Surveillance Of Catheter-associated Urinary Tract Infections Research Articles

Validation of automated surveillance of healthcare-associated infections using electronic screening algorithms

Background: Surveillance of healthcare-associated infection (HAI) is the basis of infection prevention programs. However, manual review of medical records is a labor-intensive and time-consuming process. We evaluated the diagnostic performance of automated surveillance of HAI using electronic screening algorithms. Methods: Between April and June 2022, we conducted surveillance of HAI manually and automatically using electronic screening algorithm on 75 units (general medical and surgical wards and ICUs) in a 2,700-bed, tertiary-care hospital in South Korea. Algorithms for surveillance of HAI were developed accordance with NHSN surveillance definitions (Fig. 1). Catheter-associated urinary tract infections (CAUTIs) were automatically detected when eligible pathogen and fever (>38°C) were matched within infection window period. Other specific types of infection were automatically classified based on laboratory results that met NHSN criteria. After the algorithm showed possible cases that met laboratory-confirmed bloodstream infection (LCBI) criteria, we excluded secondary BSIs using the automatic surveillance algorithm. We analyzed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the automated surveillance system compared to manual surveillance. Results: An algorithm for detecting CAUTI showed 98.7% sensitivity (78 of 79), 100.0% specificity (2,443 of 2,443), 100.0% PPV (78 of 78), and 100.0% NPV (2,443 of 2,444). For CLABSI, the algorithm had 97.3% sensitivity (214 of 220), 98.3% specificity (5,759 of 5,861), 67.7% PPV (214 of 316), and 99.9% NPV (5,759 of 5,765). In total, 102 cases of possible CLABSI were identified by the algorithm, and 76 (74.5%) were eventually diagnosed as secondary BSIs. Also, by chart review, 20 BSIs (19.6%) were present on arrival in ER (ER-POA). In 4 cases (3.9%), an original pathogen reoccurred in a repeated infection timeframe (RIT), and 2 cases (2%) were mucosal barrier injury-LCBI (MBI-LCBI). When we additionally performed manual surveillance for intra-abdominal infection secondary BSI, ER-POA, and assigning pathogen to original BSI in RIT, PPV increased to 87.7% (214 of 244). Conclusions: Algorithm for automated surveillance of CAUTI had good performance; however, automated surveillance of CLABSI was suboptimal. More elaborate screening algorithm for diagnosis CLABSI is needed, and further studies are needed to determine whether an automated surveillance system can reduce workload for surveillance of HAI.Disclosures: None

A National Intervention to Reduce Undesirable Urinary Tract Events in Internal Medicine Wards

Background: Catheter-associated urinary tract infection (CAUTI) is considered a preventable healthcare-associated infection. Many local and national interventions using multimodal prevention measures have targeted CAUTI incidence as the primary outcome. Other undesirable events related to urinary catheters and infections such as overuse of urine culturing and antimicrobial prescribing for asymptomatic bacteriuria, are not captured by CAUTI surveillance, and may not be the targets of such interventions. The aim of this study was to assess the impact of expanded national surveillance targeting various aspects of urinary tract infections, culturing and treatment practices, and catheter use in internal medicine wards. Methods: The Israeli National Center for Infection Control (NCIC) issued CAUTI prevention guidelines and initiated in 2016 a urinary tract event surveillance system that targets the incidence of CAUTI, urinary catheter utilization ratio, and the proportion of urine cultures sent and patients treated in the absence of symptoms. The surveillance is conducted for 1 month 3 times per year. Hospitals are required to report all positive urine cultures (>100,000 CFU) collected in internal medicine wards, along with the following data: admission date, symptoms of infection, dates of urinary catheter use, and antibiotic treatment. These data enable the NCIC to validate hospital classifications of each event. In addition, during each surveillance month, hospitals conduct point-prevalence surveys of compliance with CAUTI prevention measures. An electronic data collection form with built-in algorithms supports the local teams during the surveillance process. Results: Between 2016 and 2019, a total of 3,028 positive urine cultures not present on admission were reported by internal medicine wards in 30 hospitals. A significant decrease was observed in the incidence of CAUTI (from 4.7 to 2.9; P < .001) and in the proportion of asymptomatic bacteriuria treated with antibiotics (from 31% to 20%; P = .02) (Table 1). The catheter utilization ratio decreased from 0.25 to 0.23 (P < .001). The rate of cultures sent from asymptomatic patients decreased from 1.5 to 1.1 (P < .01). Point-prevalence surveys in internal medicine wards detected a significant increase in the use of closed urinary drainage systems (from 79% to 97% in 2018, P < .001) and documentation of a daily nurse assessment of the need for a catheter (from 74% to 81%, P < .001). Conclusions: National surveillance of undesirable urinary tract events resulted in a significant reduction in CAUTI, antibiotic treatment for ASB, and the rate of cultures sent from asymptomatic patients. A small decrease was observed in catheter utilization ratio. CAUTI surveillance programs should include other undesirable urinary tract events.Funding: NoneDisclosures: None

