ruckeri (organism)BACTERIUM131295004Yersinia species (organism)BACTERIUM89477001Yokenella regensburgei (organism)BACTERIUM131296003Yokenella species (organism)
Required Pathogen-specific Drug-susceptibility Tests
Table SEQ Table \* ARABIC 20: Required Pathogen-specific Drug-susceptibility Tests
For the full SNOMED CT/NHSN pathogen code and LOINC/NHSN drug code mappings, and their codeSystem values, see the respective tables.Pathogen Code
SNOMED CT/NHSN CodesRequired Drug-susceptibility Tests:
LOINC/NSHN Codes116197008/CNS
60875001/SE
45654003/STAAR
113962001/STACC
66872005/STACO
40347003/STACS
103492009/STACU
8056006/STAGA
83452006/STAHA
44827007/STAHO
40253001/STALE
103494005/STALU
19743000/STASA
70806002/STASC
131360000/STASH
52122005/STASI
41103009/STASL
63550006/STAWA
32737005/STAXY19000-9/VANC78065002/ENTFS18864-9/AMP
35789-7/DAPTO
29258-1/LNZ 18965-4/PENG
19000-9/VANC90272000/ENTFM18864-9/AMP
35789-7/DAPTO
29258-1/LNZ 18965-4/PENG
23640-6/QUIDAL
19000-9/VANC3092008/SA18908-4/CLIND
35789-7/DAPTO
18919-1/ERYTH
18928-2/GENT
29258-1/LNZ 18961-3/OX
23640-6/QUIDAL
18974-6/RIF
18998-5/TMZ
19000-9/VANCAcinetobacter spp:
116456006/ACS
91288006/ACBA
113376007/ACCA
77045006/ACHA
252000/ACJH
13879009/ACJU
83088009/ACLW18860-7/AMK
18865-6/AMPSUL
18879-7/CEFEP
18893-8/CEFTAZ
18906-8/CIPRO 18932-4/IMI
20629-2/LEVO
18943-1/MERO
18970-4/PIPTAZ112283007/EC
83285000/ECEP18860-7/AMK
18879-7/CEFEP
18886-2/CEFOT
18893-8/CEFTAZ
18895-3/CEFTRX 18906-8/CIPRO
18932-4/IMI
20629-2/LEVO
18943-1/MEROEnterobacter spp:
131263000/ESP
62592009/EA
14385002/ENC
114452005/ENTA1
114453000/ENTA2
33115003/ENTAB
51494007/ENTAG
372407009/ENTAS
84221003/ENTAU
5381002/ENTGE
114454006/ENTHO
35165009/ENTIN
77614008/ENTSA
88127002/ENTTA
18860-7/AMK
18879-7/CEFEP
18886-2/CEFOT
CEFTAX
18895-3/CEFTRX
18906-8/CIPRO
18932-4/IMI
20629-2/LEVO
18943-1/MERO40886007/KO18860-7/AMK
18879-7/CEFEP
18886-2/CEFOT
18893-8/CEFTAZ
18895-3/CEFTRX 18906-8/CIPRO
18932-4/IMI
20629-2/LEVO
18943-1/MERO56415008/KP18860-7/AMK
18879-7/CEFEP
18886-2/CEFOT
18893-8/CEFTAZ
18895-3/CEFTRX 18906-8/CIPRO
18932-4/IMI
20629-2/LEVO
18943-1/MERO33522002/SM
115006001/SERM118860-7/AMK
18879-7/CEFEP
18886-2/CEFOT
18893-8/CEFTAZ
18895-3/CEFTRX 18906-8/CIPRO
18932-4/IMI
20629-2/LEVO
18943-1/MERO52499004/PA18860-7/AMK
18879-7/CEFEP
18893-8/CEFTAZ
18906-8/CIPRO 18932-4/IMI
20629-2/LEVO
18943-1/MERO
18969-6/PIP113697002/STEMA18998-5/TMZAny other bacterial pathogenAt least one testProcedure Category Codes
The NHSN procedure-category codes represent a specific collection of ICD-9-CM codes, and the categorization is enhanced each year as ICD-9 releases new codes. Therefore, the CDA document uses the NHSN vocabulary to record procedure category. ICD-9-CM codes are shown in the third column of this table for the developers information only.
The far right-hand column in this table shows which SSI Location codes and SSI Anatomic Site codes are appropriate for use with each procedure category code. The SSI Location and SSI Anatomic Site codes are used in the CDA document; they are listed here for reference only. The full vocabularies are provided in separate tables: REF _Ref184466077 \h \* MERGEFORMAT Table 5: Surgical Site Infection Location Type Value Set and REF _Ref184361124 \h \* MERGEFORMAT Table 22: SSI Anatomic Site Value Set.
See REF _Ref184188172 \r \h \* MERGEFORMAT 1.3.3 REF _Ref184188172 \h \* MERGEFORMAT Change Notification Process for information on how to access NHSNs up-to-date list of ICD-9-CM codes mapped to NHSN procedure categories.
Table SEQ Table \* ARABIC 21: Procedure Category Value Set
Value Set: NHSNProcedureCategoryCode 2.16.840.1.113883.3.117.1.1.6.4
Code System: NHSNProcedureCategoryCode 2.16.840.1.113883.3.117.1.1.4.4NHSN CodeMeaningICD-9-CM Codes (Informative)Appropriate Codes:
SSI Location
SSI Anatomic SiteAAAAb aortic aneurysm repair38.34, 38.44DIP SIP
ENDO GIT IAB VASCAMPLimb amputation84.00-84.19, 84.91DIP SIP
BONE JNT APPYAppendix surgery47.01, 47.09, 47.2, 47.91-47.92, 47.99DIP SIP
GIT IAB AVSDAV shunt for dialysis39.27DIP SIP
VASC BILIBile duct/liver/pancr50.0, 50.12, 50.21-50.22, 50.29-50.3, 50.4, 50.61, 50.69, 51.31-51.37, 51.39, 51.41-51.43, 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, 52.99DIP SIP
GIT IAB BRSTBreast abscess/ mastitis85.12, 85.20-85.23, 85.31-85.36, 85.41-85.48, 85.50, 85.53-85.54, 85.6, 85.7, 85.93-85.96DIP SIP
BRST CARDMyocarditis/pericard35.00-35.04, 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, 37.10-37.11, 37.24-37.25, 37.31-37.35, 37.4DIP SIP
