Good afternoon, and welcome to today's navigating your way through session for, uh, this brings us to a conclusion for our program. It has been a tremendous tremendous experience. My name is Victor Gonzales. I'm a quality improvement specialist and it is my pleasure today to introduce YOLANDA. Our speaker, but before to get to that, I do want to thank you for sharing your time with us. Today we're going to cover a few slides before we begin just a few housekeeping issues. If you're a frequent flyer with us, you've been with us from the very beginning. This is gonna be old hat to you. So. Remember this is an interactive session we want you to send in your your questions and interact with us in the material that we're going to be providing. Today's topic is multi drug resistant organisms. And I'm not even gonna try to pronounce it. I know these are some scary bugs. So, if you drop by for some extermination tips, I think yolanda's got a few of those for you as well. Here's how you're going to interact with us when you have the opportunity you use the Q and a section that is located on the right hand. Side of your screen. We refer to that as the participant panel if it's collapsed. Don't worry just click on the Chevron. That's the little icon to the left of the word. Q. A, it will expand. Enter your question, make sure it's going all panelists, send it over to us and we'll incorporate it into the conversation to try to answer as best. We can. You can also interact with us by raising your hand. Just to the right of your name, you'll see a hand icon click on it. I'll find you unmute your line and at the. Appropriate time bringing into the conversation, have you ask your question? Because not only does it allow you the opportunity to interact with. Our expert YOLANDA, but it also gives everybody else on the call, an opportunity to benefit from your questions. So don't be shy. To make sure you get your questions in also be sure to check your chat. Or links, I'm going to be dropping in lots of good stuff for you as YOLANDA is covering this very important topic. So check that often, if it's not available on your participant panel, you can certainly click on this 3. Ellipses down at the bottom. You'll see we have it circled on this line. Click on it. It'll be added to your participant panel, Pro, tip user or user Pro tip. Excuse me? I said that backwards. You can collapse some sections of the participant panel to expand others. So, make sure you play around with that. Whatever works for you. We want to make sure you're comfortable. So before we get to our objectives, let me introduce our speaker. It is my pleasure to introduce YOLANDA. She is a health. Care quality improvement specialists with TMF, health quality Institute before joining TMF YOLANDA worked as a long term care administrator, and was the director of quality improvement and infection control in acute care hospitals for more than 35 years. She was certified in both health care quality for acute care facilities and long term care quality improvement. Yolanda obtained her lean 6 Sigma, green and black belt certifications from Purdue University. She holds a bachelor of science, and nursing from the university report. Federico a long term care administrative degree from San Marcus University in addition to a masters in healthcare administration and gerontology. Yolanda is also a niece and subject matter, expert for long term care facilities in hospitals where she assist assist Nissan users with technical assistance and provides training to ensure data quality reporting Denise and Yolanda. Welcome to today's call. Thank you very much in good afternoon. So, um, today we were going to go over the and the C difficile module and we will, um. We will discuss, let me go to the subject is here. Have come back with just a few. Let me see, so I have to go. I'm here, yes, if you click on the center of the screen there, and, uh, hit page down, it should advance your slides. If that's not cooperating for you. Yeah, you can move your way. Okay, just move your mouse over to to the left and if you float your mouse over, you'll see the navigating controls there. You'll see a number. Uh, of the slide and arrows on top and bottom, you can advance that way. As well, let's see. See. See, if this works. Okay there it goes. So, the year 2020, as we all know, has been a really challenged year marked by the, the new global pandemic. Unfortunately, the. A national, the national and state, uh. Progress report suggested that the grounds that had been in place before for preventing health associated infections have have been lost. So, in regards to the progress that you'll have that have been done in acute care hospitals. Because this report actually demonstrated that there was an increase on many of the including 15 was an increase on there was 24% on Central line, blood stream infections. 