Correlating incidence densities and point-prevalence for the surveillance of catheter-associated urinary tract infections

We aimed to validate the use of point-prevalence to identify catheter-associated urinary tract infections against the gold standard of incidence densities. We did not find a significant association, and hence our findings do not support the common practice of using point-prevalence as a less resource intensive method for catheter-associated urinary tract infections surveillance.

A Nurse-Led Low-Cost Intervention Effectively Traces Prevalence of Catheter Associated Urinary Tract Infections at a Low-Resourced Regional Referral Hospital in Western Uganda: A Case for Policy Change.

Catheter associated urinary tract infection (CAUTI) is the most common hospital-acquired infection worldwide. Low- and middle-income countries (LMICs) with limited resources for health care have not allocated resources to adequately monitor or prevent CAUTIs. The infection is associated with several adverse clinical outcomes, including antibiotic resistance, septicemia, and prolonged hospital stays, that burden the already resource-constrained health systems in LMICs with increased morbidity, health care costs, and deaths. Owing to the lack of resource allocation, little is known about the prevalence of CAUTI in the government-owned and operated hospitals in LIMCs. The purpose of this research was to test a method of CAUTI prevalence surveillance suitable to the resource-constrained health system in a LMIC and to determine the prevalence of CAUTI among hospitalized patients at the study site. In an intermittent 4-week data collection plan, the sample of 68 catheterized adult participants was evaluated for the presence of CAUTI using the three-pronged screening criteria of American Urological Society. CAUTI prevalence in the sample was 17.6%. The high prevalence of CAUTI in this sample represents a substantial risk of consequences to hospitalized patients and to the resource-constrained health system in this LMIC. This first report of CAUTI surveillance using readily available and affordable tools provides evidence to health ministry policymakers of the need for and value of monitoring and prevention programs for hospital-acquired infections in LMICs. We recommend LMIC health policymakers to establish infection prevention teams in hospitals and provide resources to continue surveillance and prevention of CAUTI and other hospital-acquired infections.

Spinal Cord Injury Creates Unique Challenges in Diagnosis and Management of Catheter-Associated Urinary Tract Infection.

Background: Catheter-associated urinary tract infection (CAUTI) is associated with increased morbidity and mortality and influences the quality of life of patients with spinal cord injury (SCI). Objectives: This clinical review aims to highlight the unique surveillance, prevention, diagnosis, and management challenges of CAUTI in the SCI population. Methods: Narrative review of the current literature on catheter use in persons with SCI was conducted to determine gaps in knowledge and opportunities for improvement. Results: Surveillance of CAUTI is challenging in the SCI population as the ability to detect symptoms used to diagnose CAUTI (ie, suprapubic pain, dysuria) is impaired. In terms of prevention of CAUTI, current strategies refocus on appropriate catheter insertion and care and early removal of catheters, which is not always feasible for persons with SCI. Prophylactic antibiotics, nutraceuticals, and coated catheters show limited efficacy in infection prevention. Diagnosing CAUTI after SCI is challenging, often resulting in an overdiagnosis of CAUTI when truly asymptomatic bacteriuria exists. In the management of CAUTI in patients with SCI, the use of multiple antibiotics over time in an individual increases the rate of multidrug-resistant organisms; therefore, the exploration of novel non-antibiotic treatments is of importance. The patient experience should be at the center of all these efforts. Conclusion: Better diagnostic tools or biomarkers are needed to define true CAUTI in people with SCI. SCI-specific evidence to inform catheter management and CAUTI treatment guidelines is needed, with the goal to minimize catheter-related harm, reduce antibiotic resistance, and improve satisfaction and overall quality of life for SCI patients.