BONE CARD ENDO LUNG MED VASCCBGB-CABGchest/donor sites36.10-36.14, 36.19DIP DIS SIP SIS
BONE CARD ENDO LUNG MED VASCCBGC-CABGchest site only36.15-36.17, 36.2DIP SIP
BONE CARD ENDO LUNG MED VASCCEACarotid endarterectomy38.12DIP SIP SIS DIS
VASC CHOLGallbladder surgery51.03-51.04, 51.13, 51.21-51.24DIP GIT IAB SIP COLOColon surgery45.03, 45.26, 45.41, 45.49, 45.52, 45.71-45.76, 45.79-45.8, 45.92-45.95, 46.03-46.04, 46.10-46.11, 46.13-46.14, 46.43, 46.52, 46.75-46.76, 46.94DIP SIP
GIT IAB OREP OUTICRANCraniotomy01.12, 01.14, 01.21-01.25, 01.31-01.32, 01.39, 01.41-01.42, 01.51-01.53, 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, 39.28DIP SIP
BONE IC MEN SINU CSECCesarean section74.0, 74.1, 74.2, 74.4, 74.91, 74.99DIP SIP
EMET GIT IAB OREP OUTI FUSNSpinal fusion81.00-81.08, 81.61-81.64, 84.51-84.52DIP DIS SIP SIS
BONE DISC IAB IC LUNG MEN SA FXOpen reduction of fracture79.21-79.22, 79.25-79.26, 79.31-79.32, 79.35-79.36, 79.51-79.52, 79.55-79.56DIP SIP
BONE JNT GASTGastric surgery43.00, 43.3, 43.42, 43.49-43.5, 43.6, 43.7, 43.81, 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, 44.95-44.98DIP SIP
GIT IAB LUNG HERHerniorrhaphy53.00-53.05, 53.10-53.17, 53.21, 53.29, 53.31, 53.39, 53.41, 53.49, 53.51, 53.59, 53.61, 53.69DIP SIP
IAB HPROHip Replacement81.51-81.53DIP SIP
BONE JNT HTPHeart transplant37.51-37.54DIP SIP
BONE CARD ENDO LUNG MED VASCHYSTAbdominal hysterectomy68.31, 68.39-68.4, 68.6,DIP SIP
IAB OREP KPROKnee Replacement81.54-81.55DIP SIP
BONE JNT KTPKidney transplant55.61, 55.69DIP SIP
IAB OREP OUTI LAMLaminectomy03.01-03.02, 03.09, 80.50-80.51, 80.59, 84.60-84.69DIP SIP
BONE DISC IAB IC MEN SA LTPLiver transplant50.51, 50.59DIP SIP
GIT IAB NECKNeck surgery30.1, 30.21-30.22, 30.29-30.3, 30.4, 31.45, 40.40-40.42DIP SIP
EAR ORAL UR NEPHKidney surgery55.01-55.02, 55.11-55.12, 55.24, 55.31, 55.39-55.4, 55.51-55.52, 55.54, 55.91DIP SIP
IAB OREP OUTI OVRYOvarian surgery65.01, 65.09, 65.12-65.13, 65.21-65.25, 65.29, 65.31, 65.39, 65.41, 65.49, 65.51-65.54, 65.61-65.64, 65.71-65.76, 65.79, 65.81, 65.89, 65.92-65.95, 65.99DIP SIP
IAB OREP OUTI PACEPacemaker surgery00.50-00.54, 37.70-37.77, 37.79-37.83, 37.85-37.87, 37.89, 37.94-37.99DIP SIP
CARD ENDO IAB VASCPRSTProstate surgery60.12, 60.3, 60.4, 60.5, 60.61-60.62, 60.69DIP SIP
IAB OREP OUTI PVBYPeriph vasc bypass surg39.29DIP SIP
VASCRECRectal surgery48.25, 48.35, 48.49-48.5, 48.61-48.65, 48.69, 48.74DIP SIP
IAB GIT OREP OUTI RFUSNRefusion of spine81.30-81.39DIP DIS SIP SIS
BONE DISC IAB IC MEN SA SBSmall bowel surgery5.01-45.02, 45.15, 45.31-45.34, 45.51, 45.61-45.63, 45.91, 46.01-46.02, 46.20-46.24, 46.31, 46.39, 46.41, 46.51, 46.71-46.74, 46.93DIP SIP
GIT IAB OREP OUTI SPLESpleen surgery41.2, 41.33, 41.41-41.43, 41.5, 41.93, 41.95, 41.99DIP SIP
IAB THORThoracic surgery32.09-32.1, 32.21-32.22, 32.29-32.3, 32.4, 32.5, 32.6, 32.9, 33.0, 33.1, 33.31-33.34, 33.39, 33.41-33.43, 33.48-33.49, 33.98-33.99, 34.01-34.03, 34.1, 34.26, 34.3, 34.4, 34.51, 34.59-34.6, 34.81-34.84, 34.89, 34.93, 34.99, 53.80-53.82DIP SIP
BONE BRST LUNG THYRThyroid and/or parathyr06.02, 06.09, 06.12, 06.2, 06.31, 06.39-06.4, 06.50-06.52, 06.6, 06.7, 06.81, 06.89, 06.91-06.95, 06.98-06.99DIP SIP
EAR GIT URVHYSVaginal hysterectomy68.51, 68.59, 68.7DIP SIP
IAB OREP OUTI VCUFVSHNVentricular shunt02.2, 02.31-02.35, 02.39, 02.42-02.43, 54.95DIP SIP
BONE IC MEN SA XLAPExploratory abd surgery53.7, 54.0, 54.11-54.12, 54.19, 54.3, 54.4, 54.51, 54.59, 54.61-54.64, 54.71-54.75, 54.92-54.93DIP SIP
EMET GIT IAB OREP OUTI OTHOther operations on the Nervous system01.6, 02.01-02.07, 02.94-02.95, 02.99, 03.1, 03.29, 03.4, 03.51-03.53, 03.59-03.6, 03.71-03.72, 03.79, 03.97-03.98, 04.01-04.07, 04.12, 04.3, 04.41-04.44, 04.49-04.5, 04.6, 04.71-04.76, 04.79, 04.91, 05.0, 05.21-05.25, 05.29, 05.81, 05.89-05.9DIP SIP SIP SIS
[any]OTHOther operations on the Endocrine System07.00-07.02, 07.12, 07.21-07.22, 07.29-07.3, 07.41-07.45, 07.49, 07.80-07.82, 07.91-07.94, 07.99DIP SIP SIP SIS
[any]OTHOther Operations on the Eye, Ear, Nose, Mouth, and Pharynx08.01-08.02, 08.09, 08.20-08.25, 08.31-08.38, 08.41-08.44, 08.49, 08.51-08.52, 08.59, 08.61-08.64, 08.69-08.74, 08.81-08.87, 08.89, 09.20-09.23, 09.3, 09.6, 09.73, 09.81-09.83, 18.02, 18.09, 18.21, 18.29, 18.31, 18.39-18.4, 18.5, 18.6, 18.71-18.72, 18.79, 18.9, 20.21-20.23, 20.41-20.42, 20.49, 20.51, 20.59, 20.92, 20.95-20.99, 21.1, 21.30, 21.32, 21.4, 21.72, 21.82-21.87, 21.89, 22.12, 22.31, 22.39, 25.02, 26.12, 26.30-26.32, 27.55-27.57, 27.62-27.63, 27.69, 29.0, 29.2, 29.31-29.33, 29.39-29.4, 29.51-29.54, 29.59, 29.92DIP SIP SIP SIS