35% on banner later related infections. However, there was a demonstration of a decrease on the seat of a sale. So you got it by. It was decreased by 11%, keep in keep keeping in mind your contribution on reporting and more deals and see the facility infections and then you just send will remain a key factor for successful, reliable data. So, it's really important notes for you all to keep. Contributing to input your data in there and again, I wanted to also thank you for your hard work and your dedication to report infections to. So, um, so let's go over this important, the importance of monitoring the instead of a sale and for the purpose of this presentation. What I'm going to do is I'm going to focus a lot on the difficile as these are the 2 microorganism that you are mostly tracking. So. With asset, health care associated infections is known to increase a lot of the economic burden and in the hospitals and medical costs have increased so much. Be due to the, um, there was a, there was a report, um. That was published where actually they were. Referring that the costs on to treat was ranging between 25,000 dollars to 36,000 dollars and the price might go up, depending on the type of, um, that is actually resistant to. Very few antibiotics regarding the treatment. For a lot of this infections. The estimated costs in 2017 was actually 4.6Billion dollars in the United States for community and hospital associated infections but, and sales can be control and prevent it with the proper use of antibiotics, maintaining a surveillance on the pathogens, implementing and monitoring and evaluating infection prevention strategies. And also educating staff and patients, so let's go over what the are, and the different type of pathways in this category. So 1st, I wanted to do a little brief, you know. Definition of what are they're actually bacteria resistant micro organism that harvest into 1 more class of ended by anti microbial agents and where the options for treating patients with this infections is extremely, extremely limited. Although my antimicrobials are now available for treatment for resistance. So a lot of these new engines is actually emerging. So, um. The more, you know, the more new antibiotics we have the more of assistance, um, depending on the use that is being, um. The proper use or improper use overuse of antibiotics they become more resistance are also increase the cost medical care. The length of stay. In the hospital, in the risk of mortality, in the high population that the population that's actually a higher risk is this, those patients are 65 and older they're are immunocompromised or that half an dwelling. Medical device, um, so. So, let me, uh, let me mention some of these different pathogens that cost Here we have the, and you also have the, uh, the resistant and the sensitive. And then I also have here like this, the antibiotic that they are susceptible or resistant to. I'm just going to glance through these, so that way we can, you know, in a matter of time, we can use our time wisely on the demo. And then here you have to your vancomycin resisting and thorough. clinicals you have those cephalosporin resistant in your E. You see all right. Bye. Bye. There's also the by clip and then also they asked. And here, um, this 1, this last 1 actually has, um, a lot of resistance to, to at least 1 agent within this. In the last on the at least 3 antimicrobial classes. So I listed here that anti microbial classes for you as well. Okay, let's talk now about, um, the different type of serving us that is available for you to, um. Monitor your, we're gonna compare the lab ID and the rules and the rules. Lab ID and are not the same. And they are, they're use actually using 2 different pathways, although you won't notice the difference because when you're trying to enter the events in in HSN, it's only everything goes through the event tab. So, on the surveillance rules. We have on the lab ID event, um, that the. The health associated infection, the pressing on admission as well as the transfer rules do not apply. On the HR they do applying. Then you have the location actually, in the, in the lab ID. Location is the is the place where the patient, um, specify the. The specimen was actually collected, so, if the location where the patient was actually house or care for. The event day is the specimen collection date so that's the date that the specimen was actually collected not the day that the positive results came back. There's categorizations of infections under the lab ID that include health care health care. Ah, facility onset, and those are the ones where it is collected over 3 days of after ambition. And then the community unsaid, and those are less than 3 days after our mission. So, if patients coming into your facility, and has the community onset, it will be counted for those infections between day, 12 and 3. and then those. On the healthcare facility onset, then those will be counted on day 4 on. On the on the health on the surveillance. Like I said, you know, you're. In your mission as well as transferable supplying. And then considers transfers to impatient if you say, for example, you have an inpatient rehab, and you do have a psych unit. In your facility, those those locations actually will continue. You won't be considered like, if you move from a patient from your rehab into your medical surgical unit, they won't be considered a transfer because they are actually. And for