406. Impact and Limitations of 2015 NHSN Case Definition on CAUTI Rates: Implications for Assessing Effect of CAUTI Prevention Measures
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Impact and Limitations of the 2015 NHSN Case Definition on CAUTI rates.pdf (571.0 kB)
  • Background:

    In 2015 the NHSN definition of catheter-associated urinary tract infection (CAUTI) was modified, to improve specificity and produce a measure that accurately identifies patients (pts) with CAUTI. However, presence of a concurrent alternate infection is not an exclusion criteria for CAUTI. The goals of this study were to (a) estimate the impact of 2015 NHSN criteria on CAUTI rates in 2013-14 for intensive care units (ICU) (b) determine if these estimated rates were consistent with the actual CAUTI rate in 2015 (c) determine the accuracy of 2015 criteria in classifying pts with CAUTI.  

    Methods:

    This retrospective study was done at an 800-bed teaching hospital (142 ICU beds), in urban Detroit. CAUTI rates were calculated per 1000 catheter days. In January 2015, CAUTIs from 2013-14 were reviewed and 2015 criteria were applied to estimate the impact on CAUTI rates. In January 2016, the actual CAUTI rate for 2015 was confirmed. All CAUTIs from 2013-15 defined using 2015 criteria were reviewed to identify any concurrent (±1 day) microbiologically confirmed infections using NHSN definitions.

    Results: Application of 2015 criteria resulted in an approximate 50% reduction of 2013-14 CAUTI rates and exclusion of 166 (52.2%) CAUTI events (Table 1). The actual CAUTI rate in 2015 was 2.87%, consistent with our estimate. Despite use of more specific 2015 criteria, 22 (9.3%) pts with CAUTI had concurrent infections confirmed by blood/sterile site cultures: 5-Laboratory confirmed bloodstream infection (BSI), 5-Central line associated BSI, 4-surgical site infection–meningitis, 6-Intraabdominal infection, 2-Pneumonia with bacteremia/empyema.


    Table 1

    2013

    2014

    2015

    CAUTI events

    Criteria used: 2013

    2015

     

    173

    76

     

    145

    76

     

    NA

    85

    CAUTI rates %

    Criteria used: 2013

    2015

     

    4.47

    1.96

    (estimate)

     

    5.04

    2.64

    (estimate)

     

    NA

    2.87

    (actual)

    Conclusion:

    Application of the 2015 NHSN definition reduced CAUTI rates by about half. The impact of the definition change should be recognized and success of CAUTI improvement measures should be reflected in a reduction of CAUTI rates by >50%. About 1 in 10 ICU pts with NHSN defined CAUTI have concurrent alternate infection. Modification of criteria may be needed in this population to improve specificity of the definition.

    Ana C. Bardossy, MD1, Rachna Jayaprakash, MD2, Patricia Starr, RN3, Marcus Zervos, MD4 and George Alangaden, MD, FIDSA2, (1)Infectious Diseases, Henry Ford Health System, Detroit, MI, (2)Infectious Diseases, Henry Ford Hospital, Detroit, MI, (3)Henry Ford Health System, Detroit, MI, (4)Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI

    Disclosures:

    A. C. Bardossy, None

    R. Jayaprakash, None

    P. Starr, None

    M. Zervos, Pfizer: Research Contractor , Research support
    Cerexa: Research Contractor , Research support
    Cubist: Research Contractor , Research support
    Merck: Research Contractor , Research support
    Tetraphase: Research Contractor , Research support
    Melinta: Research Contractor , Research support
    Paratek: Research Contractor , Research support
    Rempex: Research Contractor , Research support
    Cempra: Grant Investigator , Research support

    G. Alangaden, 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.