This page is part of the Healthcare Associated Infection Implementation Guide (v2.0.0: STU 2) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions 
XML Format: Questionnaire-hai-questionnaire-opc-ssi-event
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<Questionnaire xmlns="http://hl7.org/fhir"> <id value="hai-questionnaire-opc-ssi-event"/> <meta> <profile value="http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire"/> </meta> <language value="en-US"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml" lang="en-US"> <h1 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Outpatient Procedure Component Surgical Site Infection (SSI) Event</h1> <p xmlns:xsl="http://www.w3.org/1999/XSL/Transform">This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Surgical Site Infection Event. This report is for reporting data on each patient having a SSI event related to one of the NHSN operative procedures selected for monitoring.</p> <p xmlns:xsl="http://www.w3.org/1999/XSL/Transform">For further details on reporting healthcare-associated infections see the specific protocols and data collection forms on the NHSN website <a href="https://www.cdc.gov/nhsn/">https://www.cdc.gov/nhsn/</a>.</p> <h2 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Questionnaire Details</h2> <table xmlns:xsl="http://www.w3.org/1999/XSL/Transform"> <tr> <td> <b>Id:</b> </td> <td>hai-questionnaire-opc-ssi-event</td> </tr> <tr> <td> <b>Profile:</b> </td> <td>http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire</td> </tr> <tr> <td> <b>Language:</b> </td> <td>en-US</td> </tr> <tr> <td> <b>Url:</b> </td> <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-event</td> </tr> <tr> <td> <b>Identifier:</b> </td> <td> <span>hai-questionnaire-opc-ssi-event-v1</span> </td> </tr> <tr> <td> <b>Version:</b> </td> <td>Version: 2.0.0</td> </tr> <tr> <td> <b>Name:</b> </td> <td>HAI_questionnaire_opc_ssi_event</td> </tr> <tr> <td> <b>Status:</b> </td> <td>draft</td> </tr> <tr> <td> <b>Experimental:</b> </td> <td>false</td> </tr> <tr> <td> <b>Subject Type:</b> </td> <td>Patient (Source Patient Resource (US Core Patient))</td> </tr> <tr> <td> <b>Date:</b> </td> <td>2019-04-01</td> </tr> <tr> <td> <b>Publisher:</b> </td> <td>HL7 Structured Documents Work Group</td> </tr> <tr> <td> <b>Jurisdiction:</b> </td> <td> <span title="Code system: urn:iso:std:iso:3166">Code: US</span> </td> </tr> <tr> <td> <b>Code:</b> </td> <td> <ul style="list-style:none; padding-left:0; margin:0 0;"> <li>Healthcare Associated Infection report Document</li> <li>Code system: <a href="http://loinc.org">http://loinc.org</a> </li> <li>Code: 51897-7</li> </ul> </td> </tr> </table> <br xmlns:xsl="http://www.w3.org/1999/XSL/Transform"/> <br xmlns:xsl="http://www.w3.org/1999/XSL/Transform"/> <h2 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Questionnaire Items (<span style="color:red">*</span> required)</h2> <ul xmlns:xsl="http://www.w3.org/1999/XSL/Transform" style="list-style:none;"> <li> <span style="color:red">* </span> <span style="font-weight:bold">Facility ID</span> [<span style="font-style:italic">facility-id</span>] (url) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Date of encounter</span> [<span style="font-style:italic">encounter-date</span>] (date) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Infection details</span> [<span style="font-style:italic">infection-details</span>] (group) <ul style="list-style:none;"> <li>This group records the infection type, with details. It records SSI level, all identification criteria used to identify this SSI event, and identified pathogen(s). [<span style="font-style:italic">infection-details-group-description</span>] (display) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Event Type</span> [<span style="font-style:italic">event-type</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20</a> </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Date of event</span> [<span style="font-style:italic">event-date</span>] (date) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">NHSN Procedure Code Category</span> [<span style="font-style:italic">nhsn-procedure-code-category</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34</a> </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Primary CPT Procedure Code</span> [<span style="font-style:italic">primary-cpt-procedure-code</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/ValueSet/cpt-all">http://hl7.org/fhir/ValueSet/cpt-all</a> </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Procedure Id</span> [<span style="font-style:italic">procedure-id</span>] (url) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Surgical Site Infection (SSI) Level</span> [<span style="font-style:italic">ssi-level</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196</a> </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis</span> [<span style="font-style:italic">criteria-of-diagnosis</span>] (group) <ul style="list-style:none;"> <li>This group records the criteria used in the diagnosis of an infection. [<span style="font-style:italic">criteria-of-diagnosis-group-description</span>] (display) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Abscess</span> [<span style="font-style:italic">criteria-of-diagnosis-abscess</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Redness</span> [<span style="font-style:italic">criteria-of-diagnosis-redness</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Fever</span> [<span style="font-style:italic">criteria-of-diagnosis-fever</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Heat</span> [<span style="font-style:italic">criteria-of-diagnosis-heat</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Purulent drainage</span> [<span style="font-style:italic">criteria-of-diagnosis-incision-purulent-drainage</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Wound spontaneously dehisced</span> [<span style="font-style:italic">criteria-of-diagnosis-wound-dehisced</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Incision deliberately opened</span> [<span style="font-style:italic">criteria-of-diagnosis-incision-opened</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam</span> [<span style="font-style:italic">criteria-of-diagnosis-evidence-found</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Localized swelling</span> [<span style="font-style:italic">criteria-of-diagnosis-localized-swelling</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Pain or tenderness</span> [<span style="font-style:italic">criteria-of-diagnosis-pain-tenderness</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Organism Identified</span> [<span style="font-style:italic">criteria-of-diagnosis-organism-identified</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Culture or non-culture based testing not performed</span> [<span style="font-style:italic">criteria-of-diagnosis-testing-not-performed</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Imaging test evidence of infection</span> [<span style="font-style:italic">criteria-of-diagnosis-imaging-test</span>] (boolean) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Criteria of Diagnosis: Diagnosis of superficial SSI by surgeon or attending physician</span> [<span style="font-style:italic">criteria-of-diagnosis-physician-diagnosis</span>] (boolean) </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Surveillence method type (active/passive) through which the SSI was detected</span> [<span style="font-style:italic">ssi-detection-method-type</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.31">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.31</a> </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Surveillence method through which the SSI was detected</span> [<span style="font-style:italic">ssi-detection-method</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.29">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.29</a> </li> </ul> </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Findings Group</span> [<span style="font-style:italic">findings-group</span>] (group, repeats) <ul style="list-style:none;"> <li>This group records whether infection organisms were identified and, if so, records details about them. [<span style="font-style:italic">findings-group-description</span>] (display) </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Pathogen Identified</span> [<span style="font-style:italic">pathogen-identified</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16</a> </li> </ul> </li> <li> <span style="color:red">* </span> <span style="font-weight:bold">Pathogen Ranking</span> [<span style="font-style:italic">pathogen-ranking</span>] (choice) <ul> <li>answerValueSet: <a href="http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking">http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking</a> </li> </ul> </li> </ul> </li> <li> <span style="font-weight:bold">Comments</span> [<span style="font-style:italic">nhsn-comment</span>] (text) </li> </ul> </div> </text> <url value="http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-event"/> <identifier> <value value="hai-questionnaire-opc-ssi-event-v1"/> </identifier> <version value="2.0.0"/> <name value="HAI_questionnaire_opc_ssi_event"/> <title value="Outpatient Procedure Component Surgical Site Infection (SSI) Event"/> <status value="draft"/> <experimental value="false"/> <subjectType value="Patient"/> <date value="2019-04-01"/> <publisher value="HL7 Structured Documents Work Group"/> <description value="This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Surgical Site Infection Event. This report is for reporting data on each patient having a SSI event related to one of the NHSN operative procedures selected for monitoring. For further details on reporting healthcare-associated infections see the specific protocols and data collection forms on the NHSN website [https://www.cdc.gov/nhsn/](https://www.cdc.gov/nhsn/). "/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> </coding> </jurisdiction> <code> <system value="http://loinc.org"/> <code value="51897-7"/> <display value="Healthcare Associated Infection report Document"/> </code> <item> <linkId value="facility-id"/> <text value="Facility ID"/> <type value="url"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="encounter-date"/> <text value="Date of encounter"/> <type value="date"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="infection-details"/> <text value="Infection details"/> <type value="group"/> <required value="true"/> <repeats value="false"/> <item> <linkId value="infection-details-group-description"/> <text value="This group records the infection type, with details. It records SSI level, all identification criteria used to identify this SSI event, and identified pathogen(s)."/> <type value="display"/> </item> <item> <linkId value="event-type"/> <text value="Event Type"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20"/> </item> <item> <linkId value="event-date"/> <text value="Date of event"/> <type value="date"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="nhsn-procedure-code-category"/> <text value="NHSN Procedure Code Category"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34"/> </item> <item> <linkId value="primary-cpt-procedure-code"/> <text value="Primary CPT Procedure Code"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/ValueSet/cpt-all"/> </item> <item> <linkId value="procedure-id"/> <text value="Procedure Id"/> <type value="url"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="ssi-level"/> <text value="Surgical Site Infection (SSI) Level"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196"/> </item> <item> <linkId value="criteria-of-diagnosis"/> <text value="Criteria of Diagnosis"/> <type value="group"/> <required value="true"/> <repeats value="false"/> <item> <linkId value="criteria-of-diagnosis-group-description"/> <text value="This group records the criteria used in the diagnosis of an infection."