[any]OTHOther operations on the Cardiovascular System36.03, 36.31-36.32, 36.39, 36.91, 36.99, 37.12, 37.61-37.67, 37.91, 38.00, 38.02-38.10, 38.13-38.16, 38.18, 38.30, 38.32-38.33, 38.35-38.40, 38.42-38.43, 38.45-38.50, 38.52-38.53, 38.55, 38.57, 38.59-38.60, 38.62-38.7, 38.80, 38.82-38.89, 39.0, 39.1, 39.21-39.26, 39.30-39.32, 39.41-39.43, 39.49-39.59, 39.8, 39.90-39.91, 39.93-39.94DIP SIP SIP SIS
[any]OTHOther operations on Hemic and Lymphatic systems40.0, 40.21-40.24, 40.29-40.3, 40.50-40.54, 40.59, 40.61-40.64, 40.69, 40.9, 41.94, 41.98
DIP SIP SIP SIS
[any]OTHOther Operations On The Digestive System42.01, 42.09-42.12, 42.19, 42.25, 42.31-42.32, 42.39-42.42, 42.51-42.56, 42.58-42.59, 42.61-42.66, 42.68-42.7, 42.82-42.87, 42.89, 42.91, 44.00-44.03, 44.66-44.67, 44.91-44.92, 44.99, 45.00, 45.50, 45.90, 46.42, 46.50, 46.60-46.64, 46.79-46.82, 46.91-46.92, 46.97, 46.99, 47.11, 47.19, 48.41, 48.72-48.73, 48.75-48.76, 52.80-52.86, 53.9, 54.94DIP SIP SIP SIS
[any]OTHOther Operations On The Genitourinary System55.53, 55.7, 55.81-55.87, 55.89, 55.97-55.98, 56.0, 56.1, 56.2, 56.34, 56.40-56.42, 56.51-56.52, 56.61-56.62, 56.71-56.75, 56.79, 56.81-56.86, 56.89, 56.95, 57.12, 57.18-57.19, 57.21-57.22, 57.34, 57.51, 57.59-57.6, 57.71, 57.79, 57.81-57.89, 57.91, 58.39, 58.42-58.47, 58.49-58.5, 58.91-58.93, 58.99, 59.00, 59.02-59.03, 59.09, 59.11-59.12, 59.19, 59.3, 59.4, 59.5, 59.6, 59.71, 59.79, 59.91-59.92, 60.0, 60.72-60.73, 60.79, 60.81-60.82, 60.93, 61.0, 61.2, 61.3, 61.41-61.42, 61.49, 61.92, 61.99, 62.0, 62.12, 62.2, 62.3, 62.41-62.42, 62.5, 62.61, 62.69-62.7, 62.91-62.92, 62.99, 63.1, 63.2, 63.3, 63.4, 63.51-63.53, 63.59-63.6, 63.70-63.73, 63.81-63.85, 63.89, 63.92-63.95, 63.99, 64.2, 64.3, 64.41-64.45, 64.49-64.5, 64.91-64.99, 66.01-66.02, 66.31-66.32, 66.39-66.4, 66.51-66.52, 66.61-66.63, 66.69, 66.71-66.74, 66.79, 66.92-66.94, 66.97, 66.99, 67.4, 67.51, 68.0, 68.13-68.14, 68.21-68.22, 68.29, 68.8, 68.9, 69.19, 69.21-69.23, 69.29-69.3, 69.41-69.42, 69.49, 70.4, 70.50-70.52, 70.61-70.62, 70.72-70.75, 70.8, 71.01, 71.09, 71.5, 71.61-71.62, 71.71-71.72, 71.79-71.8, 71.9, DIP SIP SIP SIS
[any]OTHOther Obstetrical Operations74.3, 75.50, 75.52, 75.61-75.62, 75.93DIP SIP SIP SIS
[any]OTHOther Operations On The Musculoskeletal System76.01, 76.09, 76.2, 76.31, 76.39, 76.41-76.46, 76.5, 76.61-76.70, 76.72, 76.74, 76.76-76.77,76.79, 76.91-76.92, 76.94, 76.97, 77.00-77.39, 77.51-77.54, 77.56-77.99, 78.00-78.09, 78.20, 78.22-78.25, 78.27-78.30, 78.32-78.35, 78.37-78.79, 78.90-78.99, 79.10-79.20, 79.23-79.24, 79.27-79.30, 79.33-79.34, 79.37-79.39, 79.50, 79.59-79.69, 79.80-79.99, 80.00-80.19, 80.40-80.49, 80.6, 80.70-80.99, 81.10-81.17, 81.20-81.29,81.40, 81.42-81.47, 81.49, 81.56-81.57, 81.59, 81.71-81.75, 81.79-81.85, 81.93-81.97, 82.01-82.04, 82.09, 82.11-82.12, 82.19, 82.21-82.22, 82.29, 82.31-82.36, 82.39, 82.41-82.46, 82.51-82.59, 82.61, 82.69, 82.71-82.72, 82.79, 82.81-82.86, 82.89, 82.91, 82.99, 83.01-83.03, 83.09,83.11-83.14, 83.19, 83.31-83.32, 83.39, 83.41-83.45, 83.49-83.50, 83.61-83.65, 83.71-83.77, 83.79, 83.81-83.89, 83.91-83.93, 84.21-84.30, 84.40, 84.44, 84.48, 84.53-84.55, 84.59, 84.92-84.93, 84.99DIP SIP SIP SIS
[any]OTHOther Operations On The Integumentary System85.00, 85.24-85.25, 85.82-85.87, 85.89, 85.93-85.96, 85.99, 86.03-86.07, 86.09, 86.40, 86.60-86.63, 86.65-86.67, 86.69-86.75, 86.81-86.86, 86.89, 86.91, 86.93,DIP SIP SIP SIS
[any]NONot an NHSN operation
NHSN Surgical Site Infection Anatomic Site Code System
Table SEQ Table \* ARABIC 22: SSI Anatomic Site Value Set
Value Set: NHSNSSIAnatomicSiteCode 2.16.840.1.113883.3.117.1.1.6.3.3
Code System: NHSN SSI Anatomic Site 2.16.840.1.113883.3.117.1.1.4.3.3SSI Anatomic Site CodeMeaningBONEOsteomyelitisBRSTBreast abscess/mastitisCARDMyocarditis/pericarditisDISCDisc spaceEAROtitis externa/media/internaEMETEndometritisENDOEndocarditisEYEEye, other than conjunctivitisGITGI tractIABIntra-abdominalICIntracranial/abscessJNTJoint, bursa, or tendonLUNGOther LRI, not pneumoniaMEDMediastinitisMENMeningitis/ventriculitisORALOral cavity/structuresOREPOther reproductiveOUTIOther urinary tractSASpinal abscess w/o meningitisSINUSinusitisURUpper respiratory tractVASCArterial/venous infectionVCUFVaginal cuff
NHSN Healthcare Service Location Codes
This IG defines an NHSN value set for service location codes rather than using the HL7 code system in its entirety because in the future, the values allowed for transmission to NHSN may represent only a subset of an expanded HL7 Healthcare Service Location vocabulary.
