{"aaData": [["VANC-RES ENTEROCOCCUS", "1\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nVanc-Res Enterococcus (VRE) (Reference #1)\nNote: This includes cultures positive for prevalence and surveillance \n review, including specimens of stool and rectal swabs.\n\n Vancomycin-resistant Enterococcus faecalis and E. faecium are most\ncommon, but we wish to look at all vancomycin resistant enterococci \nwhether speciated or not. Therefore, it is important to be sure to list all \nthe places in the Micro Lab package where Enterococcus are found, \neither as Enterococcus, E. (sp.), Group D-Streptococcus, E. faecalis, \nE. faecium, E. durans, E. gallinarum, E. casseliflavus, etc. \n\n\n\n\n Vancomycin-Resistant Enterococcus (VRE) is a pathogen of \nincreasing importance. Not only can it cause significant disease, but \nalso it can be spread within facilities. It is important to capture all \npositive cultures for VRE (not just disease). As such, all positive \ncultures for VRE will be reported. \n\n
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\n", "", "", "", "", "", ""], ["E. COLI 0157:H7", "10\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nE. coli O157:H7 (Reference #10)\nspecific for E-coli O157 (e.g. Escherichia coli O157, E. coli O157, E. coli \nserotype O157, etc.). Some sites have already done this and will not need to\ngenerate a new entry.\n\n\nNOTE: Entering Escherichia coli or E. coli from the bacterial etiology and \n then entering "serotype O157" or "O157", under the "Comments section"\n or in "Free Text" is not acceptable as it will not allow the data to \n be retrieved nationally).\n\n\n\n Escherichia coli serotype O157 (E. coli O157) has gained prominence as a \nfood-borne illness with potentially life threatening complications coming from\nthe associated Hemolytic Uremic Syndrome. Not all sites routinely culture for \nthe presence of E. coli O157 in stool specimens submitted for culture. Also, E.\ncoli O157 is not a microbiologic (bacterial) etiology pre-existing in the most \nrecent - national microbiology lab package. In order to nationally track \ncultures positive for this organism, each site will need to make an etiology \n
\n\n", "", "", "", "", "", "", "", "", "", "", "", ""], ["MALARIA", "11\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nMalaria (Reference 11)\nallows for easy identification. Since not all sites consistently code and \nrecord malarial parasites seen histologically or on blood smears (not all \nof these interpretations are done through the Pathology and Laboratory \nService), we have currently decided to track malaria based on ICD \ncoding.\n\n\n The plasmodial parasite is responsible for the blood-borne disease of \nmalaria. Malaria can cause acute as well as chronic, relapsing disease. \nOccasionally, U.S. troops are deployed in malaria endemic areas. This \nplacement could potentially put troops at risk for acquiring this disease. \nFor the Emerging Pathogens Initiative program, we are interested in \ntracking patients with malaria, either acute or chronic, relapsing, and in\neither inpatient or outpatient status. No standardized serologic test \n
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\n", "", "", "", "", ""], ["DENGUE", "12\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nDengue (Reference #12)\ndiagnoses to track this entity.\n\n\n The mosquito-borne disease of Dengue Hemorrhagic Fever is a rare but re-\nemerging infection, especially in the Caribbean. The VA has seen cases of \nDengue Hemorrhagic Fever over the last several years. Most of these cases \nhave been in Dengue endemic areas served by the VA. However, as our society \nbecomes more mobile, and the area of Dengue endemnity expands, more cases \nare likely to occur. Because microbiologic culture is not routinely done \nand serology can be difficult to track, we will initially use ICD coded \n
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\n", "", "", "", "", ""], ["CREUTZFELDT-JAKOB DISEASE", "13\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nCreutzfeldt-Jakob Disease (Reference #13)\npresentation. As such, we will follow this entity through ICD coding.\n\n \n Creutzfeldt-Jakob Disease (CJD) disease is a rare illness associated with\nprions. The VA has chosen to follow this entity because of historic problems\nwith certain blood products in use in both the private and public health care \nsectors. The EPI data will be one of a number of ways used to identify changes \nin trends of incidence of this illness. This task is remarkably complex because \nof the long incubation period of CJD. There are no specific tests for diagnosis \nother than central nervous system histology combined with clinical \n
