401. How National Healthcare Safety Network (NHSN) Catheter Associated (CA) Urinary Tract Infection (UTI) Criteria Changes Affected the Number of CAUTI at a University Hospital – Here we go AGAIN
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • abstr. ID Week 2016 CAUTI Overcapture Poster FINAL.PDF (724.8 kB)
  • 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 CAUTI criteria clarification. In 1/13, the NHSN released changes that further affected CAUTI definitions and in 2015 the NHSN definition changed again. Our objective was to evaluate the effect of the CAUTI clarification and definition changes on house-wide CAUTI volume at the University of Pittsburgh Medical Center (UPMC) Presbyterian over several time periods (TP).

    Methods:  CAUTIs were defined in 4 ways using NHSN criteria. Catheter use was stable throughout the study.

    NHSN CAUTI definitions

    UTI 1 - Traditional CAUTI definition

    UTI 2 – Clarification - + urine culture + fever even when attributable to a concurrent HAI or another  

    source (e.g., community acquired infection, blood transfusion, drug fever, central nervous system  etc.)

    UTI 3 – Definition change - may exclude present on admission symptoms and change to the use of calendar days.

    UTI 4 – Definition change - Fungi are no longer considered as urinary pathogens and bacterial count must be ≥ 100,000 CFU/ml

     

    Results:

    TP

    Rate change

    Rate Ratio

    CI

    P-Value

    TP 1 to TP 2

    1.65 to 3.54

    2.1

    1.9-2.4

    P<1X10-7

    TP 2 to TP 3

    3.54 to 3.0

    1.2

    0.9 – 1.4

    0.08958

    TP 3 to TP 4

    3.0 to 1.62

    2.1

    1.7-2.5

    P<1X10-7

     

     

     

     

     

     

     

     

     

     

     

    Despite exclusion of funguria and colony counts <100,000, UTI 4 definition still over captures CAUTI in patients with fever attributable to another source (red bar).

     

    Conclusion:

    ·         NHSN CAUTI 2015 definition change significantly reduced the CAUTI rate

    ·         However, not addressing the fever related to another source still leaves higher rates due to over called infections.

    ·         Additional CAUTIs may not represent true infection making it difficult to assess patient safety efforts.

    Carlene Muto, MD, MS, FSHEA1, Janina-Marie Tatar, MT (ASCP)2, Ashley Querry, BS, CIC2 and Carmelo Ciccone, BS2, (1)Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA, (2)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

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.