Visualizing Infection Surveillance Data for Policymaking Using Open Source Dashboarding.

Health care-associated infections, specifically catheter-associated urinary tract infections (CAUTIs), can cause significant mortality and morbidity. However, the process of collecting CAUTI surveillance data, storing it, and visualizing the data to inform health policy has been fraught with challenges. No standard has been developed, so the objective of this article is to present a prototype solution for dashboarding public health surveillance data based on a real-life use-case for the purposes of enhancing clinical and policy-level decision-making. The solution was developed in open source software R, which allows for the creation of dashboard applications using the integrated development environment developed for R called RStudio, and a package for R called Rshiny. How the surveillance system was designed, why R was chosen, how the dashboard was developed, and how the dashboard features were programmed and function will be described. The prototype dashboard includes multiple tabs for visualizing data, and allows the user to interact with the data by setting dynamic filters. Controls were used to facilitate the interaction between the user and application. Rshiny is reactive, in that when the user (e.g., clinician or policymaker) changes the parameters on the data, the application automatically updates the visualization as well as parameters available based on current filters. The prototype dashboard has the potential to enhance clinical and policy-level decision-making because it facilitates interaction with the data that provides useful visualizations to provide such guidance.

Changes in health care-associated infection prevention practices in Japan: Results from 2 national surveys

A national survey conducted in 2012 revealed that the rates of regular use of many evidence-based practices to prevent device-associated infections were low in Japanese hospitals. We conducted a second survey 4 years later to evaluate changes in infection prevention practices. Between July 2016 and January 2017, the instrument used in a survey of Japanese hospitals in 2012 was sent to 1,456 Japanese hospitals. The survey assessed general hospital and infection prevention program characteristics and use of practices specific to preventing catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). Independent sample chi-square tests were used to compare prevention practice rates between the first and second surveys. A total of 685/971 (71%) and 940/1,456 (65%) hospitals responded to the first and second surveys, respectively. For CAUTI, only use of bladder ultrasound scanners (11.1%-18.1%; P < .001) increased. For CLABSI, use of chlorhexidine gluconate for insertion site antisepsis (18.5%-41.1%; P < .001), antimicrobial dressing with chlorhexidine (3.4%-7.1%; P = .001), and central line insertion bundle (22.9%-33.0%; P < .001) increased. For VAP, use of semirecumbent positioning of patients (65.0%-72.3%; P = .002), sedation vacation (31.5%-41.6%; P < .001), oscillating/kinetic beds (4.7%-8.6%; P = .002), and a collective VAP prevention bundle (24.8%-34.8%; P < .001) increased. Fewer than 50% of Japanese hospitals reported conducting CAUTI and VAP surveillance. Collaborative approaches and stronger incentives promoting infection prevention efforts may be warranted to further increase use of most evidence-based practices to reduce common health care-associated infections in Japan.

Catheter-associated Urinary Tract Infection Surveillance in Intensive Care Units in a Tertiary Care Hospital: A Pilot Study

Catheter-associated Urinary Tract Infection Surveillance in Intensive Care Units in a Tertiary Care Hospital: A Pilot Study

Contemporary Epidemiology of Catheter-Associated Urinary Tract Infections (CAUTIs) in a Tertiary Care Center: Is Foley Re-Insertion a Novel Risk Factor?

