Work

Impact of the Centers for Disease Control and Prevention Definition Change on Evaluation of Catheter-Associated Urinary Tract Infection Reduction Programs: Results From an Integrated Healthcare System

Year: 2016

Type: article

Abstract: Background. Prevention of catheter-associated urinary tract infections (CAUTIs) is a national patient safety goal. To reduce these events, Intermountain Healthcare created a CAUTI workgroup to reduce CAUTIs in all 22 of its facilities. The goal of this study was to determine whether the interventions undertaken from 2012 to 2015 resulted in a significant reduction in CAUTIs and catheter days, despite the CAUTI definition change. Setting. Intermountain Healthcare (IHC) is a 22 hospital system with a uniform electronic medical record. The facilities support 33 Infection Preventionists (IPs). All hospitals report to NHSN, and use Centers for Disease Control and Prevention (CDC) definitions. Intervention. All unit managers received email notices of patients with urinary catheters in place for longer than 48 hours. Managers review these alerts with providers for removal. These alerts (2012), along with review of insertion technique, sampling instructions were added, and maintenance bundles were implemented (2013-4). Standardized Foley kits were utilized to optimize insertion practices (2014). Methods. CAUTI data is collected by IPs per CDC definitions and is reported to NHSN per 1000 catheter-days. The definition of CAUTI changed in 2015 to exclude Candida spp. as a cause of CAUTI. