1. (a) ICD-9 codes as designated by the federal Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) or its successor shall constitute the definition of events listed in this rule. Facilities shall adapt to changes in ICD-9-CM specifications as directed by NHSN and the department.
2. (b) All general hospitals shall report the number of device days and laboratory-confirmed central line-associated primary bloodstream infections in special care settings including the causative pathogen.

3. (c) General hospitals, other than pediatric and adolescent hospitals, and ambulatory surgical centers (except those hospitals or ambulatory surgical centers described in subsection (d) of this section) shall report the HAI data related to the following surgical procedures. The surgical procedure is defined by the NHSN operative procedure and the ICD-9-CM codes linked to that operative procedure.

   1. (1) Colon surgeries (Colon surgery--17.31 - 17.36, 17.39, 45.03, 45.26, 45.41, 45.49, 45.52, 45.71 - 45.76, 45.79, 45.81 - 45.83, 45.92 - 45.95, 46.03, 46.04, 46.10, 46.11, 46.13, 46.14, 46.43, 46.52, 46.75, 46.76, 46.94).
   2. (2) Hip arthroplasties (Hip prosthesis--00.70 - 00.73, 00.85 - 00.87, 81.51 - 81.53).
   3. (3) Knee arthroplasties (Knee prosthesis--00.80 - 00.84, 81.54, 81.55).
   4. (4) Abdominal hysterectomies (Abdominal hysterectomy--68.31, 68.39, 68.41, 68.49, 68.61, 68.69).
   5. (5) Vaginal hysterectomies (Vaginal hysterectomy--68.51, 68.59, 68.71, 68.79).
   6. (6) Coronary artery bypass grafts (Coronary artery bypass graft with both chest and donor site incisions--36.10 - 36.14, 36.19; Coronary artery bypass graft with chest incision only--36.15 - 36.17, 36.2).
   7. (7) Vascular procedures (Abdominal aortic aneurysm repair--38.34, 38.44, 38.64; Carotid endarterectomy--38.12; Peripheral vascular bypass surgery--39.29).
4. (d) A general hospital, other than a pediatric and adolescent hospital, or ambulatory surgical center that does not perform at least a monthly average of 50 of any combination of the procedures listed in subsection (c) of this section shall report HAI data relating to all of the three surgical procedures most frequently performed at the facility that are also listed by NHSN. The average number of procedures and the three most frequently performed procedures shall be determined based on the calendar year prior to the reporting year as determined by facility contact.

5. (e) Pediatric and adolescent hospitals except those described in subsection (f) of this section shall report the HAI data relating to the following surgical procedures. The surgical procedure is defined by the NHSN operative procedure and the ICD-9-CM codes linked to that operative procedure.

   1. (1) Spinal surgery with instrumentation (Spinal fusion--81.00 - 81.08, 81.62 - 81.64; Laminectomy--03.01, 03.02, 03.09, 80.50, 80.51, 80.53, 80.54, 80.59, 84.60 - 84.69, 84.80 - 84.85; Refusion of spine--81.30 - 81.39).
   2. (2) Cardiac procedures, excluding thoracic cardiac procedures (Cardiac surgery--35.00 - 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, 37.31 - 37.33, 37.35, 37.36, 37.41, 37.49, 37.60; Heart transplant--37.51 - 37.55).
   3. (3) Ventriculoperitoneal shunt procedures (Ventricular shunt operations), including revision and removal of shunt--02.2, 02.31 - 02.35, 02.39, 02.42, 02.43, 54.95).
6. (f) A pediatric and adolescent hospital that does not perform at least a monthly average of 50 of any combination of the procedures listed in subsection (e) of this section shall report the HAI data relating to all of the three surgical procedures most frequently performed at the facility that are also listed by NHSN. The average number of procedures and the three most frequently performed procedures shall be determined based on the calendar year prior to the reporting year. Reporting of HAI data for all three surgeries shall begin for the entire quarter in which the enrollment deadline occurs as specified in §200.6 of this title (relating to When to Initiate Reporting).
7. (g) Facilities shall also report denominator data for the events identified above for calculation of risk adjusted infection rates as required in Texas Health and Safety Code, §98.106(b). NHSN protocols shall be used for the determination of denominator data.

Source Note:The provisions of this §200.4 adopted to be effective May 4, 2011, 36 TexReg 2729.