Catheter-associated Urinary Tract Infection Definition Research Articles

Comparison of metrics used to track central-line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) across a regional network.

The paradoxical relationship between standardized infection ratio and standardized utilization ratio for catheter-associated urinary tract infections (CAUTIs) in contrast to central-line-associated bloodstream infections (CLABSIs), in addition to CAUTI definition challenges, incentivizes hospitals to focus their prevention efforts on urine culture stewardship rather than catheter avoidance and care.

809. Modified Laboratory Reporting to Prevent Catheter-Associated Urinary Tract Infections (CAUTIs)

BackgroundCatheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Many patients at our institution with a CAUTI do not have signs or symptoms of infection and bacterial growth likely represents asymptomatic bacteriuria (ASB). As a result, we implemented a Modified Lab Workflow (MLW) focused on diagnostic stewardship to improve urine culture (UCx) reporting and prevent misclassification and unnecessary treatment of CAUTIs.MethodsOn Sep. 1, 2019, laboratory reporting of Foley UCx was modified according to the protocol in Figure 1. UCx results were divided into 3 groups: (1) no growth, (2) mixed bacterial flora (≥3 organisms) not consistent with infection or (3) growth of ≤2 organisms with at least 1 organism ≥105 cfu/ml per National Healthcare Safety Network (NSHN) CAUTI definition. Group 3 UCx were resulted with instructions to the clinician (see Figure 1.). When requested, group 3 results were reviewed by Infection Prevention and released with organism identification and antibiotic susceptibility if it met Infectious Diseases Society of America (IDSA) CAUTI criteria. Otherwise they were resulted as: “Bacterial growth indicative of contamination or colonization.”Figure 1. Modified Laboratory Workflow for Reporting Urine Cultures from Foley Catheters ResultsBetween Sep. 1, 2019 to Mar. 1, 2020, a total of 134 UCx from catheterized patients were reviewed. Forty-two (31%) of UCx were from patients with a Foley in-situ ≥48 hours and processed through MLW; 92 UCx were from a Foley in place < 48 hours and excluded from the study. Of the 42 UCx processed via MLW, 16 (38%) were no growth and 7 (17%) had bacterial growth suggestive of contamination. For group 3, 19/42 (45%) had growth of significant bacteria but only 1(5%) met IDSA criteria for reporting. During the study, 6 additional CAUTIs were reported due to incorrect specimen labeling causing Foley urine specimens to subvert MLW.ConclusionDuring our study, we identified 1 CAUTI through apt MLW use. Seven total CAUTIs occurred (SIR=0.66); a majority due to incorrect UCx source labeling, resulting in missed MLW screening. Ten CAUTIs (SIR=0.97) were reported in the preceding 6 months. As part of a comprehensive CAUTI prevention program, a MLW can help reduce classification of ASB as a CAUTI. Education to providers on precise labeling of UCx source is a key component of a successful MLW.Disclosures All Authors: No reported disclosures

Catheter-Associated Urinary Tract Infection Reduction in the Solutions for Patient Safety Pediatric Safety Engagement Network

Background: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of healthcare-associated infection. Catheter insertion and maintenance bundles have been developed to prevent CAUTIs, but they have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children’s hospitals. Methods: Children’s hospitals joined the Solution for Patient Safety (SPS) safety engagement network from 2011 through 2017 and elected to participate in CAUTI prevention efforts, with 26 hospitals submitting data initially and 128 participating by the end. CAUTI prevention recommendations were first released in May 2012, and insertion and maintenance bundles were released in May 2014 (Table 1). Hospitals reported on CAUTIs, patient days, urinary catheter line days (CLD), and they tracked reliability to each bundle. For the network, control charts were used to plot CAUTI rates, urinary catheter utilization, and reliability to each bundle component. Results: Following the introduction of the pediatric CAUTI insertion and maintenance bundles, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1,000 CLD (Fig. 1). Centerline shifts occurred both before and after the 2015 CDC CAUTI definition change, which may also have contributed to a centerline shift. Urinary catheter utilization rates did not decline during the intervention period. Network reliability to the insertion and maintenance bundles increased to 95.4% and 86.9%, respectively. Conclusions: Insertion and maintenance bundles aimed at preventing CAUTIs were introduced across a large network of children’s hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.Funding: NoneDisclosures: None

Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network.

Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals. Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively. IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.

Foley Vacation Use to Reduce CAUTI in an ICU

<h3>Background</h3> This project identifies the impact to Catheter Associated Urinary Tract Infection (CAUTI) with the use of a Foley Vacation Algorithm. An increase in CAUTIs was noted in the Intensive Care Unit (ICU) at a Comprehensive Stroke Center. <h3>Methods</h3> This project includes patients admitted to the ICU. The intended target for the Foley vacation algorithm was patients with an indication of "urinary retention." The Foley vacation algorithm was implemented in June 2018. Pre-data was collected starting in January 2018, when the increase in CAUTIs was identified. Post implementation data is through Quarter 3 2019. The hypothesis of the change was that CAUTIs would decrease with implementation of the Foley Vacation Algorithm with an expected decrease in device utilization contributing to a decreased infection risk. The CAUTI definition used was based on NHSN criteria and the outcome data includes a Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) also defined by NHSN. <h3>Results</h3> After implementation of the Foley Vacation Algorithm in June 2018, the SUR dropped and the ICU has had 2 infections in the first 3 quarters of 2019 as compared to 7 in the same time frame the year prior. The SIR dropped more than half from an average of 2.4 per quarter in 2018 to 1.093 per quarter in 2019. <h3>Conclusions</h3> This project found that utilization of a Foley Vacation Algorithm for patients in the ICU with an indication of "urinary retention" resulted in a decrease in CAUTIs. Utilization of this practice when other CAUTI prevention bundle measures are in place can help decrease utilization and prevent CAUTI in other units or facilities.

Imprecision Medicine: Challenges in Diagnosis, Treatment, and Measuring Quality for Catheter-Associated Urinary Tract Infection.

We question the reliability of the vague symptoms that most commonly define catheter-associated urinary tract infection (CAUTI) and encourage further examination of whether the current CAUTI definition reflects a true infection. While diagnosing CAUTI using the current surveillance definition, physicians may be missing a number of nonurinary etiologies for fever, prematurely diagnosing urinary tract infection, and prescribing unnecessary antibiotics. We believe it is time to reconsider the quality metric of CAUTI. By doing so, we can improve antibiotic use and quality of patient care.

1152. Implementation of Enhanced Data Surveillance Methods to Reduce Catheter-Associated Urinary Tract Infections

BackgroundUrinary tract infections (UTIs) continue to be one of the most common types of healthcare-associated infections (HAIs). Instrumentation of the urinary tract using devices such as indwelling urinary catheters (IUCs) is the leading cause of healthcare-associated UTIs. Every day that a patient has an IUC increases their risk of acquiring a UTI. After an increase in the number of catheter-associated urinary tract infections (CAUTIs), a mid-sized acute care hospital in the Northeast United States used an electronic surveillance system to monitor IUC order compliance and appropriateness in order to reduce IUC utilization and prevent CAUTIs.MethodsUsing an Infection Prevention (IP) electronic surveillance system, a line list was generated of patients who had an IUC documented in the urinary flow sheet of their electronic medical record. This list contained variables such as: catheter insert date, catheter order status, and catheter indication. IP staff sent this list in a daily e-mail to clinical leadership and front line staff over a 14 month period. The e-mail notified providers when their patients had an IUC without an order. Clinical staff was directed to discontinue the IUC if it was no longer indicated or to place a new IUC order if still indicated. The National Healthcare Safety Network (NHSN) CAUTI definition and data functions were used for the purposes of this study.ResultsA statistically significant (P = 0.017) reduction in the hospital CAUTI rate was found when a comparison was made between the 14-month pre-intervention baseline period (1.12 CAUTI per 1,000 catheter days) and the 14 month post-intervention period (0.29 CAUTI per 1,000 catheter days). A statistically significant decrease (P = 0.0004) in IUC utilization was also noted for the same time period, decreasing from 8.2 catheters per 100 patient-days to 7.8 catheters per 100 patient-days.ConclusionA significant reduction in CAUTIs and IUC utilization was seen over the 14-month IP-driven e-mail intervention. This study suggests that regular electronic communication of surveillance system information to providers may reduce CAUTIs. Disclosures All authors: No reported disclosures.

