TRIC-MAN

Should we only audit those newly admitted during the “Day 0”, not those who are already there?

No. All patients already admitted on the ICU plus those newly admitted during the Day 0 (between 0000-2359) should be enrolled.

How is elective vs emergency surgery defined?

As per the protocol, elective surgery is defined as surgery scheduled > 24 hours in advance and emergency surgery as that scheduled within 24 hours of operation

If a new antimicrobial was changed yesterday from a different one, is that the date that I use on the patient demographics form? 

No. You would use the date an antimicrobial was first prescribed for that episode of infection/that indication. 

For example, if someone was on Meropenem for a VAP for 5 days, and was yesterday changed to co-amoxiclav – the start date would be 5 days ago. 

Do I enter all the antimicrobials for the cohort that have been on antimicrobials for >3 days? 

You enter all the current antimicrobials on Day 0 but you don’t add any of the ones that have already stopped. 

Similarly, you wouldn’t add any new ones that are prescribed after Day 0 for this group (unlike the group who have been on antimicrobials for ≤3 days). 

Can I write “as per micro” as the reason for antimicrobial? 

It would be better to give the reason why they chose that if that’s possible (maybe by speaking to others in the clinical team if it’s not clear). If it’s outside of guidance with no documentation as to why, then choose that option (the next question will ask if it was discussed with micro/ID anyway and this will be picked up in analysis). 

When do I answer “empiric” vs “targeted against known organism”? 

If there is a current or old microbiological culture result that is being used to guide therapy choices – then choose “targeted”. If the antimicrobial is being prescribed ‘blindly’ against what is most likely to be causing the infection, then choose “empiric”. 

What if the antimicrobial is named on the antimicrobial guideline but a different dose or course-length is chosen?

You can still answer “yes” to "prescribed as per antimicrobial guideline". In this question we are talking about the choice of medication.

If someone has been on antimicrobials for >3 days, but then starts a new antimicrobial for a different indication ≤3 days ago, which cohort do they go into?

Choose the earliest start date for any antimicrobial that is currently prescribed. So, for this case they would go into the >3 day cohort.

What “source” (e.g., community-, hospital- or ICU-acquired) should we put in for surgical prophylaxis?

Choose wherever the underlying need for surgery arose. E.g., if developed the surgical issue at home then choose “community-acquired”

Does every patient need a microbiology form opening? 

No. This is only for those who have positive culture results of the type specified in the protocol (blood cultures, BAL, urine, line tips etc.) in those in the prospective cohort. 

We aren’t recording negative results or other samples in this audit. 

Not every sample type is listed, for example, how do I put in a sputum result?

If the sample type isn’t listed then it doesn’t need entering. This is an audit/service evaluation and therefore we aren’t collecting every single type of sample – just key ones that might be driving antimicrobial prescription changes. 

So things like standard sputum, wound swabs etc are not on the list and don’t need entering.