Background: Catheter-associated urinary tract infection (CAUTI) is one of the most common health-care associated infections. The NHSN CAUTI definition was updated in 2015, with increase in cut off for bacteria to greater than or equal to 105 CFU/ml and exclusion of candida, yeasts or molds as potential CAUTI pathogens.
Methods: This is a retrospective study that was conducted at a 1100-bed academic medical center in the Southern US. The new 2015 CAUTI definition was applied to the 2013 and 2014 cases of CAUTI to determine the impact of change in NHSN definitions on the CAUTI rates in 7 intensive care units (ICU). A nurse-driven indication-based protocol for removal of urinary catheters was implemented in March 2013. A multidisciplinary CAUTI prevention team was established to implement a comprehensive CAUTI prevention bundle in July 2014.
Results: When the applicable NHSN definition was applied to the CAUTI cases, there was trend for decreasing yearly rates (4.55, 3.66 and 0.87/1000 device days for 2013, 2014, and 2015 respectively, figure 1). A total of 345 CAUTIs occurred in the 2-year period from January 2013 to December 2014 (4.74/1000 device days). Of these, 210 CAUTIs (59.7%) were due to yeast, and did not meet the current (2015) NHSN definition. When the current definition was applied to the 2013 and 2014 cases, the resulting CAUTI rates decreased > 2 fold (1.87 vs 4.55/1000 device days; p<0.05, figure 2). The yearly CAUTI rate for 2014 was dramatically different if the current definition was applied (1.37 vs 3.6/1000 device days; p<0.05). Despite no further interventions and with just application of the current NHSN definition, the yearly CAUTI rate in 2015 remained very low (0.87/1000 device days; SIR= 0.31)
Conclusion: Since CAUTI rates are publicly reported and may affect a hospitals reimbursement rate, accurate epidemiological definitions are essential. Our own experience showed that despite implementation of a multidisciplinary CAUTI prevention bundle in 2014, the CAUTI rate was not at goal. However, when the current definition was applied to the same cases, majority of the cases had no clinical implications and were due to yeasts or Candida species. Our experience underscores the utility of constantly updating NHSN epidemiological definitions to coincide with clinical definitions more closely.
M. Schmitz, None
B. Camins, None