Applying CAUTI Definitions And Catheter-Associated Urinary Tract .

Intermountain APIC and Qualis HealthpresentI-APIC HAI Prevention Learning Network Webinar SeriesApplying CAUTI Definitions andProtocol to Case StudiesCAUTI: Case Studies with the CDCCatheter-Associated Urinary Tract InfectionsFebruary 15, 2012Angela Bivens-Anttila RN, MSN, NP-C, CICNurse EpidemiologistCenters for Disease Control and PreventionDivision of Healthcare Quality Promotionwith Angela Bivens‐Anttila, MSN, RN, FNP‐C, CICFebruary 2012Device-associated Module5 EventsObjectives Review requirements for CAUTI reporting to CMSthrough NHSNDefine CAUTI key termsReview and apply CAUTI criteria and applicationDefine resources and methods for catheter-associatedurinary tract infection (CAUTI) TIDECLABSI Central line-associatedbloodstream infectionCLIPCentral line insertion practicesVAPVentilator-associated pneumoniaCAUTI Catheter-associated urinary tractinfectionDE*Dialysis event*For outpatient dialysis onlyCMS Reporting via NHSN – Current RequirementsDRAFT (11/14/2011)HAI EventFacility TypeReporting Start DateCLABSIAcute Care HospitalsAdult, Pediatric, and Neonatal ICUsJanuary 2011CAUTIAcute Care HospitalsAdult and Pediatric ICUsJanuary 2012NHSN and CMS SSIAcute Care HospitalsColon and Abdominal HysterectomyJanuary 2012I.V. antimicrobial startDialysis FacilitiesJanuary 2012Positive blood cultureDialysis FacilitiesJanuary 2012Signs of vascular access infectionDialysis FacilitiesJanuary 2012CLABSILong Term Care Hospitals *October 2012CAUTILong Term Care Hospitals *October 2012CAUTIInpatient Rehabilitation FacilitiesOctober 2012MRSA BacteremiaAcute Care HospitalsJanuary 2013C. difficile LabID EventAcute Care HospitalsJanuary 2013HCW Influenza VaccinationAcute Care HospitalsJanuary 2013HCW Influenza VaccinationASCsOctober 2014SSI (TBD)Outpatient Surgery/ASCsTBD CAUTI must be included in Monthly ReportingPlans for data to be reported on behalf of thehospital/facility to CMSMust follow the NHSN CAUTI pprotocol exactlyyand report complete and accurate data in atimely manner. Report each CAUTI detected or indicate that noCAUTI occurred for selected reporting locations Report total device days and total patient days forselected locations* Long Term Care Hospitals are called Long Term Acute Care Hospitals in NHSN1

CMS Reportable Data Must Be Includedin Monthly Reporting PlansKey Termshttp://www.cdc.gov/nhsn/PDFs/pscManual/3PSC MonthlyReportingPlanCurrent.pdfAll CAUTIs Must be HAIKey Term:Healthcare-associated Infection (HAI)A localized or systemic conditionresulting from an adverse reactionto the presence of an infectiousagent(s) or its toxin(s) that OccursOini a patientti t ini ahealthcare setting and Was not present or incubatingat the time of admission, unlessthe infection was related to aprevious admissionKey Term:Indwelling CatheterA drainage tube that is inserted intothe urinary bladder through theurethra, is left in place, and isconnected to a closed collectionsystem. Also called a Foley catheter Does not include (among others): Straight in and out catheters Suprapubic catheters Nephrostomy tubesKey Term:CAUTIA UTI in a patient who had an indwelling urinarycatheter is in place at the time of or within 48 hoursprior to infection onset.*Note: There is no minimum period of time that thecatheter must be in place in order for the UTI to beconsidered catheter-associated.2

