Attitudes Towards the Definition of UNOS 3 Exception for MCSD with Device Infection

Thank you for taking the few minutes to fill out this 9-question survey about your opinions regarding the definition of MCSD Infection used by UNOS/OPTN.

Before starting, please review the UNOS/OPTN definition of Mechanical Circulatory Support Device related infection, section 6.1.C.vi and Table 6-1, pages 110-111 of the current guidelines at https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf

Question Title

* 1. My clinical role is:

Infectious Diseases specialist

Cardiologist

Cardiothoracic surgeon

Clinical pharmacist

Outpatient Coordinator (NP, PA, RN, other)

Inpatient PA

Inpatient RN

Inpatient NP

Data manager

Other (please specify)

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* 2. I believe the UNOS definition for device-related infection is:

Too strict (too hard to classify an LVAD patient as infected)

Appropriate

Too lenient (too easy to classify an LVAD patient as infected)

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* 3. I agree that the following criteria for the UNOS definition of device-related infection are appropriate:

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
Erythema, warmth, and pain along the driveline	Erythema, warmth, and pain along the driveline Strongly agree	Erythema, warmth, and pain along the driveline Agree	Erythema, warmth, and pain along the driveline Neither agree nor disagree	Erythema, warmth, and pain along the driveline Disagree	Erythema, warmth, and pain along the driveline Strongly disagree
Leukocytosis	Leukocytosis Strongly agree	Leukocytosis Agree	Leukocytosis Neither agree nor disagree	Leukocytosis Disagree	Leukocytosis Strongly disagree
50 percent increase in white blood cell count from the last recorded white blood cell count	50 percent increase in white blood cell count from the last recorded white blood cell count Strongly agree	50 percent increase in white blood cell count from the last recorded white blood cell count Agree	50 percent increase in white blood cell count from the last recorded white blood cell count Neither agree nor disagree	50 percent increase in white blood cell count from the last recorded white blood cell count Disagree	50 percent increase in white blood cell count from the last recorded white blood cell count Strongly disagree
Positive bacterial or fungal cultures from the driveline exit site	Positive bacterial or fungal cultures from the driveline exit site Strongly agree	Positive bacterial or fungal cultures from the driveline exit site Agree	Positive bacterial or fungal cultures from the driveline exit site Neither agree nor disagree	Positive bacterial or fungal cultures from the driveline exit site Disagree	Positive bacterial or fungal cultures from the driveline exit site Strongly disagree
A culture-positive fluid collection between the exit site and the device	A culture-positive fluid collection between the exit site and the device Strongly agree	A culture-positive fluid collection between the exit site and the device Agree	A culture-positive fluid collection between the exit site and the device Neither agree nor disagree	A culture-positive fluid collection between the exit site and the device Disagree	A culture-positive fluid collection between the exit site and the device Strongly disagree
Surgical debridement of the driveline with positive cultures from sites between the exit site and the device	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Strongly agree	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Agree	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Neither agree nor disagree	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Disagree	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Strongly disagree
Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Strongly agree	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Agree	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Neither agree nor disagree	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Disagree	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Strongly disagree
Positive culture of material from the pump pocket of an implanted device	Positive culture of material from the pump pocket of an implanted device Strongly agree	Positive culture of material from the pump pocket of an implanted device Agree	Positive culture of material from the pump pocket of an implanted device Neither agree nor disagree	Positive culture of material from the pump pocket of an implanted device Disagree	Positive culture of material from the pump pocket of an implanted device Strongly disagree

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* 4. I believe my patients with device-related meet the following criteria for the UNOS definition of device-related infection:

	Very frequently	Frequently	Occasionally	Rarely	Almost never
Erythema, warmth, and pain along the driveline	Erythema, warmth, and pain along the driveline Very frequently	Erythema, warmth, and pain along the driveline Frequently	Erythema, warmth, and pain along the driveline Occasionally	Erythema, warmth, and pain along the driveline Rarely	Erythema, warmth, and pain along the driveline Almost never
Leukocytosis	Leukocytosis Very frequently	Leukocytosis Frequently	Leukocytosis Occasionally	Leukocytosis Rarely	Leukocytosis Almost never
50 percent increase in white blood cell count from the last recorded white blood cell count	50 percent increase in white blood cell count from the last recorded white blood cell count Very frequently	50 percent increase in white blood cell count from the last recorded white blood cell count Frequently	50 percent increase in white blood cell count from the last recorded white blood cell count Occasionally	50 percent increase in white blood cell count from the last recorded white blood cell count Rarely	50 percent increase in white blood cell count from the last recorded white blood cell count Almost never
Positive bacterial or fungal cultures from the driveline exit site	Positive bacterial or fungal cultures from the driveline exit site Very frequently	Positive bacterial or fungal cultures from the driveline exit site Frequently	Positive bacterial or fungal cultures from the driveline exit site Occasionally	Positive bacterial or fungal cultures from the driveline exit site Rarely	Positive bacterial or fungal cultures from the driveline exit site Almost never
A culture-positive fluid collection between the exit site and the device	A culture-positive fluid collection between the exit site and the device Very frequently	A culture-positive fluid collection between the exit site and the device Frequently	A culture-positive fluid collection between the exit site and the device Occasionally	A culture-positive fluid collection between the exit site and the device Rarely	A culture-positive fluid collection between the exit site and the device Almost never
Surgical debridement of the driveline with positive cultures from sites between the exit site and the device	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Very frequently	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Frequently	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Occasionally	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Rarely	Surgical debridement of the driveline with positive cultures from sites between the exit site and the device Almost never
Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Very frequently	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Frequently	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Occasionally	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Rarely	Recurrent bacteremia that recurs from the same organism within 4 weeks of completing antibiotic treatment to which the bacteria is susceptible Almost never
Positive culture of material from the pump pocket of an implanted device	Positive culture of material from the pump pocket of an implanted device Very frequently	Positive culture of material from the pump pocket of an implanted device Frequently	Positive culture of material from the pump pocket of an implanted device Occasionally	Positive culture of material from the pump pocket of an implanted device Rarely	Positive culture of material from the pump pocket of an implanted device Almost never

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* 5. I have patients with device-related infections have difficulty obtaining a staus 3 exception because they do not strictly meet criteria:

Very frequently

Frequently

Occasionally

Rarely

Almost never

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* 6. I have patients with device-related infections who have suffered complications because they could not obtain a status 3 exception.

Very frequently

Frequently

Occasionally

Rarely

Almost never

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* 7. My patients that I believe have device-related infections meet the UNOS criteria by strict definitions:

Very frequently

Frequently

Occasionally

Rarely

Almost never

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* 8. I use the following diagnostic modalities to determine the presence or extent of a potential device-related infection:

	Almost always	Frequently	Occasionally	Rarely	Never
Computed tomography	Computed tomography Almost always	Computed tomography Frequently	Computed tomography Occasionally	Computed tomography Rarely	Computed tomography Never
Ultrasound	Ultrasound Almost always	Ultrasound Frequently	Ultrasound Occasionally	Ultrasound Rarely	Ultrasound Never
fluorine-18 deoxyglucose positron emission tomography (FDG-PET)	fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Almost always	fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Frequently	fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Occasionally	fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Rarely	fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Never
(99m)Tc-labeled leukocyte single-photon emission computed tomography (SPECT-CT)	(99m)Tc-labeled leukocyte single-photon emission computed tomography (SPECT-CT) Almost always	(99m)Tc-labeled leukocyte single-photon emission computed tomography (SPECT-CT) Frequently	(99m)Tc-labeled leukocyte single-photon emission computed tomography (SPECT-CT) Occasionally	(99m)Tc-labeled leukocyte single-photon emission computed tomography (SPECT-CT) Rarely	(99m)Tc-labeled leukocyte single-photon emission computed tomography (SPECT-CT) Never
indium-111-labeled leukocyte SPECT-CT	indium-111-labeled leukocyte SPECT-CT Almost always	indium-111-labeled leukocyte SPECT-CT Frequently	indium-111-labeled leukocyte SPECT-CT Occasionally	indium-111-labeled leukocyte SPECT-CT Rarely	indium-111-labeled leukocyte SPECT-CT Never
gallium-67 (Ga) SPECT-CT	gallium-67 (Ga) SPECT-CT Almost always	gallium-67 (Ga) SPECT-CT Frequently	gallium-67 (Ga) SPECT-CT Occasionally	gallium-67 (Ga) SPECT-CT Rarely	gallium-67 (Ga) SPECT-CT Never