Validation and impact of the use of automated urine culture streak system in a diagnostic laboratory on surveillance of catheter-associated urinary tract infections at a tertiary care setting

Background: Quantitative urine culture reporting on plates inoculated by automated streaking system (PREVI® Isola) demonstrates maximum growth only equivalent up to 104 colony-forming unit (CFU)\ml, according to the manufacturer's recommendation. Therefore, there is a probability of erroneous catheter-associated urinary tract infection (CAUTI) surveillance data as a count of ≥105 CFU/ml is required according to CAUTI definition. This study aimed to validate automated urine culture streak system for improving the surveillance of hospital-acquired CAUTIs. Materials and Methods: This was a prospective, cross-sectional study. In 1-month duration, urine samples of 1000 consecutive patients reported to the microbiology section for culture and sensitivity were included. Samples were processed simultaneously manually (1 μl loop) and with an automated streaking system. Plates streaked by automated method were arbitrarily divided into eight equally sized segments. After 24 h of incubation at similar conditions, microbial growths in each segment were noted and correlated with its manual colony count. To minimize the error, colony count and morphotype were analyzed by a senior technologist and counterchecked by a consultant. Results were recorded on an Excel sheet. Results: Growth on the 7th and 8th segments corresponded with ≥105 CFU/ml. Growth up to the 4th, 5th, and 6th segments corresponded with 104 CFU/ml, whereas the 3rd segment with >103 but

The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center.

The 2015 changes in the catheter-associated urinary tract infection definition led to an increase in central line-associated bloodstream infections (CLABSIs) and catheter-related candidemia in some health systems due to the change in CLABSI attribution. However, our rates remained unchanged in 2015 and further declined in 2016 with the implementation of new vascular-access guidelines.Infect Control Hosp Epidemiol 2018;878-880.

Definitional Change in NHSN CAUTI Was Associated with an Increase in CLABSI Events: Evaluation of a Large Health System

BACKGROUND The National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) definition was revised as of January 2015 to exclude funguria and lower bacteriuria levels. We evaluated the effect of the CAUTI definition change on NHSN-defined central-line-associated bloodstream infection (CLABSI) outcomes. METHODS We compared CAUTI and CLABSI NHSN-defined outcomes for calendar years 2014 and 2015 in the adult intensive care units (ICUs) of a single large health system. Changes in the event rates, the associated organisms, and the standardized infection ratio (SIR) were evaluated. RESULTS The study included 137 adult ICUs from 65 hospitals. The CAUTI SIR dropped from 1.04 in 2014 to 0.58 in 2015 (-44.2%), while the CLABSI SIR increased from 0.36 in 2014 to 0.47 in 2015 (+30.6%). CAUTI rates dropped 44.8% from 2.09 to 1.15 events per 1,000 device days (P<.001). Gram-positive-associated CAUTI rates dropped 36.7% from 0.34 to 0.22 per 1,000 device days (P=.007). CLABSI rates increased 27.1% from 0.71 to 0.90 per 1,000 device days (P=.027). Candida-associated CLABSI increased by 91.1% from 0.104 to 0.198 per 1,000 device days (P=.012), and Enterococcus-associated CLABSI increased by 121.6% from 0.071 to 0.16 per 1,000 device days (P=.008). CONCLUSIONS The revised CAUTI definition led to a large reduction in CAUTI rates and, in turn, an increase in candidemia and enterococcemia cases classified as CLABSI events. These findings have important implications on the perceived successes or failures to eliminate both infections. Infect Control Hosp Epidemiol 2017;38:685-689.