/> <type value="display"/> </item> <item> <linkId value="criteria-of-diagnosis-abscess"/> <code> <system value="http://snomed.info/sct"/> <code value="128477000"/> <display value="Abscess"/> </code> <text value="Criteria of Diagnosis: Abscess"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-redness"/> <code> <system value="http://snomed.info/sct"/> <code value="386713009"/> <display value="Redness"/> </code> <text value="Criteria of Diagnosis: Redness"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-fever"/> <code> <system value="http://snomed.info/sct"/> <code value="386661006"/> <display value="Fever"/> </code> <text value="Criteria of Diagnosis: Fever"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-heat"/> <code> <system value="http://snomed.info/sct"/> <code value="304214002"/> <display value="Feels warm (finding)"/> </code> <text value="Criteria of Diagnosis: Heat"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-incision-purulent-drainage"/> <code> <system value="http://snomed.info/sct"/> <code value="255320000"/> <display value="Infection - suppurative (disorder)"/> </code> <text value="Criteria of Diagnosis: Purulent drainage"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-wound-dehisced"/> <code> <system value="http://snomed.info/sct"/> <code value="225553008"/> <display value="Wound dehiscence"/> </code> <text value="Criteria of Diagnosis: Wound spontaneously dehisced"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-incision-opened"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1967-9"/> <display value="Incision deliberately opened or otherwise drained by physician"/> </code> <text value="Criteria of Diagnosis: Incision deliberately opened"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-evidence-found"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1905-9"/> <display value="Other evidence of infection found on direct exam, during surgery, or by diagnostic tests"/> </code> <text value="Criteria of Diagnosis: Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-localized-swelling"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1920-8"/> <display value="Localized swelling"/> </code> <text value="Criteria of Diagnosis: Localized swelling"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-pain-tenderness"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1960-4"/> <display value="Pain or tenderness"/> </code> <text value="Criteria of Diagnosis: Pain or tenderness"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-organism-identified"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1952-1"/> <display value="Positive culture"/> </code> <text value="Criteria of Diagnosis: Organism Identified"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-testing-not-performed"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1901-8"/> <display value="Not cultured"/> </code> <text value="Criteria of Diagnosis: Culture or non-culture based testing not performed"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-imaging-test"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1924-0"/> <display value="Radiographic evidence of infection"/> </code> <text value="Criteria of Diagnosis: Imaging test evidence of infection"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="criteria-of-diagnosis-physician-diagnosis"/> <code> <system value="http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1963-8"/> <display value="Physician Diagnosis of this event type"/> </code> <text value="Criteria of Diagnosis: Diagnosis of superficial SSI by surgeon or attending physician"/> <type value="boolean"/> <required value="true"/> <repeats value="false"/> </item> </item> <item> <linkId value="ssi-detection-method-type"/> <text value="Surveillence method type (active/passive) through which the SSI was detected"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.31"/> </item> <item> <linkId value="ssi-detection-method"/> <text value="Surveillence method through which the SSI was detected"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.29"/> </item> </item> <item> <linkId value="findings-group"/> <code> <system value="http://loinc.org"/> <code value="18769-0"/> <display value="Microbial susceptibility tests Set"/> </code> <text value="Findings Group"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <linkId value="findings-group-description"/> <text value="This group records whether infection organisms were identified and, if so, records details about them."/> <type value="display"/> </item> <item> <linkId value="pathogen-identified"/> <text value="Pathogen Identified"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16"/> </item> <item> <linkId value="pathogen-ranking"/> <text value="Pathogen Ranking"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking"/> </item> </item> <item> <linkId value="nhsn-comment"/> <code> <system value="http://www.loinc.org"/> <code value="86468-6"/> <display value="Report Comment Section"/> </code> <text value="Comments"/> <type value="text"/> <required value="false"/> <repeats value="false"/> <maxLength value="2000"/> </item> </Questionnaire>
