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Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

  • Marc-Oliver Wright (a1), Maureen Kharasch (a2), Jennifer L. Beaumont (a3), Lance R. Peterson (a1) (a4) (a5) and Ari Robicsek (a1) (a4) (a6) (a7) (a8)...

Abstract

Objective.

To evaluate two different methods of measuring catheter-associated urinary tract infection (CAUTI) rates in the setting of a quality improvement initiative aimed at reducing device utilization.

Design, Setting, and Patients.

Comparison of CAUTI measurements in the context of a before-after trial of acute care adult admissions to a multicentered healthcare system.

Methods.

CAUTIs were identified with an automated surveillance system, and device-days were measured through an electronic health record. Traditional surveillance measures of CAUTI rates per 1,000 device-days (R1) were compared with CAUTI rates per 10,000 patient-days (R2) before (T1) and after (T2) an intervention aimed at reducing catheter utilization.

Results.

The device-utilization ratio declined from 0.36 to 0.28 between T1 and T2 (P< .001), while infection rates were significantly lower when measured by R2 (28.2 vs 23.2, P = .02). When measured by R1, however, infection rates trended upward by 6% (7.79 vs. 8.28, P = .47), and at the nursing unit level, reduction in device utilization was significantly associated with increases in infection rate.

Conclusions.

The widely accepted practice of using device-days as a method of risk adjustment to calculate device-associated infection rates may mask the impact of a successful quality improvement program and reward programs not actively engaged in reducing device usage.

Copyright

Corresponding author

NorthShore University Health System, 2650 Ridge Avenue, Burch 125, Evanston, IL 60201 (mwright@northshore.org)

References

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Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

  • Marc-Oliver Wright (a1), Maureen Kharasch (a2), Jennifer L. Beaumont (a3), Lance R. Peterson (a1) (a4) (a5) and Ari Robicsek (a1) (a4) (a6) (a7) (a8)...

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