images and purpose, it is considered a continuous day. So. Because these infections have different protocols. What I recommend is actually referred to your protocols on the patient safety manual when you're trying to do a surveillance because depending on the infection, um, the rules have some variance. So, now let's talk about the denominator. In here, I wanted to mention that, although you see, like, I mentioned a distinction between the lab ID and the surveillance, um. As 2 different methods, when, when you look at the paper form in, they do have 2 different forms, but when you're trying to enter the information, um, when you enter information on, on online on the website, um, you will notice the difference because everything goes through the event tab so. And that's what I recommend you to do is just do it through the online. Um, event, so it, it, it doesn't create confusion for you. And the reason is because on the lab ID. You don't you look for laboratory and admission data without looking at clinical evaluation of the patient. So you don't look at symptoms, science and symptoms on the survey unless you do look at both. So, um. And I know that you want to look at both, so you can capture everything. So. And the lab ID actually is strictly used by is only uses. Lab data, without considering the clinical evaluation of the patient. So therefore, you know, they don't look at symptoms. Um, and it just allows for less intensive, um, data collection process but. You might miss on capturing the same symptoms. If you're doing just the lab ID. The lab IDs are attributed to a location where the, the positive specimen was collected. So, for example, if you have a positive specimen that was collected in the, the location will be the. When even when the patient is currently in your met search unit. So, however, if the prior positive specimens were identified at a different facility, let's say, um, you. Get a patient into your and positive was, was taking at another facility that would not influence your reporting because every time, um. You know, the, the lab ID actually resets to the new facility. So, um, you will have to get the, the lab results and. And do the testing again um. In the lab ID, um. 14 day rule is location specific so Y, Y. You have, you know, if you're looking at lap ID. Pressing on admission, you can include that information if it happens on the first second and 3rd day. If it's on the 4th day, then that will you will have a lot results in your hands to do that and put it in in HHS. And then after that, if you have a another positive test, that is actually after 14 days. Then you will have to enter a 2nd event, but if it's less than 14 days after the 1st, positive test, or after the positive test that you have, um, you don't have to enter again because it's considered a duplicate report. So here is some algorithm about how the process works and I know this a little tiny, but, um. What it does is actually gives you helps you determine if it's if it's a duplicate. Report or not so you have like, the 1st test the test result and then if you get a 2nd test result, and it's less than 14 days, that will be considered a duplicate. So, you don't have to report that 1 if it's not consider if it's over to 14 days, then is a new is considered a new lab ID results positive and you will report that to. There is a different 1 for, um, when you're looking at. At, for example, you know, a bacterium if you have a positive, um. Test it still goes through the 14 days but, um, so, here it's just like this is what it's showing here is that you have an isolated from blood is per patient per location. So, if this patient goes to from 1, location to another is a different different because it resets. So you start a new 1 um. But here, for example, it says, you know, if you have a prior positive from blood is less than 14 days. From the same patient and location. Even if it crosses month, you know, from from January to February, it doesn't matter it crosses your month. When you're looking at. It doesn't matter if let's say, for example, if you have less than 14 days, then it is is a lab ID. If if if if it's no, it's a lot ID and if it's yes, then it will be a duplicate and it's not a lab ID. In that comes really handy when you are actually trying to make a decision, if you have to report it to or not. When I work with on the nursing homes, and I'll just bring this to so you can you can understand this. We create a form that I'm going to, um. Make it an update for the for the hospitals to be able to use it if you want to use it and I'll, I'll share with the team so we can get that approved and send it to you. Um. What it is, is actually use a tracking tool where you can write the C, difficile positive task, because you'll have to kind of like, account when is the next 1 um, and if it's less than 14 days or more than 14 days. So, you can kind of track if you have to report it to or not. The other thing that is available in, um, on the CDC website is your calculator, your and calculator and you can also use that to determine if you have a lab we sold that was less than 14 days, or more than 14 days from the prior positive