Table SEQ Table \* ARABIC 23: Healthcare Service Location Value Set
Value Set: NHSNHealthcareServiceLocationCode 2.16.840.1.113883.3.117.1.1.6.5
Code System: HL7 HealthcareServiceLocationCodeSystem 2.16.840.1.113883.6.259 CodeMeaningINPATIENT LOCATIONS
Inpatient Adult Critical CareIN:ACUTE:CC:BBurn Critical CareIN:ACUTE:CC:CMedical Cardiac Critical CareIN:ACUTE:CC:MMedical Critical CareIN:ACUTE:CC:MSMedical/Surgical Critical CareIN:ACUTE:CC:NNeurologic Critical Care IN:ACUTE:CC:NSNeurosurgical Critical CareIN:ACUTE:CC:PNATLPrenatal Critical CareIN:ACUTE:CC:RRespiratory Critical CareIN:ACUTE:CC:CTSurgical Cardiothoracic Critical CareIN:ACUTE:CC:SSurgical Critical CareIN:ACUTE:CC:TTrauma Critical CareNeonatal UnitsIN:ACUTE:WARD:NURSInpatient Well Baby Nursery (Level I)IN:ACUTE:CC_STEP:NURSNeonatal Critical Care(Level II/III)IN:ACUTE:CC:NURSNeonatal Critical Care (Level III)IN:ACUTE:STEP:NURSStep-down Neonatal ICU (Level II)Pediatric Critical CareIN:ACUTE:CC:B_PEDPediatric Burn Critical CareIN:ACUTE:CC:CT_PEDPediatric Cardiothoracic Critical CareIN:ACUTE:CC:M_PEDPediatric Medical Critical CareIN:ACUTE:CC:MS_PEDPediatric Medical/Surgical Critical Care IN:ACUTE:CC:NS_PEDPediatric Neurosurgical Critical CareIN:ACUTE:CC:R_PEDPediatric Respiratory Critical CareIN:ACUTE:CC:S_PEDPediatric Surgical Critical CareIN:ACUTE:CC:T_PEDPediatric Trauma Critical CareSpecialty Care Areas (SCA)IN:ACUTE:SCA:BMTBone Marrow Transplant SCAIN:ACUTE:SCA:HONCHematology/Oncology SCAIN:ACUTE:SCA:DIALInpatient Acute Dialysis SCAIN:ACUTE:SCA:LTACLong-term Acute Care (LTAC)IN:ACUTE:SCA:BMT_PEDPediatric Bone Marrow Transplant SCAIN:ACUTE:SCA:DIAL_PEDPediatric Dialysis SCAIN:ACUTE:SCA:HONC_PEDPediatric Hematology/Oncology SCAIN:ACUTE:SCA:SOTP_PEDPediatric Solid Organ Transplant SCAIN:ACUTE:SCA:SOTPSolid Organ Transplant SCAInpatient Adult WardsIN:ACUTE:WARD:BHVInpatient Behavioral Health/Psych WardIN:ACUTE:WARD:BInpatient Burn WardIN:ACUTE:WARD:ENTInpatient Ear/Nose/Throat WardIN:ACUTE:WARD:GIInpatient Gastrointestinal WardIN:ACUTE:WARD:GUInpatient Genitourinary WardIN:ACUTE:WARD:GNTInpatient Gerontology WardIN:ACUTE:WARD:GYNInpatient Gynecology WardIN:ACUTE:WARD:JALInpatient Jail UnitIN:ACUTE:WARD:IFMInpatient School InfirmaryIN:ACUTE:WARD:LDLabor and Delivery WardIN:ACUTE:WARD:LD_PPLabor, Delivery, Recovery, Postpartum Suite (LDRP)IN:ACUTE:WARD:M Inpatient Medical WardIN:ACUTE:WARD:MSInpatient Medical/Surgical WardIN:ACUTE:WARD:NInpatient Neurology WardIN:ACUTE:WARD:NSInpatient Neurosurgical WardIN:ACUTE:WARD:OPHInpatient Ophthalmology WardIN:ACUTE:WARD:ORTInpatient Orthopedic WardIN:ACUTE:WARD:T_ORTInpatient Orthopedic Trauma WardIN:ACUTE:WARD:PLSInpatient Plastic Surgery WardIN:ACUTE:WARD:PPInpatient Postpartum WardIN:ACUTE:WARD:PULMInpatient Pulmonary WardIN:ACUTE:WARD:REHABInpatient Rehabilitation WardIN:ACUTE:WARD:STRKAcute Stroke WardIN:ACUTE:WARD:SInpatient Surgical WardIN:ACUTE:WARD:VSInpatient Vascular Surgery WardPediatric WardsIN:ACUTE:WARD:BHV_ADOLInpatient Adolescent Behavioral Health WardIN:ACUTE:WARD:M_PEDInpatient Medical Pediatric WardIN:ACUTE:WARD:BHV_PEDInpatient Pediatric Behavioral Health WardIN:ACUTE:WARD:B_PEDInpatient Pediatric Burn WardIN:ACUTE:WARD:ENT_PEDInpatient Pediatric Ear, Nose, Throat WardIN:ACUTE:WARD:GU_PEDInpatient Pediatric Genitourinary WardIN:ACUTE:WARD:MS_PEDInpatient Pediatric Med/Surg WardIN:ACUTE:WARD:N_PEDInpatient Pediatric Neurology WardIN:ACUTE:WARD:NS_PEDInpatient Pediatric Neurosurgical WardIN:ACUTE:WARD:ORT_PEDInpatient Pediatric Orthopedic WardIN:ACUTE:WARD:REHAB_PEDInpatient Pediatric Rehabilitation WardIN:ACUTE:WARD:S_PEDInpatient Pediatric Surgical WardStep Down UnitsIN:ACUTE:STEPAdult Step Down Unit (post-critical care)IN:ACUTE:STEP:PEDPediatric Step Down Unit (post-critical care)Operating RoomsIN:ACUTE:OR:CATHCardiac Catheterization Room/SuiteIN:ACUTE:OR:LDCesarean Section Room/SuiteIN:ACUTE:ORInpatient Operating Room/SuiteIN:ACUTE:OR_STEPPost-Anesthesia Care Unit/Recovery RoomAntimicrobial Use and Resistance (AUR) Documentation OnlyIN:ACUTE:WARDAll Inpatient Areas (not ICU or SCA) combinedOUTAll Outpatient AreasMiscellaneous AreasIN:ACUTEOptional hospital-wide summary location/all inpatient bedsOUT:NONACUTE:DIAG:PULMPulmonary Function TestingIN:NA:SUPPORT:TRASHSoiled Utility AreaIN:NONACUTE:CLINIC:SLEEPSleep Studies (for in- and outpatients)OUT:NONACUTE:MOBILETransport ServiceLong-term CareIN:NONACUTE:LTC:HSPInpatient HospiceIN:NONACUTE:LTC:ALZLong-Term Care Alzheimer's UnitIN:NONACUTE:LTC:BHVLong-term Care Behavioral Health/Psych UnitIN:NONACUTE:LTC:REHABLong-term Care Rehabilitation UnitIN:NONACUTE:LTCLong-term Care UnitIN:NONACUTE:LTC:RVentilator Dependent UnitOUTPATIENT LOCATIONSAcute CareOUT:ACUTE:WARD24-Hour Observation AreaOUT:ACUTE:ORAmbulatory Surgery CenterOUT:ACUTE:MOBILE:UEMobile Emergency Services/EMSOUT:ACUTE:EDOutpatient Emergency DepartmentOUT:ACUTE:OR:PEDOutpatient Pediatric Surgery CenterOUT:ACUTE:OR:PLSOutpatient Plastic Surgery CenterOUT:ACUTE:OR_STEPOutpatient Surgery Recovery Room/Post-Anesthesia Care UnitOUT:ACUTE:ED:PEDPediatric Emergency DepartmentOUT:ACUTE:CLINIC:UE Urgent Care CenterClinic (Nonacute) SettingsOUT:NONACUTE:CLINIC:ALRGAllergy ClinicOUT:NONACUTE:CLINIC:BHVBehavioral Health ClinicOUT:NONACUTE:CLINIC:BLOODBlood Collection CenterOUT:NONACUTE:CLINIC:C_REHABCardiac Rehabilitation CenterOUT:NONACUTE:CLINIC:CCardiology ClinicOUT:NONACUTE:CLINIC:CONContinence ClinicOUT:NONACUTE:CLINIC:DERMDermatology ClinicOUT:NONACUTE:CLINIC:DIABDiabetes/Endocrinology ClinicOUT:NONACUTE:CLINIC:ENTEar, Nose, Throat ClinicOUT:NONACUTE:DIAG:GIEndoscopy SuiteOUT:NONACUTE:CLINIC:FAMFamily Medicine ClinicOUT:NONACUTE:CLINIC:GENGenetics ClinicOUT:NONACUTE:CLINIC:GYNGynecology ClinicOUT:NONACUTE:CLINIC:HOLHolistic Medicine CenterOUT:NONACUTE:CLINIC:HBOHyperbaric Oxygen CenterOUT:NONACUTE:CLINIC:FUSInfusion CenterOUT:NONACUTE:MOBILE:BLOODMobile Blood Collection centerOUT:NONACUTE:MOBILE_DIAG:RADMobile MRI/CTOUT:NONACUTE:CLINIC:NNeurology ClinicOUT:NONACUTE:CLINIC:OCCOccupational Health ClinicOUT:NONACUTE:CLINIC:OT_REHABOccupational Therapy ClinicOUT:NONACUTE:CLINIC:OPHOphthalmology