399. Impact of the CDC Definition Change on Evaluation of Catheter Associated Urinary Tract Infection Reduction Programs: Results from an Integrated Healthcare System
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Poster CAUTI central2016.pdf (606.5 kB)
  • Background: Prevention of Catheter-associated urinary tract infections (CAUTIs) is a national patient safety goal. To reduce these events, Intermountain Healthcare created a CAUTI workgroup to reduce CAUTIs in all twenty-two of its facilities. The goal of this study was to determine if the interventions undertaken from 2012-2015 resulted in a significant reduction in CAUTIs and catheter days, despite the CAUTI definition change.

    Setting: Intermountain Healthcare (IHC) is a 22 hospital system with a uniform electronic medical record. The facilities support 33 Infection Preventionists (IPs). All hospitals report to NHSN, and use CDC definitions.

    Intervention: All unit managers received email notices of patients with urinary catheters in place for longer than 48hrs. Managers review these alerts with providers for removal. These alerts (2012), along with review of insertion technique, sampling instructions were added, and maintenance bundles were implemented (2013-4). Standardized foley kits were utilized to optimize insertion practices (2014).

    Methods:  CAUTI data is collected by IPs per CDC definitions, and is reported to NHSN per 1000 catheter-days. The definition of CAUTI changed in 2015 to exclude Candida spp. as a cause of CAUTI. Consequently, we examined our rate of candiduria from 2012-2014. We determined that 15.1% of CAUTIs identified were attributable to Candida. 2015 CAUTI counts were increased by 15.1% to account for this change (adjusted CAUTI count). Rates were compared with a z-score for person-time data.

    Results: In 2012, IHC reported 299 CAUTI infections in 96691 catheter days (CAUTI rate 3.09 per 1000 catheter-days). In 2015, ICH reported 148 in 88273 catheter-days 2015. Adjusted for definition change, this is estimated to be 170 CAUTIs (a reduction of 129 infections, or 43.1%, CAUTI rate 1.67 per 1000 catheter-days). IHC demonstrated a significant reduction in CAUTI rates between 2012 and 2015, despite the definition change: Rate ratio 0.57 (0.48,0.69, p=0.0000001).

    Conclusion: A significant reduction in CAUTIs was accomplished at IHC between 2012 and 2015. The 2015 definition change does result in a significant reduction in CAUTI rate, and should be addressed when evaluating CAUTI interventions.

    Kristin Dascomb, MD, PhD1, Nathan Barton, BS2, Janette Orton, MS2, Joan Golden, RN, CIC2, Robini Betts, RN2, Douglas Smith, MD2, Sean D Firth, PhD, MPH2 and John P. Burke, MD, FIDSA, FSHEA3, (1)Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, UT, (2)Intermountain Healthcare, Murray, UT, (3)LDS Hospital, Salt Lake City, UT

    Disclosures:

    K. Dascomb, Medicines Company: Investigator , Research grant

    N. Barton, None

    J. Orton, None

    J. Golden, None

    R. Betts, None

    D. Smith, None

    S. D. Firth, Medicines Company: Investigator , Research grant

    J. P. Burke, 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.