Location of AttributionCAUTIs are attributed to inpatientlocation at time of urine collection orsymptom onset, whichever comes first.Transfer Rule:ExampleMr. Smith is transferred from SICU with aFoley and 36 hours after transfer has a feverof 38.2 C. The next day a urine culturecollected has 105 CFU/ml of E.E coli.coli ThisCAUTI is attributed to the SICU.*Exception: If a CAUTI develops within 48 hours of transferfrom one inpatient location to another in the same facility,or a new facility, the infection is attributed to thetransferring location (Transfer Rule).CAUTI Criteria andApplicationCatheter Associated Urinary TractInfection DefinitionsThere are two** criteria than can be applied fory g a CAUTIidentifying Symptomatic UTI (SUTI) Asymptomatic Bacteremic UTI (ABUTI)SUTI OverviewSymptomatic Urinary Tract InfectionMust have symptoms AND4 different criterion groups: Criteria 1 (a & b):Urine culture 105CFU/ml no more than 2CFU/ml,species Criteria 2 (a & b):Urine culture 103 and 105 CFU/ml, no morethan 2 species, ANDpositive U/A“a” Criteria: catheter at/within48 hours prior to urinecollection or onset of signsor symptoms“b” Criteria: no catheterat/within 48 hours prior tourine collection or onset ofsigns or symptomsSUTI OverviewSymptomatic Urinary Tract InfectionCriteria 3 & 4: Patients 1year of age; have age-specificsigns and symptoms AND Criterion 3: Urine culture 105 CFU/ml no morethan 2 species Criterion 4: Urine culture 103 and 105 CFU/ml nomore than 2 species ANDpositive U/A3

Symptomatic UTISUTI 2aSymptomatic UTISUTI 1a2a1aPatient had an indwelling urinary catheter in place at the time of specimen collectionandat least 1 of the following signs or symptoms with no other recognized cause:fever ( 38 C), suprapubic tenderness, or costovertebral angle pain or tenderness.anda positive urine culture of 105 colony-forming units (CFU)/ml with no more than 2species of --------------------------Patient had indwelling urinary catheter removed within the 48 hours prior tospecimen collectionandat least 1 of the following signs or symptoms with no other recognized cause:fever ( 38 C), urgency, frequency, dysuria, suprapubic tenderness, or costovertebralangle pain or tendernessanda positive urine culture of 105 colony-forming units (CFU)/ml with no more than 2species of microorganismsPatient had an indwelling urinary catheter in place at the time of specimen collectionandat least 1 of the following signs or symptoms with no other recognized cause:fever ( 38 C), suprapubic tenderness, or costovertebral angle pain or tendernessanda positive urinalysis demonstrated by at least 1 of the following findings:a. positive dipstick for leukocyte esterase and/or nitriteb. pyuria (urine specimen with 10 white blood cells [WBC]/mm3 of unspun urine or 3 WBC/highpower field of spun urine)c. microorganisms seen on Gram stain of unspun urineanda positive urine culture of 103 and 105 CFU/ml with no more than 2 species of atient had indwelling urinary catheter removed within the 48 hours prior to specimen collectionandat least 1 of the following signs or symptoms with no other recognized cause:fever ( 38 C), urgency, frequency, dysuria, suprapubic tenderness, or costovertebral angle pain ortendernessanda positive urinalysis demonstrated by at least 1 of the following findings:a. positive dipstick for leukocyte esterase and/or nitriteb. pyuria (urine specimen with 10 white blood cells [WBC]/mm3 of unspun urine or 3 WBC/highpower field of spun urine)c. microorganisms seen on Gram stain of unspun urineanda positive urine culture of 103 and 105 CFU/ml with no more than 2 species of microorganisms.Asymptomatic Bacteremic UTI(ABUTI)Patient with** or without an indwelling urinary catheter has no signs or symptoms (i.e., for any agepatient, no fever ( 38 C), urgency, frequency, dysuria, suprapubic tenderness, or costovertebral anglepain or tenderness, OR for a patient 1 year of age, no fever ( 38 C core), hypothermia ( 36 C core),apnea, bradycardia, dysuria, lethargy, or vomiting)anda positive urine culture of 105 CFU/ml with no more than 2 species of uropathogenmicroorganisms*anda positive blood culture with at least 1 matching uropathogen microorganism to the urine cultureculture, orat least 2 matching blood cultures drawn on separate occasions if the matching pathogen is acommon skin contaminant.*Uropathogen microorganisms are: Gram-negative bacilli, Staphylococcus spp., yeasts, betahemolytic Streptococcus spp., Enterococcus spp., G. vaginalis, Aerococcus urinae, andCorynebacterium (urease positive) . Report Corynebacterium (urease positive) as either Corynebacterium species unspecified (COS) oras C. urealyticum (CORUR) if so speciated.**The indwelling urinary catheter was in place within 48 hours prior to specimen collection (January2012 Release).Note: All ABUTIs will have a secondary bloodstream infectionSurveillance Consistencyis a Must! Criteria designed to look at a population at risk Identify patients meeting the criteria C Consistentlyi t tl applyl ththe criteriait i Ensures the comparability of the data- protects your facilityand others Strengthens the validity of the dataEntering CAUTI Events into NHSN(Numerator)4