Clinical Relevance of the 2014 and 2015 National Healthcare Safety Network’s Catheter-Associated Urinary Tract Infection Definitions

BackgroundThe National Healthcare Safety Network’s (NHSN) catheter-associated urinary tract infection (CAUTI) definition has changed multiple times in the previous decade with substantial changes occurring in 2009, 2013, and 2015. Efforts to improve the clinical relevance of this definition have been made, notably the exclusion of Candida species. This study quantifies the magnitude of discrepancy in CAUTI between the 2014 and 2015 definitions and determines which of these definitions has more clinical relevance.MethodsThis is a retrospective study at a 500 bed academic hospital. Eligible cases were identified by a query of our facility’s 2014 NHSN CAUTI cases. We reviewed cases to determine whether they met criteria for CAUTI using the 2014 and 2015 NHSN definitions and also to determine the clinical relevance of the CAUTI. Clinical CAUTI was defined as a provider documenting CAUTI in the progress notes or discharge summary. Subcategories of Clinical CAUTI included “Definite CAUTI”, the presence of UTI in clinical documentation without another documented etiology of fever, and “Possible CAUTI”, documentation of both UTI and another cause of fever. A positive urinalysis was defined as The presence of ≥10 WBC, moderate/large leukocyte esterase, or nitrites.ResultsThere were 65 eligible CAUTI in 61 patients reported to NHSN in 2014. All met the 2014 definition, but only 38 (58%) met the 2015 definition. The median age was 57 years (IQR 51–67), and 54% (n = 33) were male. Clinical CAUTI was diagnosed in 44 patients (68%) meeting the 2014 definition and 33 patients (87%) meeting the 2015 definition (P < 0.001). Half of Clinical CAUTI identified by the 2014 definition were considered to be Definite CAUTI; similar results were found using the 2015 definition. Independent predictors of Clinical CAUTI included urine cultures positive for Gram-negative bacilli (OR 5.2, 95% CI 0.9 to 29.2), positive urinalysis (OR 7.1, 1.4 to 36.1), and use of the 2015 definition (OR 4.7, 0.9 to 23.4).ConclusionThis data suggests that introduction of the 2015 definition may result in a 42% reduction in CAUTI. The 2015 definition was associated with more Clinical CAUTI. Further refinement of the 2015 CAUTI definition could be attained by excluding those cases attributed to other causes of fever.Disclosures All authors: No reported disclosures.

2015 NHSN CAUTI Definition Change and Its Impact on CLABSI Rates at an Academic Medical Center

Background The National Healthcare Safety Network (NHSN) revised their catheter-associated urinary tract infection (CAUTI) definition in January 2015 to exclude funguria. This definition change led to an increase in diagnosis of catheter-related fungemia in other health systems, due to the exclusion of CAUTI as an attributable source. We evaluated the effect of the NHSN CAUTI definition change on central line-associated blood stream infection (CLABSI) rates at our hospital.Methods This is a retrospective study that was conducted at an 1,154-bed academic medical center. We looked at the trend of our house-wide and intensive care unit (ICU) CLABSI and CAUTI incidence rates (IR) from January 2013 to December 2016. Our institutional vascular access policy was updated in 2016 to revise insertion and maintenance practices and introduce new guidelines for drawing blood cultures in setting of central lines.ResultsWith the 2015 CAUTI definition, our house-wide CAUTI IR decreased by > 75% from 2014 to 2015 (3.42 to 0.92 per 1,000 catheter days (CD) P < 0.05). Conversely, there was an initial increase in our house-wide CLABSI IR from 2014 to 2015 (1.34 to 2.1 per 1,000 CD, P < 0.05), followed by a significant decline to 1.31 per 1,000 CD in 2016 (P < 0.05). Similarly, our ICU CLABSI IR increased slightly in 2015 (1.59 to 1.83 per 1,000 CD, P = 0.1) followed by a significant decline in 2016 (1.83 to 0.91 per 1,000 CD, P < 0.05, Table 1). This initial increase in our CLABSI IR in 2015 was mainly driven by gram-positive organisms. Despite exclusion of yeast as pathogens from the 2015 CAUTI definition, our rates of catheter-related fungemia remained relatively stable (Figure 1).Conclusion The 2015 NHSN CAUTI definition resulted in a significant decline in our CAUTI rates. We did not see a sustained increase in our CLABSI rates as reported by other health systems. In fact, our CLABSI rates and catheter--related fungemia rates decreased in 2016. This could be related to implementation of new vascular access guidelines and CLABSI prevention efforts.Table 1:Incidence rates (IR) per 1000 catheter days using applicable NHSN definitionYearHouse-wide CAUTI IRHouse-wide CLABSI IRICU CAUTI IRICU CLABSI IR20134.951.543.752.0220143.421.342.541.5920150.922.10.781.8320160.801.311.060.91Disclosures All authors: No reported disclosures.