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\n", "", "", "", "", ""], ["LEISHMANIASIS", "14\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nLeishmaniasis (Reference #14)\n\n\n\n Leishmaniasis is a significant tropical disease which can cause serious \ncomplications. It is of interest to the Department of Veterans Affairs as \nLeishmania has caused illness among military personnel for many \nyears. In addition, the Persian Gulf War occurred in an area of the \nworld where the parasite is endemic. Because no simple, straight-\nforward serology exists and no standard culture techniques exist, we \nhave chosen to follow this entity through ICD diagnosis codes.\n
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\n", "", "", "", "", ""], ["HEPATITIS C ANTIBODY NEG", "15\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["HEPATITIS A ANTIBODY POS", "16\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["HEPATITIS B POS", "17\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["HEPATITIS C ANTIBODY POS", "2\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nHepatitis C Antibody Positive (Reference #2)\nlooking for are evidence of presence of antibody to Hepatitis C, whether \nit be recorded as "weakly positive", "strongly positive", "positive", or \n"present". If other phrases are used to describe a test result, one should \nbe able to differentiate the results upon entry into the program. As an \nexample, the words, "present" and "not present" would not allow retrieval \nof only positive cases as both phrases contain the word, "present".\n\n\n Hepatitis C is much more prevalent than originally thought at least in \ncertain key patient sub-populations. As new and more sensitive assays come \ninto use, we seem to find more evidence of this pathogen. We are looking for\nevidence of exposure to Hepatitis C in patients as demonstrated by Hepatitis \nC antibody positivity. The need for confirmatory testing or demonstration of \nactive disease is not currently necessary in gathering data for this program.\nDifferent facilities may use different assays for this test. What we are \n
\n\n", "", "", "", "", "", "", "", "", "", "", "", ""], ["VANC-RES COAG NEG STAPH", "21\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nStaphylococci are significant contributors to disease in humans. Staphylococcus\nbeen applied. The coagulase negative staphylococci are important emerging\npathogens in that they contribute to many infections acquired while in a\nhealthcare facility. As a general rule, the coagulase negative staphylococci\nhave lesser virulence than Staphylococcus aureus, but they can still cause\nserious, life-threatening disease in certain settings. As with other organisms,\nantibiotic resistance is occuring among the coagulase negative staphylococci.\nThere is concern in particular for resistance to vancomycin among this group \nof organisms, as it is currently the only antibiotic that has consistently\nshown activity against infections caused by this group of organisms; however,\ndecreased susceptibility and even resistance to vancomycin has been identified\naureus is the most virulent of the staphylococci, but the non-aureus \nin rare cases.\nThe purpose of this EPI pathogen entry is to capture all isolates from all\nspecimens that contain a coagulase negative staphylococcus that is not\nSusceptible to vancomycin (whether your facility calls it coagulase negative \nstaphylococcus, Staphylococcus epidermidis, Staphylococcus saprophyticus or\nthe myriad of other staphylococcal species that comprise this group).\n\nstaphylococci can also cause disease. As a general group, these non-aureus\nstaphylococci are referred to as coagulase negative staphylococci; some refer\nto this group of organisms as Staphylococcus epidermidis because the\nstaphylococcal species S. epidermidis is one of the more common members of this\ngroup to cause disease. However, to be accurate, the group of organisms\ncalled coagulase negative staphylococci includes many different species, even if\nthe generic terminology of Staphylococcus epidermidis (a.k.a. Staph epi) has\n
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\n", "", "", "", "2004-05-18 00:00:00\n"], ["ALL STREP PNEUMO", "22\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nStreptococcus pneumoniae is a bacterium that causes serious disease in humans,\nsetting has been created to identify ALL culture positive isolates of\nStreptococcus pneumoniae from any specimen site in any patient/client receiving\ncare within the VHA. \nNote: Even specimens that have been obtained from patients (not the\nenvironment) as part of an epidemiologic prevalence study or survey should be\nincluded if they are present in the VistA laboratory package results from your\nsite. \nThe results from this EPI pathogen setting will be coupled with the results \nfrom Reference #3 (Penicillin-Resistant Pneumococcus) to help determine the\npercentage of all isolates of Streptococcus pneumoniae that have penicillin\nincluding pneumonia, bacteremia, meningitis and even death. It is an important\nresistance. \npathogen to monitor in that many of the more serious sequelae of infection may\nbe ameliorated with preventive vaccination. As with many other organisms that \ncause disease in humans, resistance to antibiotics is emerging in this S.\npneumoniae. The presence of antibiotic resistance creates a challenge in \ntreatment of infections with this organism. In order to determine the \nprevalence of antibiotic resistance, a baseline of occurrence of ALL \nStreptococcus pneumoniae needs to be obtained. This particular EPI pathogen\n