Patient Information The top section of UTI data collection form is used to collectpatient demographics. Required fields have an asterisk (*).There are 4 required fields: Facility ID Patient ID Gender Date of BirthEvent InformationCAUTIPost Procedure UTI: Optional field. Mark “YES” if this eventoccurred after an NHSN defined procedure but beforedischarge from the facility.Event InformationCAUTIRequired. Enter location ofEvent InformationCAUTIEvent Type is UTIDate of Event:Required.The date thesigns orsymptomsappeared or datethe diagnosingurine specimenwas collected,whichever comesfirst.Event InformationCAUTIMDRO Infection: Enter “YES” only if the pathogen is beingfollowed for Infection Surveillance in the MDRO/CDI Module inthat location as part of your Monthly Reporting Plan.Risk FactorsCAUTIpatient to which thepatient was assignedwhen the UTI wasidentified.Required Field: Three options: INPLACE REMOVE - Removed within 48 hoursprior NEITHER – Not in place nor within 48hoursRequired. The date admittedto Inpatient locationIf the UTI develops in a patient within 48 hours of transferfrom a location, indicate the transferring location, not thecurrent location of the patient.Optional: Date indwelling urethralcatheter inserted.Optional: Patient location whereindwelling urethral catheterinserted.5

Event Details:Secondary BSIEvent Details:Specific EventAvailable selections basedon Event TypeSecondary BSI: Required.If the patient had a cultureconfirmed bloodstream anda related/documentedhealthcare associated UTI,select Yes.Secondary BSIEvent DetailsFor UTI, at least one organism from the positive urineculture must match an organism in the blood culture(antibiograms of the isolates do not have to match).Example: Patient with a urinary catheter grows E.coli in her urine and in her blood. The CAUTI isreported with Secondary BSI Yes and thepathogen is E. coli.Died: Required for completion.If the patient died during thishospitalization, circle Yes.** The record may be saved withoutcompleting this field, but it will beconsidered incomplete.UTI Contributed to Death: Requiredonly if the patient died.If the UTI caused the death orexacerbated an existing conditionwhich led to death, mark Yes.http://www.cdc.gov/nhsn/PDFs/SecondaryBSIGuide 06 11.pdfEvent DetailsPathogens IdentifiedS SusceptibleI IntermediateR ResistantNS Non-susceptibleS-DD Susceptibledose dependentRequired. Enter up to threeRequiredpathogens. If multiple pathogens,enter pathogen judged to be mostimportant cause of infection as #1,the next most important as #2 Collecting SummaryDenominator DataFor all locations, count at the same time each day Number of ppatients on the unit Number of patients with an indwelling urinarycatheterN Not tested6