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Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

Published online by Cambridge University Press:  02 January 2015

Marc-Oliver Wright*
Affiliation:
Department of Infection Control, NorthShore University HealthSystem, Evanston, Illinois
Maureen Kharasch
Affiliation:
Department of Quality, NorthShore, University HealthSystem, Evanston, Illinois
Jennifer L. Beaumont
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Lance R. Peterson
Affiliation:
Department of Infection Control, NorthShore University HealthSystem, Evanston, Illinois University of Chicago, Pritzker School of Medicine, Chicago, Illinois Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois
Ari Robicsek
Affiliation:
Department of Infection Control, NorthShore University HealthSystem, Evanston, Illinois University of Chicago, Pritzker School of Medicine, Chicago, Illinois Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois Department of Medical Informatics, NorthShore University HealthSystem, Evanston, Illinois Center for Clinical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois
*
NorthShore University Health System, 2650 Ridge Avenue, Burch 125, Evanston, IL 60201 (mwright@northshore.org)

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.

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

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References

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