ClinicOUT:NONACUTE:CLINIC:ORTOrthopedic ClinicOUT:NONACUTE:CLINIC:OSTOstomy ClinicOUT:NONACUTE:CLINIC:DENTOutpatient Dental ClinicOUT:NONACUTE:CLINIC:GIOutpatient Gastrointestinal (GI) ClinicOUT:NONACUTE:CLINIC:HONCOutpatient Hematology/Oncology ClinicOUT:NONACUTE:CLINIC:DIALOutpatient Hemodialysis ClinicOUT:NONACUTE:CLINIC:HIVOutpatient HIV ClinicOUT:NONACUTE:CLINIC:MOutpatient Medical ClinicOUT:NONACUTE:CLINIC:REHABOutpatient Rehabilitation ClinicOUT:NONACUTE:CLINIC:PAINPain ClinicOUT:NONACUTE:CLINIC:BHV_PEDPediatric Behavioral Health ClinicOUT:NONACUTE:CLINIC:PED_CPediatric Cardiology CenterOUT:NONACUTE:CLINIC:PEDPediatric ClinicOUT:NONACUTE:CLINIC:DENT_PEDPediatric Dental ClinicOUT:NONACUTE:CLINIC:DERM_PEDPediatric Dermatology ClinicOUT:NONACUTE:CLINIC:DIAB_PEDPediatric Diabetes/Endocrinology ClinicOUT:NONACUTE:CLINIC:GI_PEDPediatric Gastrointestinal ClinicOUT:NONACUTE:CLINIC:HONC_PEDPediatric Hematology/Oncology ClinicOUT:NONACUTE:CLINIC:PGU_PEDPediatric Nephrology ClinicOUT:NONACUTE:CLINIC:ORT_PEDPediatric Orthopedic ClinicOUT:NONACUTE:CLINIC:RHEUM_PEDPediatric Rheumatology ClinicOUT:NONACUTE:CLINIC:SCOL_PEDPediatric Scoliosis ClinicOUT:NONACUTE:CLINIC:PT_REHABPhysical Therapy ClinicOUT:NONACUTE:CLINICPhysician's OfficeOUT:NONACUTE:CLINIC:PODPodiatry ClinicOUT:NONACUTE:CLINIC:PNATLPrenatal ClinicOUT:NONACUTE:CLINIC:PULMPulmonary ClinicOUT:NONACUTE:DIAG:RADRadiology (includes Nuclear Medicine)OUT:NONACUTE:CLINIC:RHEUMRheumatology ClinicOUT:NONACUTE:CLINIC:IFMSchool or Prison InfirmaryOUT:NA:LAB:SPECSpecimen Collection Area (Healthcare)OUT:NONACUTE:CLINIC:ST_REHABSpeech Therapy ClinicOUT:NONACUTE:CLINIC:S Surgical Services ClinicOUT:NONACUTE:CLINIC:NURSWell Baby ClinicOUT:NONACUTE:CLINIC:WNDWound CenterOUT:NONACUTE:CLINIC:WND_OST_CONTWound Ostomy Continence ClinicCommunity LocationsCOMM:NONACUTE:CLINIC:BLOODBlood Collection (Blood Drive Campaign)COMM:NONACUTE:HOMEHome Care COMM:NONACUTE:HOME:HSPHome-based Hospice COMM:NA:LAB:SPECSpecimen Collection Area (Community)Non-patient Care LocationsNONPTC:NA:SUPPORT:ADMINAdministrative AreasNONPTC:NA:HOMEAssisted Living AreaNONPTC:NA:LAB:BLOODBlood Bank NONPTC:NA:SUPPORT:CSSCentral Sterile Supply NONPTC:NA:SUPPORT:TRASHCentral Trash Area NONPTC:NA:LAB:CHEMClinical Chemistry NONPTC:NA:SUPPORT:GRNDSFacility Grounds NONPTC:NA:LABGeneral Laboratory NONPTC:NA:LAB:HHematology NONPTC:NA:LAB:HIST_PATHHistology/Surgical Pathology NONPTC:NA:SUPPORT:HSKPHousekeeping/Environmental ServicesNONPTC:NA:SUPPORT:LAUNLaundry Room NONPTC:NA:LAB:MICROMicrobiology NONPTC:NA:LAB:PATH_MORGMorgue/Autopsy Room NONPTC:NA:SUPPORT:PHARMPharmacyNONPTC:NA:SUPPORT:ENGPhysical Plant Operations Center NONPTC:NA:SUPPORT:PUBPublic Area in FacilityNONPTC:NA:LAB:SERSerology LabNONPTC:NA:LAB:VIRVirology Lab
Template IDs (Non-normative)
The templateIds used in this DSTU are temporary. They will be replaced with permanent templateIds issued by SDTC on publication.
Table SEQ Table \* ARABIC 24: NHSN Temporary Template IDs
Template IDAsserts Conformance to Constraints for:2.16.840.1.113883.3.117.1.1.1HAI Generic Constraints2.16.840.1.113883.3.117.1.1.2.1Risk Factors Section2.16.840.1.113883.3.117.1.1.2.1.1Risks Organizer 2.16.840.1.113883.3.117.1.1.2.1.1.1BSI Risk Factors Observation 2.16.840.1.113883.3.117.1.1.2.1.1.2Risk Factors Measurement Observation2.16.840.1.113883.3.117.1.1.2.1.2Wound Class Observation2.16.840.1.113883.3.117.1.1.2.1.3Endoscope Used Procedure 2.16.840.1.113883.3.117.1.1.2.2Details Section2.16.840.1.113883.3.117.1.1.2.2.3Bloodstream Infection Type Observation2.16.840.1.113883.3.117.1.1.2.2.3.1LCBI Pathway Observation2.16.840.1.113883.3.117.1.1.2.2.4 Death Observation2.16.840.1.113883.3.117.1.1.2.2.5SSI Detected Observation 2.16.840.1.113883.3.117.1.1.2.2.7Procedure Details2.16.840.1.113883.3.117.1.1.2.2.7.1Procedure Details - Procedure Record Constraints2.16.840.1.113883.3.117.1.1.2.2.7.2Procedure Details - SSI Report Constraints2.16.840.1.113883.3.117.1.1.2.2.7.3Anesthesia Administration 2.16.840.1.113883.3.117.1.1.2.2.7.4ASA Class Observation2.16.840.1.113883.3.117.1.1.2.2.7.5Trauma Observation2.16.840.1.113883.3.117.1.1.2.2.7.6Multiple Procedures Observation2.16.840.1.113883.3.117.1.1.2.2.7.7Diabetes Observation2.16.840.1.113883.3.117.1.1.2.2.7.8Spinal Fusion Level Observation 2.16.840.1.113883.3.117.1.1.2.2.7.9Height Observation2.16.840.1.113883.3.117.1.1.2.2.7.10Weight Observation2.16.840.1.113883.3.117.1.1.2.2.7.11Labor Duration Observation 2.16.840.1.113883.3.117.1.1.2.2.7.12Blood Loss Observation2.16.840.1.113883.3.117.1.1.2.2.7.13SSI Anatomic Site Observation2.16.840.1.113883.3.117.1.1.2.2.7.15Secondary Bloodstream Infection Observation2.16.840.1.113883.3.117.1.1.2.2.7.16Infection Contributed to Death Observation2.16.840.1.113883.3.117.1.1.2.2.7.17Procedure Risk Factors2.16.840.1.113883.3.117.1.1.2.5Findings Section 2.16.840.1.113883.3.117.1.1.2.5.0Findings Organizer2.16.840.1.113883.3.117.1.1.2.5.1Pathogen Identified Observation 2.16.840.1.113883.3.117.1.1.2.5.1.1Pathogen Ranking Observation 2.16.840.1.113883.3.117.1.1.2.5.1.2Drug Susceptibility Test Observation 2.16.840.1.113883.3.117.1.1.2.5.2Pathogens Identified Observation (negated)2.16.840.1.113883.3.117.1.1.2.6Summary Section2.16.840.1.113883.3.117.1.1.2.6.1Summary Encounter2.16.840.1.113883.3.117.1.1.2.6.1.1Summary Data Observation 2.16.840.1.113883.3.117.1.1.2.6.1.2Summary Encounter Constraints for ICU Denominator Report 2.16.840.1.113883.3.117.1.1.3.1BSI Numerator Report2.16.840.1.113883.3.117.1.1.3.2SSI Numerator Report2.16.840.1.113883.3.117.1.1.3.3ICU Denominator Report2.16.840.1.113883.3.117.1.1.3.4Procedure Denominator Report
Instance Identifier OIDS(Non-normative)
As discussed in REF _Ref190916446 \r \h \* MERGEFORMAT 1.3.2 REF _Ref190916463 \h \* MERGEFORMAT Development of This Specification, much of the development of this DSTU was driven by a pilot project in July 2007. The pilot project assigned OIDs (under a root owned by Alschuler Associates, LLC) to a fictional facility and vendor as a base for displaying the numbering schemes for which facilities and vendors are responsible.