BackgroundCAUTIs are one of the most common causes of hospital-acquired infections. We report on a retrospective analysis performed on prospectively collected CAUTI surveillance data from 2014 to 2016 at a large tertiary care academic hospitalMethodsA total of 181 CAUTIs by NHSN definition were reviewed to describe contemporary demographics, risk factors, microbiology, and outcomes.ResultsThe 181 CAUTIs involved 178 patients. 61% were female. Events mostly occurred in an ICU setting (65%), specifically our neurosurgical unit (23%), followed by floors (24%) and intermediate units (11%). Most episodes occurred within a week after the initial catheter insertion (60%). 40% of CAUTIs occurred within an average of 5.5 days (SD ± 5.12) after a Foley re-insertion. Of the 221 cultured micro-organisms, Gram-negatives accounted for 74% (predominately K. pneumoniae and E. coli), followed by Gram-positives and yeast at 18% and 8%, respectively. 8% of organisms showed multi-drug resistance, 8% of patients developed C. difficile co-infections, 23% had concomitant bacteremia, and the length of stay averaged 28 days (SD ± 26.74). 55% of patients were discharged to another facility. 12% of patients expired and 4% were discharged to hospiceConclusionWe describe the contemporary demographics, microbiology and outcomes of CAUTIs in a large tertiary care center. We also found that 40% of our CAUTIS are associated with a Foley removal and re-insertion event. Reasons requiring catheter exchanges and reinsertions include leakage, bleeding, obstruction, failed voiding trial, and general malfunction. Although this observation needs to be confirmed case control studies and larger observational trials, this new insight may provide an opportunity to intervene and focus infection prevention interventions in this novel high-risk population.Disclosures All authors: No reported disclosures.

Education on Basics Results in Significant CAUTI Reduction, Cost Savings

PHOENIX — Staff at the 162-bed Henry J. Carter Nursing Facility in New York City achieved a 78% reduction in the rate of catheter-associated urinary tract infections (CAUTI) with training on basic care and strict adherence to preventive practices, Emalyn Bravo, RN, MA, LNHA, reported at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference. “We emphasized the concept that CAUTI prevention is about basic, simple care,” said Ms. Bravo, associate director of performance improvement at the facility. The nursing facility participated in a year-long project with the Agency for Healthcare Research and Quality’s (AHRQ) budding Safety Program for Long-Term Care to reduce CAUTI and other health care–acquired infections. Between September 2015 and July 2016, the facility’s CAUTI rate declined from 3.28 per 1,000 catheter days to 0.72 per 1,000 catheter days, resulting in a 73% cost reduction for the facility (from $30,470 down to $8,310), Bravo reported at the meeting. Moreover, the cost savings attributable to eliminated antibiotic use during the project period were almost $26,000, she added in a later interview with Caring. Education and training included webinars and coaching calls by program coordinators from The Joint Commission and AHRQ, as well as competency assessments, care checklists, daily huddles, and weekly sharing of data within the facility. More than 200 staff (including physicians, registered nurses, licensed practical nurses, certified nurse assistants, housekeepers, and nursing home leaders) received some kind of education or training during the year, and five staff members (one LPN and four CNAs) were appointed “CAUTI champions” to encourage and lead staff through the project. A key factor in CAUTI prevention, Bravo said at the conference, was the timely evaluation of residents admitted with Foley catheters from acute care hospitals. During the course of the program, 15 of 21 residents admitted with Foleys had their catheters removed. “The sooner we remove the catheter, the less risk there will be for infection,” she emphasized in the interview. “Hospitals use Foley catheters all the time, and when they discharge, they [don’t] discontinue them.” The other key to their CAUTI reduction was education and vigilance about basic care concepts such as aseptic insertion of Foley catheters and proper catheter care (such as using routine hygiene, maintaining a closed drainage system and unobstructed urine flow, and keeping the drainage bag below the level of the bladder at all times). With education, CNAs began avoiding the shortcuts that previously led to catheter contamination, Ms. Bravo told Caring. The facility’s Foley catheter utilization rate among its 130 long-term care residents remained steady throughout the project at about 6% because of clinical necessity, but the residents with long-term use neither developed UTI nor were hospitalized. CAUTI can lead to complications such as cystitis, pyelonephritis, bacteremia, and septic shock, each of which can result in hospitalizations, increased mortality, and declines in function and mobility. “We do believe that education is an investment and ignorance is expensive,” Ms. Bravo said at the meeting. The indwelling urinary catheter should not substitute for nursing care of residents with incontinence, she emphasized. Nor should it serve as a means of obtaining urine for culture or other diagnostic testing when the resident can voluntarily void. As participants of the AHRQ project, staff at the Henry J. Carter Nursing Facility also learned more about current CAUTI surveillance definitions, interpretation of urine diagnostics, and judicious use of antibiotics. “If there’s no symptom like fever or pain, we don’t send for a culture … and we’re more proactive about [pushing] more nourishment and fluids,” Ms. Bravo told Caring. A key factor in CAUTI prevention was the timely evaluation of residents admitted with Foley catheters from acute care hospitals. Based on the experience at her facility and at several hundred other nursing homes that participated in the AHRQ project, the agency fine-tuned its Toolkit to Reduce CAUTI and Other HAIs in Long-Term Care Facilities (www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/index.html). The Carter facility’s experience was also described in the March issue of JAMDA (J Am Med Dir Assoc 2017;18:B18). Christine Kilgore is a freelance writer in Falls Church, VA.