test. So, now let's talk about the advantages of doing that by D, even reporting. It is based on specimen data report so therefore it doesn't require you to do an extensive chart review and it also allows for standard case definitions for surveillance. For example, if you have a lab ID, um, event omarosa, it is the 1st positive. Blood culture for that patient in the location and it excludes your, um, active survey specimens. If, um. The finding in the blood specimen for the patient. In the location with no prior positive test results collected. Collected within 614 days of the patient and the location and even when the specimen across the state, you know, you still can report it. The other thing is that you can also compare it to different type of healthcare settings and. This is something that in HSN actually categorizes the lab ID events, but this is automatically done on the system. And I'll show you this when we go to the demo. When you're trying to enter a monthly reporting plan, you know, make sure you have 1 for each month of the year. Um, 1 thing that we wanted to mention is that when you do in HSN reporting, um, under the reporting plan, you know, it is important for you to select the faculty right in the call for study wide inpatient. Um. You know, that I'll just mention fact in, in this. In because it is a stand standard reporting process, you know, that's the 1 that they select because when you select that on your monthly reporting plan, it actually pulls your outpatient. So, it, it includes all your inpatient. That you have mapped plus your and your observation unit. If you have 1, so if the facility has an inpatient rehab and inpatients unit, then those needs to be added to the reporting plan as a separate. Location, because that doesn't get pulled through the fact. And if you're monitoring and see the facility, just make sure that you include, like, all specimens on the box. Um, if you're monitoring, you can include all specimens or inclusive your blood and all the other type of cultures. But you can also, if you're only looking at. Bacteria is, you can select, you know, the blood's specimen only. The way in, um, standard reporting includes the 1st, positive specimen for the patient and the location is submitted as a lab ID. Following this a mission there. And, you know, they have that 14 day rule. So you'll have to follow that. And if the patient moves to another new location. Then reset, let's say, for example, you have a, um, a patient that has a positive task, and he sends your medical unit, right? He's in your medical location. So. He got a positive test there, and they say he was moved to another location. He was moved to your medical surgical unit that will be considered a different location. So it will reset. So, when the say, for example, he had a positive test that day. But, um. And it moved to another location, and he has another positive test there. You would enter both both in if you're following them. By location, if you're following them by. Back in, then you will enter that. That information there, and you can select the different location as well. Hello. The only thing that is actually the only exception that they have is like, if there's if you have. An affiliated organization, let's say, for example, you're part of a chain and you have an affiliated. Organization where the patient chairs, the same. Medical record number, then they say he had a positive test on on 1 of your affiliated facilities then you would take you could use you can use that. Positive test and and enter it in in, and it will be attributed to the meeting location to the place where he was admitted. 1st. Here's an example of a denominator form using. Um, the specific locations, and as you can see, um, you will need to enter the total patient data and the total emissions for each location for each month. If you do it by location. So here assessment unit, you'll have to enter that information here. And then you'll have to select your surgical unit and then enter the same, you know, the patient days and the total emissions. and then the information here so if you do it by location it consumes you a little bit more time and that's why we encourage everybody to include the fact white in so that way you can enter the information there When you are just scroll down here. Let me show you the form. This is the form for, um, the fact why in. So, on the fact my end you hear you have different lines that you have um. You make this bigger. Okay you have. Back in line 1, so you'll enter here your total facility patient days and your total facility admissions. If you do not have a, um, inpatient rehab in a site, or it's like. Unit then you would enter the same numbers on the line too. You will enter the same patient to 8 numbers. They have on your total facility here on the 2nd line. And you will enter also the same number on the 3rd line. If you do not have a unique you or well, baby unit. If you do have it, then those, those will be counted in there. Then you will select here on the bottom, the surveillance for doing the infection surveillance for, for and then also you would, um, enter if you don't have events