These OIDs are used in the examples in this IG and in the accompanying sample files. Where appropriate, they will be replaced in a future release.
These OIDs all begin with 2.16.840.1.113883.3.117.1.1.5.
Table SEQ Table \* ARABIC 25: Instance Identifier OIDs
Facility IDs and Facility-assigned OIDs.5.1.1Facility OID - Good Health Hospital.5.1.1.1Good Health Hospital Patients.5.1.1.2Good Health Hospital Non-patients (surgeons, authors, etc) Vendor IDs and Vendor-assigned OIDs.5.2.1Vendor OID Zippy Software.5.2.1.1Zippy Software Software Installation One.5.2.1.1.2Software Installation One Documents.5.2.1.1.3Software Installation One Event IDs.5.2.1.1.4Software Installation One Procedure IDsNHSN and NHSN-assigned Event OIDs.2NHSN.4.1.2NHSN Procedure IdsDocument and Section Codes(Non-normative)
The document and section codes used in this DSTU will be replaced with permanent templateIds issued by LOINC on publication.
Table SEQ Table \* ARABIC 26: Document and Section Codes
codeSystemNamecodeMeaning2.16.840.1.113883.6.1LOINCx-HAIHealthcare Associated Infection Reportx-RISKSRisk Factors Sectionx-DETAILSDetails Section18769-0Findings Sectionx-SUMMARYSummary Section
Summary of Vocabularies (Non-normative)
For the users convenience, this table summarizes the vocabularies (code systems) used in this DSTU.
Table SEQ Table \* ARABIC 27: List of Vocabularies
Root OIDscodeSystemcodeSystemName2.16.840.1.113883.5.25HL7 Confidentiality 2.16.840.1.113883.5.4HL7 actCode2.16.840.1.113883.5.83HL7 Observation Interpretation 2.16.840.1.113883.6.1LOINC 2.16.840.1.113883.6.96SNOMED CT 2.16.840.1.113883.6.104ICD-9-CM Procedure 2.16.840.1.113883.3.117.1.1.4.2NHSN Vocabulary2.16.840.1.113883.3.117.1.1.4.3.2NHSN LCBI Pathways 2.16.840.1.113883.3.117.1.1.4.4NHSN Procedure Category 2.16.840.1.113883.3.117.1.1.4.7NHSN BSI Risk Factors2.16.840.1.113883.3.117.1.1.4.16NSHN Spinal Fusion Level 2.16.840.1.113883.3.117.1.1.4.17NHSN Spinal Fusion Approach 2.16.840.1.113883.3.117.1.1.4.18NHSN Hip Replacement 2.16.840.1.113883.3.117.1.1.4.19NHSN Knee Replacement 2.16.840.1.113883.3.117.1.1.4.20NHSN Occasion of HAI Detection2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic Site2.16.840.1.113883.3.117.1.1.4.3.21NHSN SSI Location Type2.16.840.1.113883.3.117.1.1.4.3.22NHSN Infection Type2.16.840.1.113883.3.117.1.1.4.12NHSN Summary Data
Summary of HAI Value Sets (Non-normative)
The following table summarizes the HAI value sets. Single-value bindings are not included here, but are listed in REF _Ref184368960 \r \h \* MERGEFORMAT Appendix J REF _Ref184368960 \h \* MERGEFORMAT Summary of HAI Single-Value Bindings (Non-normative).
Note: all value sets are STATIC unless noted as DYNAMIC.