Potential Misclassification of Urinary Tract-Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network.

The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1 × 10(5) colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary tract infections.

Natural Language Processing for Real-Time Catheter-Associated Urinary Tract Infection Surveillance: Results of a Pilot Implementation Trial.

Incidence of catheter-associated urinary tract infection (CAUTI) is a quality benchmark. To streamline conventional detection methods, an electronic surveillance system augmented with natural language processing (NLP), which gathers data recorded in clinical notes without manual review, was implemented for real-time surveillance. To assess the utility of this algorithm for identifying indwelling urinary catheter days and CAUTI. Large, urban tertiary care Veterans Affairs hospital. All patients admitted to the acute care units and the intensive care unit from March 1, 2013, through November 30, 2013, were included. Standard surveillance, which includes electronic and manual data extraction, was compared with the NLP-augmented algorithm. The NLP-augmented algorithm identified 27% more indwelling urinary catheter days in the acute care units and 28% fewer indwelling urinary catheter days in the intensive care unit. The algorithm flagged 24 CAUTI versus 20 CAUTI by standard surveillance methods; the CAUTI identified were overlapping but not the same. The overall positive predictive value was 54.2%, and overall sensitivity was 65% (90.9% in the acute care units but 33% in the intensive care unit). Dissimilarities in the operating characteristics of the algorithm between types of unit were due to differences in documentation practice. Development and implementation of the algorithm required substantial upfront effort of clinicians and programmers to determine current language patterns. The NLP algorithm was most useful for identifying simple clinical variables. Algorithm operating characteristics were specific to local documentation practices. The algorithm did not perform as well as standard surveillance methods.

An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units

Traditional methods of surveillance of catheter-associated urinary tract infections (CAUTIs) are error-prone and resource-intensive. To resolve these issues, we developed a highly sensitive electronic surveillance tool. To develop an electronic surveillance tool for CAUTIs and assess its performance. The study was conducted at a 947-bed tertiary care center. Patients included adults aged ≥18years admitted to an intensive care unit between January 10 and June 30, 2012, with an indwelling urinary catheter during their admission. We identified CAUTIs using 4 methods: traditional surveillance (TS) (ie, manual chart review by ICPs), an electronic surveillance (ES) tool, augmented electronic surveillance (AES) (ie, ES with chart review on a subset of cases), and reference standard (RS) (ie, a subset of CAUTIs originally ascertained by TS or ES, confirmed by review). We assessed performance characteristics to RS for reviewed cases. We identified 417 candidate CAUTIs in 308 patients; 175 (42.0%) of these candidate CAUTIs were selected for review, yielding 32 confirmed CAUTIs in 22 patients (RS). Compared with RS, the sensitivities of TS, ES, and AES were 43.8% (95% confidence interval [CI], 26.4%-62.3%), 100.0% (95% CI, 89.1%-100.0%), and 100.0% (95% CI, 89.1%-100.0%). Specificities were 82.5% (95% CI, 75.3%-88.4%), 2.8% (95% CI, 0.8%-7.0%), and 100.0% (95% CI, 97.5%-100.0%). Electronic CAUTI surveillance offers a streamlined approach to improve reliability and resource burden of surveillance.

