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Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

Published online by Cambridge University Press:  02 January 2015

Marc-Oliver Wright ,
Maureen Kharasch ,
Jennifer L. Beaumont ,
Lance R. Peterson  and
Ari Robicsek
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)
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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
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 7 , July 2011 , pp. 635 - 640
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Hooton, TM, Bradley, SF, Cardenas, DD, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50(5):625–663.CrossRefGoogle Scholar
2.Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160–166.CrossRefGoogle ScholarPubMed
3.Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28(1):68–75.CrossRefGoogle ScholarPubMed
4.Hospital-acquired conditions (HAC) in acute inpatient prospective payment system (IPPS) hospitals. https://www.cms.gov/HospitalAcqCond/Downloads/HACFactsheet.pdf Accessed November 9, 2010.Google Scholar
5.Saint, S, Olmsted, RN, Fakih, MG, et al. Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf 2009;35(9):449–455.Google ScholarPubMed
6.Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31(4):319–326.CrossRefGoogle Scholar
7.Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114(5):404–407.CrossRefGoogle ScholarPubMed
8.Wright, MO, Fisher, A, John, M, Reynolds, K, Peterson, LR, Robicsek, A. The electronic medical record as a tool for infection surveillance: successful automation of device-days. Am J Infect Control 2009;37(5):364–370.CrossRefGoogle ScholarPubMed
9.Meddings, J, Rogers, MAM, Macy, M, Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51(5):550–560.CrossRefGoogle ScholarPubMed
10.Centers for Disease Control and Prevention. The National Healthcare Safety Network (NHSN) manual. Patient safety component protocol. Division of healthcare quality promotion. http://www.cdc.gov/ncidod/dhqp/pdf/nhsn/NHSN_Manual_PatientSafetyProtocol_CURRENT.pdf. Accessed May 11, 2010.Google Scholar
11.Brossette, SE, Hacek, DM, Gavin, PJ, et al. A laboratory-based, hospital-wide, electronic marker for nosocomial infection: the future of infection control surveillance? Am J Clin Pathol 2006;125(1):34–39.CrossRefGoogle ScholarPubMed
12.Rebmann, C. Validation of HAI surveillance data. Presented at Healthcare-Associated Infections: Recovery Act Second Annual Grantee Meeting; October 18–19, 2010; Atlanta, GA.Google Scholar
13.Karchmer, TB, Giannetta, ET, Muto, CA, Strain, BA, Farr, BM. A randomized crossover study of silver-coated urinary catheters in hospitalized patients. Arch Intern Med 2000;160:3294–3298.CrossRefGoogle ScholarPubMed
14.Srinivasan, A, Karchmer, T, Richards, A, Song, X, Perl, TM. A prospective trial of a novel, silicone-based, silver-coated Foley catheter for the prevention of nosocomial urinary tract infections. Infect Control Hosp Epidemiol 2006;27(1):38–43.CrossRefGoogle ScholarPubMed
15.Rupp, ME, Fitzgerald, T, Marion, N, et al. Effect of silver-coated urinary catheters: efficacy, cost-effectiveness and antimicrobial resistance. Am J Infect Control 2004;32(8):445–450.CrossRefGoogle ScholarPubMed
16.Rothfeld, AF, Stickley, A. A program to limit urinary catheter use at an acute care hospital. Am J Infect Control 2010;38(7):568–571.CrossRefGoogle ScholarPubMed