474. 2015 NHSN CAUTI Definition Change and its Impact on CLABSI Rates at an Academic Medical Center
Session: Poster Abstract Session: HAI: Surveillance + Reporting
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • CAUTIposter-SA.pdf (585.0 kB)
  • Background: The National Healthcare Safety Network (NHSN) revised their catheter-associated urinary tract infection (CAUTI) definition in January 2015 to exclude funguria. This definition change led to an increase in diagnosis of catheter-related fungemia in other health systems, due to the exclusion of CAUTI as an attributable source. We evaluated the effect of the NHSN CAUTI definition change on central line-associated blood stream infection (CLABSI) rates at our hospital.

    Methods: This is a retrospective study that was conducted at an 1154-bed academic medical center. We looked at the trend of our house-wide and intensive care unit (ICU) CLABSI and CAUTI incidence rates (IR) from January 2013 to December 2016. Our institutional vascular access policy was updated in 2016 to revise insertion and maintenance practices and introduce new guidelines for drawing blood cultures in setting of central lines.

    Results: With the 2015 CAUTI definition, our house-wide CAUTI IR decreased by > 75% from 2014 to 2015 (3.42 to 0.92 per 1000 catheter days (CD) p<0.05). Conversely, there was an initial increase in our house-wide CLABSI IR from 2014 to 2015 (1.34 to 2.1 per 1000 CD, p<0.05), followed by a significant decline to 1.31 per 1000 CD in 2016 (p<0.05).  Similarly, our ICU CLABSI IR increased slightly in 2015 (1.59 to 1.83 per 1000 CD, p=0.1) followed by a significant decline in 2016 (1.83 to 0.91 per 1000 CD, p<0.05, table 1). This initial increase in our CLABSI IR in 2015 was mainly driven by gram-positive organisms. Despite exclusion of yeast as pathogens from the 2015 CAUTI definition, our rates of catheter-related fungemia remained relatively stable (Figure 1).

    Conclusion: The 2015 NHSN CAUTI definition resulted in a significant decline in our CAUTI rates. We did not see a sustained increase in our CLABSI rates as reported by other health systems. In fact, our CLABSI rates and catheter- related fungemia rates decreased in 2016. This could be related to implementation of new vascular access guidelines and CLABSI prevention efforts.

     

    Table 1: Incidence rates (IR) per 1000 catheter days using applicable NHSN definition

    Year

    House-wide

    CAUTI IR

    House-wide

    CLABSI IR

    ICU CAUTI IR

    ICU CLABSI IR

    2013

    4.95

    1.54

    3.75

    2.02

    2014

    3.42

    1.34

    2.54

    1.59

    2015

    0.92

    2.1

    0.78

    1.83

    2016

    0.80

    1.31

    1.06

    0.91

     

    Sonali Advani, MD, MPH1, Rachael Lee, MD1, Mariann Schmitz, MPH, CIC2, Martha Long, MSN, RN, CIC2 and Bernard Camins, MD, MSc1, (1)Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, (2)Infection Prevention & Control, University of Alabama at Birmingham, Birmingham, AL

    Disclosures:

    S. Advani, None

    R. Lee, None

    M. Schmitz, None

    M. Long, None

    B. Camins, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.