Challenges and proposed improvements for reviewing symptoms and catheter use to identify National Healthcare Safety Network catheter-associated urinary tract infections

Retrospective medical record review is used to categorize urinary tract infections (UTIs) as symptomatic, catheter-associated, and/or healthcare-associated to generate National Healthcare Safety Network (NHSN) surveillance and claims data. We assessed how often patients with UTI diagnoses in claims data had a catheter in place, had documented symptoms, or met the NHSN criteria for catheter-associated UTI (CAUTI). Two physicians retrospectively reviewed medical records for 294 randomly selected patients hospitalized with UTI as a secondary diagnosis, discharged between October 2008 and September 2009 from the University of Michigan. We applied a modification of recent NHSN criteria to estimate how often UTIs in claims data may be an NHSN CAUTI. The 294 patients included 193 women (66%). The mean patient age was 63 years, and the median length of hospital stay was 7.5 days. Catheter use was noted for 216 of 294 postadmission records (74%), including 126 (43%) with a Foley catheter. NHSN symptoms were noted in 113 records (38%); 62 (21%) had symptoms other than fever. Of 136 hospitalizations meeting urine culture criteria, 17 (5.8%) met the criteria for a potential NHSN CAUTI. Retrospective medical record review to identify symptoms and catheter use is complicated and resource-intensive. Requiring standard documentation of symptoms and catheter status when ordering urine cultures could simplify and improve CAUTI surveillance and its fidelity as a hospital quality indicator.

Emergence and prevention measures for multidrug resistant Pseudomonas aeruginosa in catheter-associated urinary tract infection in spinal cord injury patients.

To evaluate measures for preventing multidrug resistant Pseudomonas aeruginosa (MDRP) in catheter-associated urinary tract infection (CAUTI) in spinal cord injury patients. Spinal Cord Injury Unit of Hyogo Prefectural Hyogo Prefectural Rehabilitation Center, Kobe, Japan. We defined MDRP as resistance to amikacin, imipenem and levofloxacin. We had eight cases of MDRP-causing CAUTI in hospitalized neurogenic bladder patients caused by spinal cord injury in 2 months. Pulse-field gel electrophoresis (PFGE) was performed for epidemiological studies. We assessed prevention measures against MDRP emergence from the 2nd month, such as surveillance of CAUTI and infection control, and evaluated the outcomes of these measures over a total of 8 months. Our PFGE results showed that these eight MDRP isolates could be considered as closely related strains. We concluded that this was an MDRP outbreak that was causing CAUTI. The isolated ratio of MDRP began to decrease over 4 months of surveillance and significantly decreased in the 4th quarter (7th and 8th months) compared with the 1st quarter (1st and 2nd months) (P=0.021) even though urinary tract device usage significantly increased over the same period (P<0.001). We experienced an outbreak of emergent MDRP causing CAUTI in neurogenic bladder patients with spinal cord injury. Our preventive measures for isolating the outbreak, including surveillance, may have led to the decrease we observed in the ratio of MDRP isolated.

Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated urinary catheter on symptomatic catheter-associated urinary tract infections.

PURPOSE:The purpose of this study was to determine the effect of a silver-alloy hydrogel catheter on symptomatic catheter-associated urinary tract infections (CAUTIs).DESIGN:Multicenter before-after non-randomized cohort study.SUBJECTS AND SETTING:Seven acute care hospitals ranging in size from 124 to 607 beds participated in this study. The study population included adult patients with a positive urine culture 2 or more days after admission, who underwent Foley catheterization.METHODS:Catheter-associated urinary tract infection surveillance was conducted at each hospital for at least 3 months during the use of a standard catheter and 3 months during the use of the silver-alloy hydrogel catheter. Both the National Healthcare Safety Network (NHSN) surveillance and a clinical definition of CAUTI were used for rate calculation.RESULTS:A 47% relative reduction in the CAUTI rate was observed with the silver-alloy hydrogel catheter compared to the standard catheter when both infection definitions were used (0.945/1000 patient days vs 0.498/1000 patient days) (odds ratio = 0.53; P < .0001; 95% CI: 0.45–0.62). When only NHSN-defined CAUTIs were considered, a 58% relative reduction occurred in the silver-alloy hydrogel period (0.60/1000 patient days vs 0.25/1000 patient days) (odds ratio = 0.42; P < .0001; 95% CI: 0.34–0.53). Antimicrobial days for CAUTIs decreased from 1165 (standard catheter period) to 406 (silver-alloy hydrogel period).CONCLUSIONS:Use of a silver-alloy hydrogel urinary catheter reduced symptomatic CAUTI occurrences as defined by both NHSN and clinical criteria.

