Welcome to the 2020 National Healthcare Safety Network, or NHSN, Quick Learn series.
These CDC presentations are an educational resource for healthcare facilities working
to prevent Healthcare Associated Infections, or HAIs.
This presentation reviews the PATOS field, or Infection Present at Time of Surgery, found
on the Surgical Site Infection, or SSI, event form.
PATOS, or Infection Present at Time of Surgery, indicates that there is evidence of an infection
visualized during the surgical procedure to which the SSI is attributed.
PATOS is a required “Yes” or “No” field on the SSI event form.
NHSN often receives questions about the PATOS field.
In this Quick Learn, we will answer some of these frequently asked questions.
One question NHSN frequently receives is, “Where within the patient medical record
can I find the documentation I need to answer the PATOS question on the SSI event form?”
The PATOS field is answered “Yes” or “No” based on evidence of infection documented
in the operative procedure report.
The evidence of infection must be noted intraoperatively and documented within the narrative portion
of the operative procedure report.
The language or verbiage in the operative procedure report must clearly reflect infection
is seen during the operative procedure and must also include reference to the tissue
level where the infection is seen.
The patient does not have to meet the NHSN definition of an SSI at the time of the procedure,
but there must be documentation that there is evidence of an infection present at the
time of surgery.
Occasionally, NHSN is asked to give examples of what would and would not be a PATOS equals
Yes for an SSI event.
First, what are some examples that indicate evidence of infection when applying the
PATOS definition?
Examples of evidence of infection when applying the PATOS definition include abscess, purulence,
pus, phlegmon, or feculent peritonitis documented in the operative report.
An appendix that has ruptured will meet PATOS equals Yes, if the patient has a subsequent
intra-abdominal organ space SSI.
There are some exceptions to PATOS.
The use of the ending “itis” in an operative report does not necessarily meet PATOS, as
it may only reflect inflammation, which is not infectious in nature.
For example, diagnoses such as diverticulitis, peritonitis, and appendicitis.
Here’s some guidance on instances where PATOS equals No.
Culture or non-culture based microbiologic testing and pathology reports from a surgical
specimen cannot be used for PATOS determination.
For example, organisms identified from cultures collected during surgery or an abscess seen
on pathology report cannot be used for PATOS determination.
If a rupture or perforation of the colon has occurred, but there is no evidence of infection
documented, PATOS equals No.
A complication such as fecal spillage or a nicked bowel that occurs during a procedure,
without documentation of infection, would be PATOS equals No.
Inflammation, necrosis, or gangrene alone is PATOS equals No.
Traumas that are contaminated cases do not necessarily meet the PATOS requirement.
For example, a fresh gunshot wound to the abdomen may be an emergency trauma case and
a high wound class may be assigned, but without documentation of infection, PATOS equals No.
Wound class cannot be used for PATOS determination.
Another frequently asked question is, “If a patient has infection present at the time
of surgery, does that mean that a subsequent SSI will be PATOS equals Yes?”
The answer is No.
Only select PATOS equals Yes if the subsequent SSI tissue level matches the level of infection
noted during the surgery to which the SSI is attributed.
For example, if a patient has evidence of an intra-abdominal infection documented intraoperatively
at the time of surgery and then later returns with an organ space SSI, the PATOS field would
be selected as a Yes.
However, if the patient returns with a superficial incisional or deep incisional SSI, the PATOS
field would be selected as a No.
Another question NHSN is frequently asked is, “If I determine an infection meets criteria
for an SSI and PATOS equals Yes, do I report this as an SSI event to NHSN?”
The answer is Yes.
SSI Events with PATOS equals Yes are not excluded from SSI reporting.
The SSI event is entered into NHSN if the NHSN operative procedure is one monitored
within a procedure category in your monthly reporting plan.
An SSI that meets criteria for PATOS should have the PATOS field selected as Yes.
NHSN is often asked, “Using the 2015 baseline data, are SSIs reported as PATOS equals Yes
excluded from the SSI Standardized Infection Ratios, or SIRs?
Also, for COLO and HYST procedures, are these SSI events reported to CMS?”
SSI events reported as PATOS equals Yes are excluded from the numerator of all the SSI
SIR reports under the 2015 baseline.
The procedures associated to these events are also excluded from the denominator of
all the SSI SIR reports.
Although PATOS events are excluded from the SIR calculations, users can analyze their
PATOS data using frequency and line list reports.
SSIs identified as PATOS are not reported to CMS under the 2015 baseline.
For more information, visit https://www.cdc.gov/nhsn/.
You can e-mail questions to NHSN@cdc.gov.