Table SEQ Table \* ARABIC 28: HAI Value Sets Summary Table
ValueSetOID
(localValueSetName)
codeNHSN Display NameStandard code
Display NamecodeSystemcodeSystem
Name2.16.840.1.113883.3.117.1.1.6.3.1
( REF _Ref190863605 \h \* MERGEFORMAT Table 7: Blood Stream Infection Value Set)
238149007Clinical sepsisCulture negative Sepsis2.16.840.1.113883.6.96SNOMED CT91302008Laboratory confirmedSepsis2.16.840.1.113883.6.96SNOMED CT2.16.840.1.113883.3.117.1.1.6.13
( REF _Ref184360378 \h \* MERGEFORMAT Table 12: Wound Class Value Set)418780004
CleanCDC Class I/Clean2.16.840.1.113883.6.96SNOMED CT418115006
Clean-contaminatedCDC [wound] Class II/Clean Contaminated2.16.840.1.113883.6.96SNOMED CT418422005
ContaminatedCDC [wound] Class III/Contaminated2.16.840.1.113883.6.96SNOMED CT418422005
DirtyCDC Class IV/Dirty Infected
2.16.840.1.113883.6.96SNOMED CT2.16.840.1.113883.3.117.1.1.6.14
( REF _Ref184463069 \h \* MERGEFORMAT Table 13: ASA Class Value Set)413495001
Normally healthy patientASA physical status class 12.16.840.1.113883.6.96SNOMED CT413496000
Patient with mild systemic diseaseASA physical status class 22.16.840.1.113883.6.96SNOMED CT413497009
Patient with severe systemic disease not incapacitatingASA physical status class 32.16.840.1.113883.6.96SNOMED CT413498004
Patient with incapacitating systemic disease, constant threat to lifeASA physical status class 42.16.840.1.113883.6.96SNOMED CT413499007Moribund patient, < 24 hour life expectancy413499007
ASA physical status class 52.16.840.1.113883.6.96SNOMED CT2.16.840.1.113883.3.117.1.1.6.8 ( REF _Ref184461249 \h \* MERGEFORMAT Table 19: Pathogens Value Set) DYNAMIC
See REF _Ref184461597 \r \h \* MERGEFORMAT Appendix D REF _Ref184461597 \h \* MERGEFORMAT Large Vocabularies (Non-normative)50875003Acanthamoeba (organism)2.16.840.1.113883.6.96SNOMED CT91288006Acinetobacter baumannii (organism)2.16.840.1.113883.6.96SNOMED CT29822006Actinobacillus actinomycetem comitans (organism)2.16.840.1.113883.6.96SNOMED CT.....2.16.840.1.113883.3.117.1.1.6.21
( REF _Ref184363124 \h \* MERGEFORMAT Table 16: Drug-susceptibility Finding Value Set) SSusceptibleSusceptible2.16.840.1.113883.5.83HL7 Observation InterpretationIIntermediateIntermediate2.16.840.1.113883.5.83HL7 Observation InterpretationRResistantResistant2.16.840.1.113883.5.83HL7 Observation Interpretation2.16.840.1.113883.3.117.1.1.465
( REF _Ref184461324 \h \* MERGEFORMAT Table 23: Healthcare Service Location )
See the entire table in REF _Ref184461597 \r \h \* MERGEFORMAT Appendix D REF _Ref184461597 \h \* MERGEFORMAT Large Vocabularies (Non-normative)IN:ACUTE:CC:BBurn Critical CareBurn Critical Care2.16.840.1.113883.6.259HL7
Healthcare Service Location IN:ACUTE:CC:CMedical Cardiac Critical CareMedical Cardiac Critical Care2.16.840.1.113883.6.259HL7
Healthcare Service Location IN:ACUTE:CC:MMedical Critical CareMedical Critical Care2.16.840.1.113883.6.259HL7
Healthcare Service Location 2.16.840.1.113883.3.117.1.1.6.10
( REF _Ref184463130 \h \* MERGEFORMAT Table 1: Encounter Type Value Set)AMBOutPatientAmbulatory 2.16.840.1.113883.5.4HL7
ActCodeIMPInpatientInpatient2.16.840.1.113883.5.4HL7
ActCode2.16.840.1.113883.3.117.1.1.6.9
( REF _Ref184362179 \h \* MERGEFORMAT Table 18: Drug-susceptibility Tests Value Set) DYNAMIC
See entire table in REF _Ref184461597 \r \h \* MERGEFORMAT Appendix D REF _Ref184461597 \h \* MERGEFORMAT Large Vocabularies (Non-normative)18860-7Amikacin Susc IsltAmikacin Susc Islt2.16.840.1.113883.6.1LOINC18862-3Amoxicillin+ Clav Susc IsltAmoxicillin+Clav Susc Islt2.16.840.1.113883.6.1LOINC 18864-9Ampicillin Susc IsltAmpicillin Susc Islt2.16.840.1.113883.6.1LOINC 18865-6Ampicillin+ Sulbac Susc IsltAmpicillin+ Sulbac Susc Islt2.16.840.1.113883.6.1LOINC.........2.16.840.1.113883.6.1LOINC 2.16.840.1.113883.3.117.1.1.6.7
( REF _Ref184461652 \h \* MERGEFORMAT Table 6: BSI Risk Factors Value Set)
centralLine(unspecified) central line2.16.840.1.113883.3.117.1.1.4.7NHSN BSI Risk FactorspermCentral Linepermanent central line2.16.840.1.113883.3.117.1.1.4.7NHSN BSI Risk FactorstempCentral Linetemporary central line2.16.840.1.113883.3.117.1.1.4.7NHSN BSI Risk FactorsumbCatheterumbilical catheter2.16.840.1.113883.3.117.1.1.4.7NHSN BSI Risk Factorsbirthwtbirth weight2.16.840.1.113883.3.117.1.1.4.7NHSN BSI Risk Factors2.16.840.1.113883.3.117.1.1.6.3.2
( REF _Ref184461678 \h \* MERGEFORMAT Table 8: LCBI Pathways Value Set)ARecognized pathogens >=1 blood culture positive *
2.16.840.1.113883.3.117.1.1.4.3.2NHSN LCBI Pathways BOther organisms: >= 2 blood cultures from separate sites positive w/same organism + clinical sx2.16.840.1.113883.3.117.1.1.4.3.2NHSN LCBI Pathways COther organisms: >= 1 blood culture positive in pt with IV + clinical sx + antimicrobial therapy2.16.840.1.113883.3.117.1.1.4.3.2NHSN LCBI Pathways 2.16.840.1.113883.3.117.1.1.6.16
( REF _Ref184461725 \h \* MERGEFORMAT Table 14: Spinal Fusion Level Value Set)ataxatlas-axis2.16.840.1.113883.3.117.1.1.4.16NSHN Spinal Fusion Level ataxCatlas-axis/cervical2.16.840.1.113883.3.117.1.1.4.16NSHN Spinal Fusion Level Ccervical2.16.840.1.113883.3.117.1.1.4.16NSHN Spinal Fusion Level CDDcervical/ dorsal/ dorsolumbar2.16.840.1.113883.3.117.1.1.4.16NSHN Spinal Fusion Level DDdorsal/ dorsolumbar2.16.840.1.113883.3.117.1.1.4.16NSHN Spinal Fusion Level LLlumbar/ lumbosacral2.16.840.1.113883.3.117.1.1.4.16NSHN Spinal Fusion Level 2.16.840.1.113883.3.117.1.1.6.17
( REF _Ref184461751 \h \* MERGEFORMAT Table 2: Spinal Fusion Approach Value Set)Aanterior2.16.840.1.113883.3.117.1.1.4.17NHSN Spinal Fusion Approach Pposterior2.16.840.1.113883.3.117.1.1.4.17NHSN Spinal Fusion Approach APanterior posterior2.16.840.1.113883.3.117.1.1.4.17NHSN Spinal Fusion Approach LTlateral transverse2.16.840.1.113883.3.117.1.1.4.17NHSN Spinal Fusion Approach 2.16.840.1.113883.3.117.1.1.6.18
( REF _Ref190864367 \h \* MERGEFORMAT Table 3: Hip Replacement Value Set)TPtotal primary2.16.840.1.113883.3.117.1.1.4.18NHSN Hip Replacement PPpartial primary2.16.840.1.113883.3.117.1.1.4.18NHSN Hip Replacement TRtotal revision2.16.840.1.113883.3.117.1.1.4.18NHSN Hip Replacement PRpartial revision2.16.840.1.113883.3.117.1.1.4.18NHSN Hip Replacement 2.16.840.1.113883.3.117.1.1.6.19
( REF _Ref184461797 \h \* MERGEFORMAT Table 4: Knee Replacement Value Set)Tprimary (total)2.16.840.1.113883.3.117.1.1.4.19NHSN Knee Replacement Rrevision (total or partial)2.16.840.1.113883.3.117.1.1.4.19NHSN Knee Replacement 2.16.840.1.113883.3.117.1.1.6.20
( REF _Ref184461816 \h \* MERGEFORMAT Table 15: Occasion of Detection Value Set)AAdmission (during the stay in which the surgery was performed)2.16.840.1.113883.3.117.1.1.4.20NHSN Occasion of HAI DetectionPPost Discharge Surveillance2.16.840.1.113883.3.117.1.1.4.20NHSN Occasion of HAI Detection
