396. The Impact of Urinalysis Reflex Criteria on Surveillance Catheter-Associated Urinary Tract Infections (CAUTIs)
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • ID week poster 396 Oct 2016 Final.pdf (501.4 kB)
  • Background:

    The diagnosis of catheter-associated urinary tract infection (CAUTI) is challenging because of nonspecific associated symptoms and signs.

    Methods:

    We conducted a literature review of laboratory findings and urinalysis to determine which elements were a high predictor for positive cultures and infection. The evidence and literature suggests that urinalysis is an acceptable method to detect urinary tract infection. Urine cultures should be performed when a urinalysis is positive, but not routinely when a urinalysis is negative. A WBC >10 is a high predictor of a UTI regardless of other positive elements. At our institution, a Urinalysis (UA) with reflex to culture order was available. A culture would be performed based on positive UA criteria which included presence of leukocyte esterase, nitrite, or a WBC count of 6-9 per high power field. Medical records for CAUTI events identifed by surveillance defintion were retrospectively reviewed for urinalysis with microscopy as a trigger for urine culture.

    Results: Following National Healthcare Safety Network (NHSN) surveillance definitions, 31 CAUTIs were identified from September 1, 2014 – April 30, 2016. We studied which UA elements reflexed to culture and noted when cultures were ordered without urinalysis with microscopy. In May, 2016, UA reflex criteria were adjusted so that cultures would only be performed if WBC >10. Urine culture orders without UA reflex order are restricted to specific patient populations including urology, OB, neutropenic, and pediatric. Based on revised criteria for UA reflex to culture, 5 (16%) cases would not have reflexed to culture. In addition 5 (16%) cases had either no UA order or the UA was negative. This could translate to avoidance of ten (32%) NHSN surveillance CAUTIs.

    Conclusion:

    Urine cultures ordered for nonspecific signs and symptoms can lead to inflated rates/standardized infection ratio (SIR) of CAUTI as well as inappropriate treatment of asymptomatic bacteriuria. This new approach targets appropriate orders for urine culture to reduce NHSN surveillance CAUTIs and unnecessary use of antimicrobials.

    Cathy Paulus, MSN, RN-BC, CIC1, G. Wesley White, MD, FACP, FIDSA2, Christina Silkaitis, MT (ASCP), CIC3, Anessa Mikolajczak, BSN, RN, CIC1, Alexander Johnson, MSN, RN, CCNS4, Alison Keck, MSN, APN, AGCNS-BC, CCRN5, Ryan Keiler, BSN, RN1, Lorraine Mack, MSN, APN, CNL, OCN, AOCNS1 and Clinton Young, MSN, RN, ONC1, (1)Northwestern Medicine Central DuPage Hospital, Winfield, IL, (2)Infectious Diseases, Northwestern Medicine Central DuPage Hospital, Winfield, IL, (3)Healthcare Epidemiology and Infection Prevention, Northwestern University, Chicago, IL, (4)Northwestern Medicine Central Dupage Hospital, Winfield, IL, (5)Northwestern Medicine Central DuPage Hopsital, Winfield, IL

    Disclosures:

    C. Paulus, None

    G. W. White, None

    C. Silkaitis, None

    A. Mikolajczak, None

    A. Johnson, None

    A. Keck, None

    R. Keiler, None

    L. Mack, None

    C. Young, 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.