2106. What Metrics Should We Use to Evaluate CAUTI Performance for Inpatient Rehabilitation Units? An Evaluation of a Large, National Healthcare System

Abstract

BackgroundThe National Healthcare Safety Network (NHSN)’s Targeted Assessment for Prevention (TAP) Strategy is a framework for quality improvement that offers a focused approach to infection prevention. The cumulative attributable difference (CAD) is used as a prioritization metric to identify areas with the highest burden of excess infections. The standardized utilization ratio (SUR) provides risk-adjusted urinary catheter metric beyond traditional device utilization ratios (DUR). We reviewed a TAP Report and SURs for all Inpatient Rehabilitation Facilities (IRF) within a large, national healthcare system.MethodsUsing the NHSN database, we generated a catheter-associated urinary tract infection (CAUTI) TAP Report for all IRFs across the system for calendar year 2017. The standardized infection ratio (SIR) goal was set at 0.75. CAD [observed events − (predicted events multiplied by SIR goal)] was calculated. A 12-month cumulative urinary catheter SUR was also computed in NHSN.ResultsData from 26 IRFs were reviewed. Total CAUTIs ranged from 0 to 5 (median = 0, mean = 0.88). DURs ranged from 3 to 17%; CAD, −0.70 to 4.10; 12-month cumulative SURs, 0.35–2.14. Statistically significant SIRs were only calculated for two IRFs. Several IRFs with 0 infections had SURs > 1, and two IRFs with multiple CAUTIs had an SUR of ≤1 (table).ConclusionCAD is an actionable prioritization metric for infection prevention in health systems and individual facilities. In populations where events are rare, however, the SUR can be an additional metric to reduce device-associated risks. Areas with high CAD/low SUR could be evaluated for other potential causal factors, including device insertion, care/maintenance techniques and accuracy of NHSN definition application.Table.TAP Report, including SURFacility TAP RankCAUTIsDUR %12-Month SURCADSIR15141.854.104.12460.723.40*3381.002.40*4491.122.001.55170.850.80*6150.630.80*7150.670.80*81101.290.70*9160.830.70*101172.140.60*111121.570.50*12070.92-0.10*13030.35-0.10*14060.78-0.20*15060.82-0.20*16030.35-0.20*17070.87-0.20*18081.07-0.20*19050.62-0.30*20070.96-0.30*21070.92-0.30*220101.31-0.30*23070.92-0.30*24070.95-0.40*25040.58-0.40*260121.50-0.70** Not calculated.Disclosures All authors: No reported disclosures.