reported, um, these boxes will be enabled for you to check them off. And if they are. If you have enter already your events, then it will be this table will be grayed out. Okay, so let's move it into the senior is, um, the clustering difficile is the is the bacteria that causes a lot of the area. And actually, is a lot of these infections actually happen due to the use of antibiotics as a reaction to the antibiotics. So. And the individuals that are actually at risk are the patients who are 65 and older, and have are receiving medical care as well as those are staying in hospitals and nursing homes. In those that have a weak immune systems. When you're reporting, um, C, difficile infections, you will report all. For example, that happened on the day for him, then you have the community onset and those are, um. That by D specimens collected in an outpatient location in which the patient, it was not previously discharged from an impatient location. Within the same facility, and it's less or equal 20 days prior to the current. Date of the specimen collection. The lab ID specimen collected as an impatient less than 3 days after the admission. So it will be day 1. is that your day of permission day? 2 and day 3 and then you have also the committee onset health care associated. Infection and those are like your Co. Um, and here you have the event collect. The lab ID event collected from the patient was who was discharged from the facility less than 4 weeks, or equals than 4 weeks from the date of the current stool that was collected. So. So these are the, the categories that. And it uses as well as, um, they do have some that are like the, um. Incident in their. And those incident ones are that when you get the 1st test, and then the recurring ones, when you have them, those duplicate tests. But don't worry about those categories because those, those are actual, actually out of populated by and you'll see them on the analysis tab. Here on identifying a duplicate C difficile positive test, um, the specimens. Still specimen and it was tested positive for. So, um. With the toxin or toxin, or just have them be and it's really doable. In this meeting the definitions of the C difficile laboratory. So, regardless of the method of consequences of testing and testing. The same uniform a stool. The result of the last test perform is used to determine, um, if it met the criteria or not. Just submitted to, um, I see the testing only from. Form stool specimen a sample still should be come form can conform to the shape of the container. The C difficile isolate, um, categories incident. Um, AC, and that is, um, a city event where the specimen was collected over. Over 56 days after the most recent CDI event. Um, and then they also have the recurring 1 and that is. The 1 that happens, um, more than 14 days, but less than 56 days. And you'll see these, um, differences in these categories under the analysis tab. Here's the algorithm for C difficile and it's really simple. You know, it's just you have a positive test C difficile task per patient per location and let's say, for example, you had a, um, if you have a prior positive. In less than less on equal in 14 days for the same patient. On the end location, they say you say, no, I don't have a 2nd, positive task then you would report that test to HSN. If you have a initial task that was positive and you have another positive. That is that was collected less than 14 days, less or equal in the 14 days then that will be considered a duplicate, um, test and that 1 doesn't get reported to. Why is important for you to use? Fac. Back when he was actually make make it, um. Your data collection more. Um, it will help you with the data collection, because it's less time consuming. It pulls all your inpatient and your outpatient data. Um. If a patient moves from to a new location, it it resets. And also. It applies to all your inpatient and outpatient locations, so you don't have to go there to your reporting plan and just put every single 1 of your locations that you map because it will be pulling everything in there for you. So, here's the facility. Um, this is just an example of a monthly reporting plan you senior and this is how you will select them and you can select your here. You can select your lab I. D, or specimens and then on the. Facility white guy, white impatient for the, you can select as well. Um, the lab ID all specimens, or if you are only following bacteremia, then you can just select the blood, the blood specimens only. And this is just, um, this is how you would set up your monthly reporting plans. So this is, if you see when I pulled up the fact in impatient, it pulls your my in the observation unit. There is here, um, reporting requirements options and here is like, I said, your infection surveillance with and your lab ID with and you also have some additional options because you can do, um, process prevention measures and that is to look into your staff compliance on hand hygiene. And the use of gloves and gowns, um. And you also can look at your active survey on testing if you want to do that as well as your, um, your prevalence for. There is a rule called the big 5 