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\n", "", "", "", "", "", "2004-05-18 00:00:00\n"], ["ALL ENTEROCOCCI", "23\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nThe enterococci are a group of bacteria that can cause serious disease in\nin any patient/client receiving care within the VHA. \nNote: Even specimens that have been obtained from patients (not the\nenvironment) as part of an epidemiologic prevalence study or survey should be\nincluded if they are present in the VistA laboratory package results from your\nsite. \nThe results from this EPI pathogen setting will be coupled with the results\nfrom Reference #1 (Vancomycin-Resistant Enterococci [VRE]) to help determine\nthe percentage of all isolates of enterococci that have vancomycin resistance.\nhumans, including blood stream infections, urinary tract infections, wound \ninfections, endocarditis and even death. As with many other organisms that \ncause disease in humans, resistance to antibiotics is emerging in the \nenterococci. The presence of antibiotic resistance creates a challenge in\ntreatment of infections with this organism. In order to determine the \nprevalence of antibiotic resistance, a baseline of occurrence of ALL enterococci\nneeds to be obtained. This particular EPI pathogen setting has been created\nto identify ALL culture positive isolates of enterococci from any specimen site\n
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\n", "", "", "", "", "", "2004-05-18 00:00:00\n"], ["METH-RES STAPH AUREUS", "19\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nMethicillin (or oxacillin)-resistant Staphylococcus aureus (MRSA) is a pathogen \nshould capture all methicillin non-Susceptible isolates of Staphylococcus\naureus.\n\nNote: This includes all positive cultures for MRSA, both clinical cultures\nand those done as part of epidemiologic prevalence studies or surveys (such\nas nasal and rectal swabs) at your facility. \n\nAny Staphylococcus aureus isolate that is resistant to methicillin (or\noxacillin) should be captured for this. Laboratories may use different\nmethods to capture these data. An appropriate National Committee on Clinical\nof continuing importance for healthcare facilities. It is also an emerging\nLaboratory Standards (NCCLS) testing schema used and captured in VistA should\nbe adequate. \npathogen from community-acquired sources. It is an organism that can be\ntransmitted easily within facilities and in the community. It can produce a \nspectrum of illness from asymptomatic colonization to severe, life-threatening\ndisease in those patients who acquire it. Whether this organism is causing\ndisease or not, it can contribute to spread within a healthcare facility. The\npurpose of this pathogen on the EPI list is to capture all cultures that have\nMRSA present (whether the patient has disease or is just colonized). This\n
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\n", "", "", "", "2004-05-18 00:00:00\n"], ["ALL STAPH AUREUS", "18\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nStaphylococcus aureus is a bacterium that causes much disease in humans,\ncreated to identify ALL culture positive isolates of Staphylococcus aureus\nfrom any specimen site in any patient/client receiving care within the VHA. \nNote: Even specimens that have been obtained from patients (not the\nenvironment) as part of an epidemiologic prevalence study or survey \nshould be included if they are present in the VistA laboratory package \nresults from your site. \n\nThe results from this EPI pathogen setting will be coupled with the results\nfrom Reference #19 (MRSA) and Reference #20 (VRSA) to help determine the\npercentage of all isolates of Staphylococcus aureus that have methicillin\nincluding furunculosis, boils, acne, cellulitis, pneumonia, toxic shock \n(oxacillin) resistance and vancomycin resistance. \nsyndrome and even death. It has always been a significant pathogen in the \ncommunity setting, as well as in the healthcare setting where transmission\ncan occur through contact and from the hands of healthcare personnel. The\npresence of antibiotic resistance creates a challenge in treatment of\ninfections with this organism. In order to determine the prevalence of\nantibiotic resistance, a baseline of occurrence of ALL Staphylococcus\naureus needs to be obtained. This particular EPI pathogen setting has been\n