Risk factors for catheter-associated urinary tract infection in Italian elderly

Catheter-associated urinary tract infections (CAUTIs) are the most common cause of hospital-acquired infections, especially in elderly patients. Data on CAUTIs in older persons in acute care settings are lacking, however. This study aimed to describe the epidemiology of CAUTIs and related outcomes (ie, length of stay and mortality), in patients admitted to an acute geriatric care hospital in central Italy. A CAUTI surveillance program was implemented from October 2011 to April 2012, according to the Centers for Disease Control and Prevention's National Healthcare Safety Network methodology. A total of 2773 patients aged ≥65 years were included in the study, and 483 catheterized patients were monitored for the risk of CAUTI. The catheterization rate was 16.7% (95% confidence interval [CI], 15.3%-18.2%), and the overall CAUTI incidence rate was 14.7/1000 device-days (95% CI, 11.7-18.3/1000). Mortality was significantly higher in catheterized patients with a CAUTI compared with noncatheterized patients (19.2% vs 10.5%; P < .05). Female sex (odds ratio [OR], 1.31; 95% CI, 1.06-1.67), increasing age (≥90 years: OR, 2.76; 95% CI, 2.00-3.83), and longer hospital stay before catheter insertion (≥15 days: OR, 2.90; 95% CI, 2.20-3.83) were independent risk factors for catheterization; increasing age (>90 years: OR, 2.75; 95% CI, 1.03-7.35), and duration of hospital stay before catheter insertion (OR, 2.41; 95% CI, 1.12-5.51) were associated with CAUTIs. These results underscore the importance of the proper choice of patients for catheterization, particularly in individuals aged >90 years.

Using electronic medical records to increase the efficiency of catheter-associated urinary tract infection surveillance for National Health and Safety Network reporting

Streamlining health care-associated infection surveillance is essential for health care facilities owing to the continuing increases in reporting requirements. Stanford Hospital, a 583-bed adult tertiary care center, used their electronic medical record (EMR) to develop an electronic algorithm to reduce the time required to conduct catheter-associated urinary tract infection (CAUTI) surveillance in adults. The algorithm provides inclusion and exclusion criteria, using the National Healthcare Safety Network definitions, for patients with a CAUTI. The algorithm was validated by trained infection preventionists through complete chart review for a random sample of cultures collected during the study period, September 1, 2012, to February 28, 2013. During the study period, a total of 6,379 positive urine cultures were identified. The Stanford Hospital electronic CAUTI algorithm identified 6,101 of these positive cultures (95.64%) as not a CAUTI, 191 (2.99%) as a possible CAUTI requiring further validation, and 87 (1.36%) as a definite CAUTI. Overall, use of the algorithm reduced CAUTI surveillance requirements at Stanford Hospital by 97.01%. The electronic algorithm proved effective in increasing the efficiency of CAUTI surveillance. The data suggest that CAUTI surveillance using the National Healthcare Safety Network definitions can be fully automated.

Catheter –Associated Urinary Tract Infection, Management, And Preventions

Catheter-associated urinary tract infections(CA-UTIs) or health care associated UTIs are most common inhospitals, and in long term-care facilities(LTCFs)Up to 25% of patients in the hospitals have a catheter inserted at some time during their stay. Long term catheterization and catheter insertion outside operating room, lack of systemic antimicrobial therapy, female sex, old age, diabetes, elevated serum creatinine,and,instrumentation of urinary tract are the risk factors of CA-bacteriuria. Urinary catheterization provides easier access of uropathogens to bladder. Bacteria attached to catheter form micro colonies that mature into biofilims, these biofilms protect uropathogens from antibiotics. Diagnosis of UTI is based on significant bacteriuria. Frequently isolated uropathogens include Escherichia coli, enterococcus , enterobacteriacae, and Candida albicans. Empiric treatment should be based on Gram stain, culture and antibiotic susceptibility results. Lo E, et al. guidelines for prevention and surveillance of CA-UTIs are useful.

Should Electronic Markers for Catheter-associated Urinary Tract Infections (CAUTI) Be Used for CAUTI Surveillance in Pediatric Hospitals?

Should Electronic Markers for Catheter-associated Urinary Tract Infections (CAUTI) Be Used for CAUTI Surveillance in Pediatric Hospitals?