and this is because many of you are actually monitoring other type of infections. So you're doing the bloodstream infections you're doing. You're doing the with your, um, your pneumonia. Ventilate or associated infections, and even your your surgical site infections. So if you have selected these measures to be part of your. Plan to, um, to monitor into surveillance for infections at your facility. Um, and they say that you also have an, what has done is that they created a box in your reporting where you can select if it is relay if this isn't case or not. So, if you have an, let's say, you have a C difficile infection in addition to a UTI infection, what you can do is, you can select this that this is part, you know, that this has a C difficile infection as well. And the system will link both here. And it gets linked for the analysis purposes. So, um. So you don't have to, you know, you will enter the C, difficile infection and in the event tap, but when it goes to analysis, and you send your data, they will. We will link both information to the same reports. To the 2 different reports. So, um. In here, I just wanted to go through, um, some of the lab ID and forms and tools that are available. We, they has your laboratory identify and event form, and they also have the event infection event and they sort of looks similar or they're different. 1, actually, um, the laboratory identified. Uses only the lab ID data. As is strictly basically using that the. Or C, difficile infection, even actually uses your lab. Data plus your science and symptoms of your patients, clinical evaluation of the patient. So. I basically encourage everybody to use the even infection event, because it covers both both of them. It covers your symptoms, your symptoms, your clinical evaluation and your lab results. And then we also have, um, and monthly denominator form. So I'll just glance through these. And then I'll show them to you. Um. Back in the demo. This is the and I know that, um. Peter was going to put everything on another chat for you. So you can have these, these tools available. 1 thing that I wanted to mention is, like I said, you know, you have an, uh, lab ID, even calculator that will help you track those duplicate results. If you want to use that 1. But we will be working on I'll be working on the form, um. So, it can make it, they can make it available for you as well. Okay, so let me move into, um, the demo. Just. And I wanted to share with you here um. The demo for the patient safety here is where you do find, because I already created 1 for the month of May. I want to share with you and here you can see, I have the month of May. I have my missed version. I have all my other measures here. Might also be monitoring, but here you have the module. And here, what I did is I put it as the med search unit. So, I decided, you know, let's say, for example, you decided just to do it by location. So I put this to the med search and I put the, and I selected the state of fulfill. All specimen and then. I did the fact in. Because I wanted to track both things, industrial option. You can do that. You can select to do it by location. And you can also add the fact buy in. And then it will pull everything for you as well. And then, so here have to weigh in on what it did is they pulled my observation. And it also pulls my, um, my, because I have it up here. Is up here. If you want to do the, you can do it, you can select the lab ID all specimens. Or, if you want just to do bacteremia, or you are interested in doing, you know, if you want to do the bacteremia, including all your other. Ah, specimens you just have to select the all specimens. So everything is included here. Um, this option here is only for people who want to just look at bacteremia. This H, H, what it means is hand hygiene and this GG, what it means is gloves and gowns. So if you have a, like, I mentioned before the process measure, if you want to look, they say you have. Might be monitoring your a C difficile and you find that you have a lot of C. C. difficile infections in your facility, and you're just kind of like, you know, I want to kind of like, make sure that it's not that we're just like, cross contaminating our risk our patients and you want to look at the compliance of your staff. On, um, hand, hygiene protected in the user protective equipment, you can select these, these options here. The seat of fulfill on my observation unit, I can select that as well. Your have in the. I can also look at my hand hygiene. So, it depends on, you know, what you want to do. Um. If you, if you, you have these options here, if you have, if you think that that's a process measure that you would like to. To monitor to see if that's contributing to your. You're in your incident in self infection, set your facility. So, once you do that here is the event tab. And what I'll do is, I'll just go ahead and add ones that you can see it. I'm going to add 134. And I'll select. You're a female everything that is a red asterisk is a mandatory field. I'm gonna say that he this morning. 