Case #1 RP, as 63 year old resident with pancreatic cancer. Resident has a foley catheter placed due to a stage 4 decubitus pressure ulcer. She has not had any issues with it. The catheter remains in place. 4 days after placement the CNA reports to the nurse. Resident’s is complaining of chills and is visibly shaking Patient complains of slight abdominal/suprapubic pain Temperature of 97.5°F, BP 80/50 The nurse contacts the physician and labs are ordered Lab results: Urinalysis: 2+ protein, + nitrite, 2+ Leukocyte Esterase, 4+ WBC, and 3+ bacteria Urine culture: Preliminary report shows E. coli >100,000 cfu/ml Which definition would you use? Which criteria are met? Does she meet criteria for UTI?

Case #2 EH is a 84 y/o male with past medical history of MRSA, hypertension, GERD, and acute respiratory failure. He was admitted to your facility for long‐term care post hospitalization. Vitals on admission were within normal limits. Seven days post admission, the daughter tells the nurse, “dad is not responding like he used to. He can no longer hold a conversation, tires easily, and is not able to brush his teeth, eat, or dress without complete assistance.” On exam the nurse notes the following: Vitals: Temp 100.7, pulse 107, respirations 26, oxygen sats 93% Notes ronchi on auscultation of the chest and patient is confused MD is notified of findings and orders urine cultures and chest x‐ray Lab Results: U/A – negative Urine culture – E. coli 10,000 cfu/ml Chest x‐ray – no lung abnormalities noted Which category of infection(s) are you concerned about and why? Which constitutional symptoms did he meet? What other criteria did he meet? What type of infection does he have?

Case # 3 AN is a 62y/o male with a past medical history of hypertension and diabetes. He is admitted to your facility to recover from hip replacement surgery. During the admission, it is noted that resident has received treatment for a C. difficile infection while in the hospital. No vitals were taken on admission and exam was unremarkable. Two weeks after admission, resident tells nurse that he had multiple episodes of vomiting and diarrhea. Vital signs: Temp 99.0, pulse 100, resp 16, BP 150/98, pain 6/10 Stool is tested and is toxin negative and PCR positive for C. difficile. You note that this is the 8th such case of diarrhea and vomiting in the facility and that the resident’s roommate had similar symptoms 2 days ago. Upon further review of the cases you note the following trends: 6/8 residents had vomiting 5/8 had diarrhea Most residents had symptoms within 48 hours of each other Symptoms lasted on average 36 hours (range 24‐48hrs) Which definition are you going to use? Does the resident meet definition based on criteria?

Case # 4 KD is a 92 y/o male with history of arterial insufficiency, urinary and fecal incontinence. He has limited mobility and uses a wheel chair to get around. He is diapered most of the day to contain his incontinence. On a monthly skin sweep, the resident is noted to have a small area of breakdown on his lower buttock. The nurse notes the following: Measures 1.5 cm X 3 cm X 2 cm, with undermining Wound bed is 90% slough and 10% necrotic tissue Very malodorous Extensive serosanguinous exudate Surrounding skin is erythematous, hot and tender to the touch Which definition are you going to use? Does the resident meet criteria?