563. How National Healthcare Safety Network (NHSN) Catheter Associated (CA) Urinary Tract Infection (UTI) Criteria Changes Affected the Number of CA-UTI at a University Hospital
Session: Oral Abstract Session: Advancing Public Reporting and Surveillance of HAIs
Thursday, October 3, 2013: 3:15 PM
Room: The Moscone Center: 200-212

Background: A UTI is defined as an infection involving any part of the urinary system UTIs are the number one cause of health care-associated infections (HAIs) with the majority of UTIs being CA. In 3/12 and 12/12, NHSN released CA-UTI criteria clarification. In 1/13, the NHSN released changes that further affected CAUTI definitions. Our objective was to evaluate the effect of the CA-UTI clarification and definition changes on house-wide CA-UTI volume at the University of Pittsburgh Medical Center (UPMC) Presbyterian.

Methods: CA-UTIs were defined in 4 ways and summed over 3 time periods. Catheter use was stable throughout the study.

UTI 1 - NHSN traditional CA-UTI definition

UTI 2 4/12 NHSN clarification - + urine culture + fever even when fever was attributable to a concurrent HAI

UTI 3 12/12 NHSN further clarification - + urine culture + fever even when fever was attributable to another known source (e.g., community acquired infection, blood transfusion, drug fever, central nervous system fever etc.)

UTI 4 1/13 NHSN definition change - may exclude present on admission symptoms and change to the use of calendar days.

Time Period (TP) 1 UTI 1

TP 2 UTI 1 PLUS UTI 2-3

TP 3 used UTI 4 PLUS UTI 2-3

Results:

TP2 was associated with a 44% increase (CA-UTI/month) when compared to TP1.

TP3 was associated with a 165% increase (CA-UTI/month) when compared to TP1.

Overall, 71/223(32%) CA-UTIs were UTI 2 or 3.

% Yeast increased by 300% from TP1 to TP2 (5% to 20%) and by 460% from TP1 to TP3 (5% to 28%).

23/49 (27%) Yeast CA-UTIs were UTI 2 or 3 and would not have been called prior to clarification.

Conclusion:

         Recent NHSN CA-UTI clarifications and definition change has resulted in a significant increase in CA-UTIs.

         In part, the additional CA-UTIs may not represent true infection and so it will become difficult to assess patient safety efforts.

         Yeast colonization accounts a significant portion of the increased CA-UTIs.

         CA-UTI prevention measures will only reduce true infections and so perfecting prevention methods may not be reflected in reduced CA-UTI rates.

         NHSN should reconsider clarifications and new definitions.

Carlene Muto, MD, MS, FSHEA, Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA, Janina-Marie Tatar, MT ASCP, University of Pittsburgh Medical Center, Pittsburgh, PA, Ashley Querry, BS, Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center - Presbyterian Hospital, Pittsburgh, PA and Carmelo Ciccone, BS, Infection Prevention and Control, University of Pittsburgh Medical Center - Presbyterian, Pittsburgh, PA

Disclosures:

C. Muto, None

J. M. Tatar, None

A. Querry, None

C. Ciccone, None

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