2, 1. And they say that I have. Ac to facility, I'm going to report. So, I selected as a gastrointestinal, um. New type, and then I'm going to say that the event occurred on. May 11, this is asking me if this patient had a procedure done. So, I'm going to say, no, because if I say, yes, I'll ask me for information about the procedure. If if the patient did have procedure, you, you want to include it in there. Cause you'll be able to link it to the procedure as well. So, it's asking me if the, um, is this part of my surveillance on infection for, and I'm going to say, yes. And here is going to open these boxes, so I can select the microorganism as well. I'm going to say, see different cell going to say that it happened in the unit. He was telling me I didn't have it there. Remember you have when you map at your facility because I have so many in here I had to select which 1 I had mapped it for. I say you came to the facility. April tanks, and now here, I'm going to say he has a. See to fulfill, and here's where your symptoms your clinical evaluation of your patient is here. And this is where your lap is. So, this is why I'm asking you to use this 1. because if you, let's say, for example, you're only gonna use your lab results. Then you're going to do the monitoring. By that library, so that's the only thing you have. Um, then you can select, you know, what happened here and then it will open these other boxes to see if there's a secondary stream infection, say, no. I'm going to say that this patient it had coven, and it was confirmed. Um, he didn't he was discharged. Me, so. And then here, I have to select them the passages in and the sensitivity and the resistance of the antibiotics. Um. So, let's see, let me save it because I didn't select the. So, then it opens all your antibiotics, you have to select at least 1 in each box. Um, and I'm just doing this hypothetically, um, we had to select at least 1 in each box for it to save because otherwise it won't save. So, it's, it's just asking you for the antibiotic list here. There's sometimes, depending on the on the pathogen, it will ask you for certain ones because, um. You will have the live results in your hands so I'm just going to click on these all so that wait, let me save it. But you can you only have to enter 1. Um, on each box, it's just on that. Perfect. Let me send 1 this little bit simpler. Let me do something. Okay so this is how you enter. Let me go into, um. Do this after a while. For me, let me show you the, um, this lab. Um, calculator until this kind of clears up for me. Oh, okay. So, um. Here, if you select, let's say, for example, you select the. It will see, it was all specimen type. You can select, like, the month that you want to do it. Here you can enter and this is sort of like the form that we'll put together here, you can enter like, you have a. And they say the location was my main. Unit, um, and remember you only report here the positive ones. So, let's say, I got another. And is the say, it's not state. Okay, let's say I've got another 1 on the 27. So, here, you will be able to see if there are 14 days between this 1 and this 1. And when it calculates for, you. And I apologize my computer set wanting to progress with me today. This is supposed to be able to calculate for you is oh, it's telling me is unknown. Okay. So it will tell me if it's a reportable 1. Or if it's not a reportable 1, um. Telling me, it's just telling me unknown here, but usually, what was kinda happened is that when you have a positive test, the 1st, positive test, this is supposed to say here that it is reportable and he will have an option here for reportable. And then you'll know that there has to be report. Yes your 1st, 1. And then if you and just because I didn't enter probably the information about the patient. If he was admitted when he was admitted, um. But then when is the 14 days after. If it's more than 14 days, then it will come up as reportable and then you can enter it on. Let me see if this let me go back here. Okay. What I wanted to show you, is this. And I, and I'll go back to this event that I have already entered. So that way you can see it. Let me see. Enter it was 132. this is the 1 I had entered before and this was actually a. Um, and it was just a blessed specimen. So. This is the information that it will ask you for it when it's when is a. Um, you will select on the body. A specimen body site card card. So it's a cardiovascular circulatory. If. Emphatic system, uh, site. And then on the specimen source, you would select the blood specimen. So, when I go into, like. Doing the, the reporting summary the say, for example, I want to do I want to report. The data for the month of May. I will go into my facility wide. I'll domain. 