Welcome to the 2016 National Healthcare Safety Network, or N-S-H-N, Quick Learn series. These C-D-C presentations are an educational resource for healthcare facilities working to prevent Healthcare Associated Infections, or H-A-Is. This presentation reviews the Surgical Site Infection, or S-S-I, event form. PATOS, or Infection Present at the Time of Surgery, is a required field on the S-S-I event form. N-H-S-N frequently receives questions about how to fill out the PATOS field. In this session, we will answer some of the most frequently asked questions.The patient does not have to meet the N-H-S-N definition of an S-S-I at the time of the primary procedure, but there must be evidence of an infection or abscess present at the time of surgery. One question we are frequently asked is, “If I find an infection that meets criteria for a PATOS S-S-I, do I have to report this as an S-S-I event?” The answer is YES. S-S-I Events with the PATOS field marked as ‘YES’ are reported if they are attributable to an operative procedure that the facility is following in its reporting plan. Another question we get is, “If a patient has infection present at the time of surgery, does that mean that any subsequent S-S-I will automatically be PATOS equals YES?” The answer is NO. The PATOS field should only be marked ‘YES’ when it applies to an S-S-I event that is at the same level as the infection that was present at the time of surgery. For example, if a patient had an intra-abdominal infection at the time of surgery and then later returns in the surveillance period with an organ space S-S-I, the PATOS field would be YES. However, if the patient returns with a superficial or deep incisional S-S-I, the PATOS field would be NO. Here are two other questions we get: “Are S-S-I events with PATOS marked YES included in the Standardized Infection Ratio, or S-I-R? And for COLO and HYST procedures, are these S-S-I PATOS events reported to C-M-S? All S-S-Is reported as present at time of surgery are included in the S-I-R if the wound closure method is noted as a “primary closure.” Procedures with closure methods other than primary, are not included in S-I-R analysis. All COLO and HYST procedures which are primary closures and their associated SSIs events are reported to C-M-S. Recently we were asked, “How will the S-S-I, S-I-R be affected after the new baseline?” The S-S-I and procedure data reported for 2015 will be used as a new baseline for S-S-I S-I-Rs. During the re-baseline analysis, PATOS may be excluded from future S-S-I S-I-Rs calculated on the 2015 baseline. When the re-baseline and new risk adjustments are implemented later in 2016, this new data will be applied retrospectively to the 2015 data. This means there will be 2 S-I-Rs; one using the 2006-2008 baseline and the other using the new baseline. Both will be sent to C-M-S. We are frequently asked to give a few examples of what would and would not be a PATOS equals YES on an S-S-I event. First, what can be a PATOS? PATOS means that there is evidence of an infection or abscess at the start of, or during, the index surgical procedure. In other words, it’s present pre-operatively. For PATOS you do not need to meet S-S-I infection definitions. Some examples of PATOS include abscess, infection in the O-R note, purulence or pus, septic or feculent peritonitis, or a ruptured appendix. There are some exceptions to PATOS. PATOS is not diagnosis-driven. For example, diverticulitis, peritonitis, or appendicitis alone does not always mean there was a PATOS infection. There must also be evidence of infection in the organ space. Here’s some guidance to regarding what is not a PATOS. If the only finding is an organism from a culture obtained in the O-R or on a pathology report from a surgical specimen, this is not a PATOS. However, if the culture was taken from an abscess or pus, this is a PATOS equals yes for a subsequent SSI at that same level. If a rupture or perforation of the colon has occurred, but there is no evidence of infection, this would not be a PATOS. Fecal spillage or a nicked bowel during procedure would not be a PATOS. This is a complication, but there was no infection caused by this at the time of surgery. Inflammation, necrosis, or gangrene alone is not a PATOS. Fresh traumas that are contaminated cases do not necessarily meet PATOS. For example, a fresh gunshot wound to the abdomen is an emergency; it’s a trauma case with a high wound class but it would not have had time for infection to develop. You can find more details in the PATOS section of the 2016 S-S-I protocol. For more information, visit C-D-C-dot-gov-slash-N-H-S-N. You can e-mail questions to N-H-S-N at C-D-C-dot-gov.