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\n", "", "", "", "", "", "2004-05-18 00:00:00\n"], ["VANC-RES STAPH AUREUS", "20\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nVancomycin-resistant Staphylococcus aureus (VRSA) is a rare but emerging\nhealthcare facility. The purpose of this pathogen on the EPI list is to capture\nall cultures that have VRSA present (whether the patient has disease or is just\ncolonized). This should capture all vancomycin non-Susceptible strains of\nStaphylococcus aureus, whether the susceptibility interpretation is \nIntermediate or Resistant.\n\nNote: This includes all positive cultures for MRSA, both clinical cultures\nand those done as part of epidemiologic prevalence studies or surveys (such as\nnasal and rectal swabs) at your facility. \n\npathogen for healthcare facilities. It is of concern because the resistance\nAny Staphylococcus aureus isolate that is resistant to vancomycin should be\ncaptured for this. Laboratories may use different methods to capture these\ndata. An appropriate National Committee on Clinical Laboratory Standard\n(NCCLS) testing schema used and captured in VistA should be adequate. \n\nto this antibiotic can be combined with resistance to other antibiotics; it is\nthis multiple resistance that will make infection with this organism difficult\nto treat. Staphylococci can be transmitted easily within facilities; the easy\ntransmission is of concern for this organism should it occur in a patient. The\nstaphylococci can produce a spectrum of illness from asymptomatic colonization\nto severe, life-threatening disease in those patients who acquire them. Whether\nthis organism is causing disease or not, it can contribute to spread within a\n
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\n", "", "", "", "2004-05-20 00:00:00\n"], ["PEN-RES PNEUMOCOCCUS", "3\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nPenicillin- Resistant Pneumococcus (Reference #3)\nthe pneumococci (either "moderate/intermediate" or "frank/high" level \nresistance). As such, any S. pneumoniae which is not fully susceptible to \nPCN on PCN susceptibility testing should be recorded.\n\n\n\n The emergence of antibiotic resistance in microbial agents is of great \ninterest and concern for health care. Penicillin (PCN) was once the \nmainstay of therapy for Streptococcus pneumoniae infections but \nresistance to this agent is becoming more prominent. Different \ntherapeutic strategies need to be developed once the prevalence of PCN-\nresistant S. pneumoniae reaches a critical threshold in a community. In \norder to monitor this, we are looking for the presence of any resistance in \n
\n\n", "", "", "", "", "", "", "", "", "", "", "", ""], ["CLOSTRIDIUM DIFFICILE", "4\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nClostridium difficile (Reference #4) \npresence of Clostridium difficile. Laboratory services are quite varied as \nto how they identify the presence of Clostridium difficile. Some labs are set\nup to identify C. difficile as the final microbiological (bacterial) etiology\nof a culture, even if a culture method was not used. Other labs use a final \netiology of "see comment" and then enter the results in a free text format. \nStill others enter the text under a hematology or chemistry format where a \nreference range and "positive" and "negative" result values can be entered.\nWherever the facility lab places the results which are used to demonstrate \nthe presence of toxin-producing C. difficile, we need to be able to track \nthem (that means it must occur as a retrievable "positive" or "negative" \n\nresult, or as a "bacterial etiology"). Any results contained in a "Comments" \nor "Free-text" sections are not acceptable.\n\n\n Disease associated with the presence of Clostridium difficile \nenterotoxin A can cause significant morbidity, as well as mortality. It is of \nimportance as its predominant acquisition seems to occur nosocomially. \nPresence of Clostridial toxin (either enterotoxin A or cytotoxin L) by assay\n(whether it be EIA, latex agglutination, cytotoxicity of cell culture \n+ neutralization, or culture of organism with subsequent colony testing) \nis the best indicator that an inflammatory diarrheal disease is due to \n
\n\n", "", "", "", "", "", "", "", "", "", "", "", ""], ["TUBERCULOSIS", "5\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nTuberculosis (Reference #5)\nby 2-5% more) we have decided to use culture positivity for \nMycobacterium tuberculosis to track tuberculosis infections in the \ncurrent iteration of the EPI software package. Information regarding \nsusceptibility will be tracked as well. For the national EPI program, \nthere will be no need to enter specific antimycobacterial agents to be \ntracked; it will be done automatically. ICD coding is complex and \nconfusing for many cases of tuberculosis and therefore will not be used.\n\n\n Mycobacterium tuberculosis infection is an important public health \nconcern. Recent increases in incidence of disease, and occurrence of \nmultiply-drug resistant strains in outbreak situations along with the \nincreased susceptibility of HIV-infected persons for this disease has \ngenerated renewed interest in this entity. Since the national data show \nthat 80-85% of all reported active tuberculosis cases are culture positive \n(with acid fast bacilli smear-only positive cases increasing the reporting \n