RRe-admission (during a stay that is subsequent to the stay in which the surgery was performed)2.16.840.1.113883.3.117.1.1.4.20NHSN Occasion of HAI Detection
2.16.840.1.113883.3.117.1.1.6.4
( REF _Ref184363502 \h \* MERGEFORMAT Table 21: Procedure Category ) DYNAMIC
AAAAbdominal aortic aneurysm repair2.16.840.1.113883.3.117.1.1.4.4NHSN Procedure CategoryAMPLimb amputation2.16.840.1.113883.3.117.1.1.4.4NHSN Procedure CategoryAPPYAppendix surgery2.16.840.1.113883.3.117.1.1.4.4
NHSN Procedure CategoryAVSDAV shunt for dialysis2.16.840.1.113883.3.117.1.1.4.4
NHSN Procedure Category....2.16.840.1.113883.3.117.1.1.4.4
NHSN Procedure Category2.16.840.1.113883.3.117.1.1.6.3.3
( REF _Ref184361124 \h \* MERGEFORMAT Table 22: SSI Anatomic Site Value Set)
See REF _Ref184461597 \r \h \* MERGEFORMAT Appendix D REF _Ref184461597 \h \* MERGEFORMAT Large Vocabularies (Non-normative)BONEOsteomyelitis2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteBRSTBreast abscess/ mastitis2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteCARDMyocarditis/ pericarditis2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteDISCDisc Space2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteEAROtitis externa/ media/ interna2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteEMETEndometritis2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteENDOEndocarditis2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteGITGI tract2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic SiteIABIntra-abdominal2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic Site......2.16.840.1.113883.3.117.1.1.4.3.3NHSN SSI Anatomic Site2.16.840.1.113883.3.117.1.1.6.3.21
( REF _Ref184361720 \h \* MERGEFORMAT Table 5: Surgical Site Infection Location Type Value Set)DIPDeep Incisional Primary2.16.840.1.113883.3.117.1.1.4.3.21NHSN SSI Location TypeDISDeep Incisional Secondary2.16.840.1.113883.3.117.1.1.4.3.21NHSN SSI Location TypeSIPSuperficial Incisional Primary 2.16.840.1.113883.3.117.1.1.4.3.21NHSN SSI Location TypeSISSuperficial Incisional Secondary2.16.840.1.113883.3.117.1.1.4.3.21NHSN SSI Location TypeOSOrgan/Space2.16.840.1.113883.3.117.1.1.4.3.21NHSN SSILocation Type 2.16.840.1.113883.3.117.1.1.6.12
NHSNSummaryDataCode
( REF _Ref190863411 \h \* MERGEFORMAT Table 17: Summary Data Value Set)numPtDaysPatient Days2.16.840.1.113883.3.117.1.1.4.12NHSN Summary DatanumPtCLDaysCentral Line Days2.16.840.1.113883.3.117.1.1.4.12NHSN Summary DatanumPtUCath DaysUrinary Catheter Days2.16.840.1.113883.3.117.1.1.4.12NHSN Summary DatanumPtVent DaysVentilator Days2.16.840.1.113883.3.117.1.1.4.12NHSN Summary Data2.16.840.1.113883.3.117.1.1.6.3.22
NHSNInfectionTypeCode DYNAMIC
( REF _Ref190864463 \h \* MERGEFORMAT Table 10: Infection Type Value Set)BSIBlood stream infection2.16.840.1.113883.3.117.1.1.4.3.22NHSN Infection TypeSSISurgical site infection2.16.840.1.113883.3.117.1.1.4.3.22NHSN Infection TypeSummary of HAI Single-Value Bindings (Non-normative)
The following table summarizes HAI single-value bindings.
Table SEQ Table \* ARABIC 29: HAI Single-value Bindings
Single-value Bindings: NHSN Vocabulary codeNHSN Display NameStandard code
Display NamecodeSystemcodeSystem
NamepathIdentifiedpathogens identified2.16.840.1.113883.3.117.1.1.4.2NHSN VocabularysecondaryBSIsecondary blood stream infection2.16.840.1.113883.3.117.1.1.4.2NHSN VocabularymultProcmultiple procedures2.16.840.1.113883.3.117.1.1.4.2NHSN VocabularynumPtDaysPatient Days2.16.840.1.113883.3.117.1.1.4.2NHSN VocabularynumPtCLDaysCentral Line Days2.16.840.1.113883.3.117.1.1.4.2NHSN VocabularynumPtUcathdaysUrinary Catheter Days2.16.840.1.113883.3.117.1.1.4.2NHSN VocabularynumPtVentdaysVentilator Days2.16.840.1.113883.3.117.1.1.4.2NHSN VocabularypathogenRankPathogen Ranking2.16.840.1.113883.3.117.1.1.4.2NHSN Vocabulary
Single-value Bindings: SNOMED VocabularycodeNHSN display NameStandard code Display NamecodeSystemcodeSystem Name373110003Emergency procedureEmergency Procedure2.16.840.1.113883.6.96SNOMED CT417746004TraumaTrauma2.16.840.1.113883.6.96SNOMED CT50697003General anesthesia administeredgeneral anesthesia2.16.840.1.113883.6.96SNOMED CT73211009DiabetesDiabetes mellitus2.16.840.1.113883.6.96SNOMED CT50373000Patient heightBody Height2.16.840.1.113883.6.96SNOMED CT27113001Patient weightBody weight2.16.840.1.113883.6.96SNOMED CT289248003Duration of laborDuration of labor2.16.840.1.113883.6.96SNOMED CT409086003Estimated blood lossEstimated maternal blood loss2.16.840.1.113883.6.96SNOMED CT
Policy on use of local or Standard Codes (Non-normative)
In response to ballot comments, a rigorous examination was undertaken to ensure that standard codes were used for common concepts wherever fully expressive and supported by the NHSN. For this IG, use of NHSN local codes or SNOMED codes is governed by the following criteria:
Where there is a single SNOMED term and code that captures the NHSN concept, the SNOMED term and code will be used.
If post-coordination of SNOMED terms and codes would be required to capture the NHSN concept, local NHSN codes will be used.
When it is not possible to correctly capture the NHSN concept with SNOMED terms, the NHSN local code will be used.
Requests will be submitted by NHSN to SNOMED to provide codes that capture the NHSN concept with a pre-coordinated SNOMED term and code for all common concepts now covered by NHSN codes. (Common concepts are those that are not particular to the NHSN data collection process.)
Subsequent versions of the HAI DSTU will incorporate new pre-coordinated SNOMED codes as they are provided by SNOMED.
SSI Location Type is recorded in a methodCode element.
Whether the procedure was an emergency is recorded in a methodCode element. Whether the patient was an outpatient is recorded in the CDA Header in a Procedure Report.
Hip or Knee Replacement Type is recorded in a methodCode element. Spinal Fusion Approach is recorded in an approachSiteCode element.
The value of the id/@root needs to be a globally unique reference to the procedure, but there is no requirement that it represent any existing identifier such as a facility procedure ID. The function of this id element is only to convey that the procedure element in the Risks section and the procedure element in the Details section are carrying information about the same procedure.
HL7 Implementation Guide for CDA R2 NHSN HAI Reports Page PAGE 12
Draft Standard for Trial Use Release 1 February 2008
2008 Health Level Seven, Inc. All rights reserved.
HL7 Implementation Guide for CDA R2 NHSN HAI Records Page PAGE 137
Draft Standard for Trial Use Release 1 February 2008
2008 Health Level Seven, Inc., and Centers for Disease Control and Prevention. All rights reserved.
HL7 Implementation Guide L Q v x ~ G K e h "
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