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An Electronic Catheter-Associated Urinary Tract Infection Surveillance Tool

Published online by Cambridge University Press:  02 January 2015

Julie A. Choudhuri
Affiliation:
Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington
Ronald F. Pergamit
Affiliation:
Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington
Jeannie D. Chan
Affiliation:
Department of Pharmacy, Harborview Medical Center, Seattle, Washington
Astrid B. Schreuder
Affiliation:
Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington
Elizabeth McNamara
Affiliation:
Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington
John B. Lynch
Affiliation:
Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington
Timothy H. Dellit*
Affiliation:
Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington
*
Harborview Medical Center, Quality Improvement/Infection Control, Box 359778, 325 Ninth Avenue, Seattle, WA 98104 (thdellit@u.washington.edu)

Abstract

Objective.

To develop and validate an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs).

Design.

Retrospective cohort study.

Setting.

413-bed university-affiliated urban teaching hospital.

Methods.

An electronic surveillance tool was developed for CAUTI and urinary catheter utilization based on the objective components of the National Healthcare Safety Network (NHSN) definitions including fever, urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP).

Results.

During January and February 2010, 204 positive urine cultures (≥103 colony-forming units/mL) were identified in 136 patients with indwelling urinary catheters during their hospitalization. The electronic surveillance tool detected 60 CAUTI cases and 7,098 catheter-days, yielding a CAUTI incidence rate of 8.5 per 1,000 catheter-days. Urinary catheter utilization ratios (Foley-days/patient-days) were: acute care units, 0.27 (3,637 of 13,229); intensive care units, 0.77 (3,461 of 4,469); and overall, 0.40 (7,098 of 17,698). In comparison, the IP identified 59 cases by manual review with a sensitivity of 51 of 59 (86.4%), specificity 136 of 145 (93.8%), and negative predictive value of 136 of 144 (94.4%). Fever was present in 54 of 59 (91.5%) of CAUTI cases identified manually, while subjective criteria were documented in only 6 of 59 (10.2%) infections. Agreement between the electronic surveillance and manual IP review was assessed as very good (k, 0.80; 95% confidence interval, 0.71–0.89).

Conclusions.

We report an attempt at automating surveillance for CAUTI. With a high negative predictive value, the electronic tool allows for more efficient CAUTI surveillance and facilitates housewide trending of rates and catheter utilization. This approach should be validated in different patient populations.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

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