2021, if you see, I already had to answer these numbers here. Um, I entered 3321dayspatient days and I had a total of 15 ambitions. Because I didn't have, um. I don't have any inpatient rehab or any unit. I will enter the same numbers. If you if you do have those units, and you will have to consider those numbers here. And then if I. If I don't have any, any or little bit, maybe unit, then I'll enter the same numbers again. I'll hear on the summary data I was doing surveillance so this was enabled for me to check it off and let me just edit here. So you can see it. Um, I was able to select the. Infection, uh, surveillance, and then I didn't have any events, um. Then here on the seat of fulfill, I selected the infection surveillance. And I didn't have any events to report when I go to the lab ID. And this is infection surveillance when I go to the lab ID, remember I enter 1. That was a 132 patient number. Um, so this box is disabled so it's grayed out. I cannot check it off. Because I haven't even already report it. I didn't have any events proceeded for sale for the month of May. So I, I'm able to then check off this little box here. And then I can go ahead and save it. Once you do that once you do your monthly reporting plan. Uh, what do you have to do is number 1 you have to enter your events. You know, make sure that your plan is what you want it to be to monitor, um. Every month that you have events when you have Vincent in, or events, um, for the go ahead and enter them. On HSN, 1st, and then at the end of the month, when the end you can come here to your summary data and then you can add. Your summary data report, if you select, like I said, um. The reporting plan, the summary reporting plan by location. Let's say, for example, I wanted to do the math unit then I have it only gives me this space here. But then, once I do that, I have to come back here and then select the surgical unit. If I want to do it separately, that's where the fact why in is going to help you because you only do it once. You don't have to do it by location. The other thing I wanted to show you is, that is the analysis tab, and I already generated this status in. So, what you do is you go to generate data and you click here where it says generate data. I did this a little bit ago, so I won't do it again, just to save time. And then here you'll go to the report. And Here's where you have all your lab results, um, data. So, if you want to click on here, you'll be able to see all your lab ID. If you click on there, it will pull your lab ID. That you have entered, I entered the 132 recently and here is where you can see that the categorization from, um, for the infection. This is a healthcare. Um, onset health care onset infection. For the, um. When it's CEO is a committee onset. And there tells me this diaper specimen that it was. An infection that it was in the location, so I have a by location so you can pull reports by location. You can also do it for the. And you can look at all your events on and as well, this will, you know. Classify it as, um, the different type of assets. And you can see if it's on, you know, it's a facility acquire infection. If it's a committee acquired infection. Remember that is the person that mission you can enter them out in. Cause you have maintain that surveillance, you also have, like, all see the facility events you can pull that bite by report. You can also pull your surgical um. Your standard infection rate by category here. The other thing you can do is like, if you're doing the process review, and I say I was looking at the. Balance and gloves I can, I can pull it from here. This will tell me that the right. Of both if I'm monitoring that. The other report that you have is like, if you go to, um, this advance. Tap here, you can look at your summary level data. So, let's say, for example, if I wanted to run that data. It will tell me the report that I did. You see here this where my 321 days for, and my 15 admissions were. So, it will pull your report and it will pull it by by infection type. And then if you want, if you want to do it, you have done it by location also by location. I could get up here. Is there any questions? And I know we're on top of the hour. Um. Do you have any questions? Um, there for me, Victor. Yeah, there's just 1 left from Rhonda she asks when selecting the antibiotic sensitivity pattern for the pathogen. What does the eye and what does. Trying to find the, uh, definition. Or, let me tell you. So, maybe it will be able to locate those in the instructions perhaps. Yes, there are. And we can. Yeah, they're actually on the instructions. Oh, great. Yolanda, I put those in the chat and I'll tell you what we can do, we can certainly reply to Rhonda and give her that information again in the follow up. But unfortunately we are out of time. I think we covered most of it. There was so much information here, and it is phenomenal to showcase our TMF talent, particularly Yolanda Velez’s lot of, uh, expertise in niece and through a program. So, if you made it through the program congratulations to you. A big hug to yourself, Pat yourself on the back. It was a lot of information. There's a lot to unpack here. We're gonna make these resources available to you on TMF Networks. We hope that you come back and join us again. And again, we are a resource for you make sure that you reach out to TMF. Yolanda. Thank you so much for sharing your expertise. It was fantastic to host this event. We want to thank everybody who participated that does conclude our call for today. All right, well, that does it for today. You may I'll disconnect Thank you for joining the call. YOLANDA - Thank you.