Background: Catheter-associated urinary tract infections (CAUTI) negatively impact patient morbidity, mortality and insurance reimbursement rates in acute care hospitals. Since CAUTIs are solely defined by the National Health and Safety Network (NHSN), not by clinical definition or urinalysis (UA) result, eliminating unnecessary urine cultures will improve the accuracy of reportable CAUTI rates. Negative UA can accurately detect false positive (FP) CAUTIs in patients with 100% negative predictive value.
Methods: We conducted a retrospective analysis of 2017 CAUTIs reported from two acute care hospitals (A & B) to determine the effectiveness of a UA screening protocol and the distribution of FPs. Hospital B implemented a UA screening protocol requiring a UA prior to urine culture. Hospital A relied solely on microbiology cultures. FPs were identified by a negative UA result, the absence of bacteria, performed on the same or prior day to the urine culture that resulted in a CAUTI.
Results: Our analysis showed that 13 (34%) of the 38 reported CAUTIs with an associated UA result at hospital A were FPs. Patients with a UC line duration >7 days had a CAUTI FP rate of 62% compared to 27% of those with a line duration between 3 and 7 days (Fig 1) (OR 4.6, CI: 0.9, 23.7, p = 0.09). Hospital A (no screening protocol) was 37.4 times more likely to have a FP CAUTI compared to hospital B (UA screening protocol) (CI: 2.1, 660.6; p <.0004).
Conclusion: A positive culture with a negative UA is indicative of asymptomatic colonization, not true infection. Preventing FP CAUTIs would result in a 34% reduction in CAUTI rates at hospital A, placing the hospital in a better reimbursement benchmark (Fig 2). Interventions include: 1.) A best practice alert in the patients electronic medical record that can be used to notify the providers to re-evaluate patients with UCs in place ≥ 5 days 2.) A screening protocol that requires a UA order prior to/during specimen collection and prevents processing of urine cultures with a negative UA. In patients with UCs, a protocol should be implemented to reduce FP CAUTIs to better understand the true epidemiology of CAUTIs in hospitals and increase reporting accuracy.
A. Stachel, None