Removing Yeast from the Catheter-Associated Urinary Tract Infection Definition: The Impact on Rates for a Large Healthcare System

Removing Yeast from the Catheter-Associated Urinary Tract Infection Definition: The Impact on Rates for a Large Healthcare System

Impact of changes in the NHSN catheter-associated urinary tract infection (CAUTI) surveillance criteria on the frequency and epidemiology of CAUTI in intensive care units (ICUs).

The impact of the 2013 NHSN CAUTI definition on CAUTI rates was analyzed. A total of 107 CAUTI episodes were identified; 60 according to NHSN 2013 definitions only and 47 according to the 2012 and 2013 definitions. Physician-diagnosed "other infections" were more common among patients who had CAUTI only according to NHSN 2013 definitions (P<.001).

Epidemiology of Foley Utilization and Impact of Changed NHSN CAUTI Definition on Surveillance Practice and CAUTI Rates

In January, 2013, the wording of the NHSN (National healthcare safety network) definition for CAUTI (Catheter-associated urinary tract infection) was changed to include fever regardless of the source or presence of an alternative NHSN-defined infection. We surveyed Infection Preventionists (IPs) in a large healthcare system to determine the impact of the changes in CAUTI definition on surveillance and/or reporting practices since this change.

Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection

The National Healthcare Safety Network (NHSN) definition for catheter-associated urinary tract infection (CAUTI) is used to evaluate improvements in CAUTI prevention efforts. We assessed whether clinician practice was reflective of the NHSN definition. We evaluated all adult inpatients hospitalized between July 2010 and June 2011, with a first positive urine culture > 48 hours of admission obtained while catheterized or within 48 hours of catheter discontinuation. Data comprised patients' signs, symptoms, and diagnostic tests; clinician's diagnosis; and the impression of the infectious diseases (ID) consultant. The clinician's practice was compared with the NHSN definition and the ID consultant's impression. Antibiotics were initiated by clinicians to treat CAUTI in 216 of 387 (55.8%) cases, with 119 of 387 (30.7%) fitting the NHSN CAUTI definition, and 63 of 211 (29.9%) considered by ID to have a CAUTI. The sensitivity, specificity, and positive and negative predictive values of a clinician diagnosis of CAUTI were 62.2%, 47%, 34.3%, and 73.7% when compared with NHSN CAUTI definition (n = 387) and 100%, 57.4%, 50%, and 100% when compared with the ID consultant evaluation (n = 211), respectively. The positive predictive value of the NHSN CAUTI definition was 35.1% when compared with the ID consultant's impression (n = 211). NHSN CAUTI definition did not reflect clinician or ID consultant practices. Our findings reflect the differences between surveillance definitions and clinical practice.

Active training and surveillance: 2 good friends to reduce urinary catheterization rate

Because catheter-associated urinary tract infections (CAUTI) represent the most frequent health care-associated infection (HAI), we implemented an educational intervention on urinary catheter use to reduce the CAUTI rate. The intervention was focused on correct management of catheterized patients. To assess the participants' knowledge, pre- and post-tests were performed. An active CAUTI surveillance program took place in a 900-bed teaching hospital in central Italy before and after the educational intervention. CAUTI definition, catheterization rate, and CAUTI rate were expressed according to the Centers for Disease and Prevention/National Healthcare Safety Network definitions. The level of significance was set at P ≤ .05. Two hundred ninety-six health care workers attended the educational intervention; the analysis of the pre- and post-tests highlighted a statistically significant improvement (P < .05). Before the intervention, mean catheterization rate was 18.5% (95% confidence interval [CI]:18.1-18.9); 46 cases of CAUTI were detected, with an incidence rate of 6.6/1,000 catheter-days (95% CI: 4.8-8.8). After the intervention, mean catheterization rate was 9.2% (95% CI: 8.9-9.5); 19 cases of CAUTI were detected, with an incidence rate of 5.8/1,000 catheter-days (95% CI: 3.5-9.0). Through an active educational update and thanks to the implementation of a surveillance system, a successful reduction of catheterization rate was achieved. More efforts are needed to preserve this goal and to improve the CAUTI rate also.