\n\n", "", "", "", "1\n", "", "", "", "", "", "", "", ""], ["STREPTOCOCCUS GROUP A", "6\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nStreptococcus Group A (Reference #6)\nthe specimen is obtained. We are aware that some sites may use rapid \nscreenings for Streptococcus-Group A, especially from pharyngeal \nsources. These rapid screens may be difficult to capture, so we are not \nasking for them on this first iteration of the EPI program.\n\n\n Streptococcus-Group A can be associated with or cause significant \ndisease such as severe fasciitis and streptococcal toxic shock \nsyndrome. We are especially interested to find out how much \nsevere/deep seated disease the VA is experiencing, but other disease \nentities are of interest also. To this end, we are looking for all episodes \nof culture positivity for Streptococcus- Group A, regardless of site and \nregardless of inpatient or outpatient status of the person from whom \n
\n\n", "", "", "", "", "", "", "", "", "", "", "", ""], ["LEGIONELLA", "7\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nLegionella (Reference #7)\nthis first iteration of the EPI program. Because it is not yet approved, the \nnewer test of Legionella urinary antigen will not be used either. The Selected\nEtiology screen display has been partially pre-populated.\n\n\n Since the American Legion Convention in Philadelphia in the 1970s, \nLegionnaires Disease has been an illness of keen interest to the DVA. Because \ndiagnosis is complex, we have chosen to review for presence of Legionella in \nculture and in ICD DIAGNOSIS file (#80). We will not look at Legionella \ndirect fluorescent antibody positivity because of the potential high false \npositivity of this test. Likewise, serology is not easy to interpret or easily \nextracted from VISTA for our purposes and will not be included as a marker in \n
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\n", "", "", "", "", ""], ["CANDIDA", "8\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nCandida (Reference #8)\nprevalent or significant entity at your site, but its presence is more \nlikely to be indicative of serious or true infection than other organisms \nwhich may commonly be isolated from the blood in association with IV lines.\nAdditionally this yeast is more likely to be associated with nosocomial \nacquisition than other organisms such as Staphylococcus aureus and coagulase\nnegative Staphylococcus, which can cause a number of community acquired \nsyndromes not at all related to IV lines.\n\n We wish to capture all episodes of Candida (Torulopsis, yeast) isolation \nfrom blood or a blood source (central line, IV catheter tip, etc.). For \n \nCandida a partial pre-populated list of (etiologies/organisms) to choose\nfrom has been included. These should be entered, in addition to any \nsite specific (etiologies organisms) which also fit the description.\n\n Fungal infections are rising in significance especially in severely ill \npatients. The same is true for bloodstream infections acquired in the \nhospital, especially those associated with intravenous lines. Fungal \nbloodstream infections are increasing in prevalence.\n\n As a marker of bloodstream infections we have chosen the fungus Candida\n(and Torulopsis) as an initial indicator organism. This may not be a \n
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\n", "", "", "", "", "", ""], ["CRYPTOSPORIDIUM", "9\n", "NO\n", "MONTHLY\n", "15\n", "", "File: 69.4, IEN: 1590\n", "YES\n", "", "\nCryptosporidium (Reference #9)\nas well as ICD coding to track this disease as both are narrowly defined \nparameters.\n\n NOTE: Microsporidiosis is a similar disease, but we do not currently \nwash to follow this disease process and Microsporidian etiologies \nshould not be entered.\n\n\n The parasite Cryptosporidium parvum is a cause of water-borne diarrheal \ndisease. It has gained recent prominence after evaluation of the outbreak \nin the greater Milwaukee area in 1993 which is estimated to have affected \n<400,000 persons. In addition to affecting HIV-infected persons and young \nchildren, information exists which demonstrates that the chronically-ill,\nelderly are also a higher risk group than the general population. We will\nutilize both microbiology laboratory data (parasitology for most laboratories),\n
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