Other (please specify)

Question Title

* 9. I believe that these should be explored as possible criteria in a definition of device-related infection:

	Strongly Agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
Infection suggested by computed tomography	Infection suggested by computed tomography Strongly Agree	Infection suggested by computed tomography Agree	Infection suggested by computed tomography Neither agree nor disagree	Infection suggested by computed tomography Disagree	Infection suggested by computed tomography Strongly disagree
Infection suggested by ultrasound	Infection suggested by ultrasound Strongly Agree	Infection suggested by ultrasound Agree	Infection suggested by ultrasound Neither agree nor disagree	Infection suggested by ultrasound Disagree	Infection suggested by ultrasound Strongly disagree
Infection suggested by fluorine-18 deoxyglucose positron emission tomography (FDG-PET)	Infection suggested by fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Strongly Agree	Infection suggested by fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Agree	Infection suggested by fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Neither agree nor disagree	Infection suggested by fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Disagree	Infection suggested by fluorine-18 deoxyglucose positron emission tomography (FDG-PET) Strongly disagree
Infection suggested by (99m)Tc-labeled leukocyte single-photon emission computed tomography	Infection suggested by (99m)Tc-labeled leukocyte single-photon emission computed tomography Strongly Agree	Infection suggested by (99m)Tc-labeled leukocyte single-photon emission computed tomography Agree	Infection suggested by (99m)Tc-labeled leukocyte single-photon emission computed tomography Neither agree nor disagree	Infection suggested by (99m)Tc-labeled leukocyte single-photon emission computed tomography Disagree	Infection suggested by (99m)Tc-labeled leukocyte single-photon emission computed tomography Strongly disagree
Infection suggested by indium-111-labeled leukocyte SPECT-CT	Infection suggested by indium-111-labeled leukocyte SPECT-CT Strongly Agree	Infection suggested by indium-111-labeled leukocyte SPECT-CT Agree	Infection suggested by indium-111-labeled leukocyte SPECT-CT Neither agree nor disagree	Infection suggested by indium-111-labeled leukocyte SPECT-CT Disagree	Infection suggested by indium-111-labeled leukocyte SPECT-CT Strongly disagree
Infection suggested by gallium-67 (Ga) SPECT-CT	Infection suggested by gallium-67 (Ga) SPECT-CT Strongly Agree	Infection suggested by gallium-67 (Ga) SPECT-CT Agree	Infection suggested by gallium-67 (Ga) SPECT-CT Neither agree nor disagree	Infection suggested by gallium-67 (Ga) SPECT-CT Disagree	Infection suggested by gallium-67 (Ga) SPECT-CT Strongly disagree
Bacteremia with no other clear source	Bacteremia with no other clear source Strongly Agree	Bacteremia with no other clear source Agree	Bacteremia with no other clear source Neither agree nor disagree	Bacteremia with no other clear source Disagree	Bacteremia with no other clear source Strongly disagree
Infection related to the device with no reasonable chance of cure without explantation, as assessed by expert opinion	Infection related to the device with no reasonable chance of cure without explantation, as assessed by expert opinion Strongly Agree	Infection related to the device with no reasonable chance of cure without explantation, as assessed by expert opinion Agree	Infection related to the device with no reasonable chance of cure without explantation, as assessed by expert opinion Neither agree nor disagree	Infection related to the device with no reasonable chance of cure without explantation, as assessed by expert opinion Disagree	Infection related to the device with no reasonable chance of cure without explantation, as assessed by expert opinion Strongly disagree

Other (please specify)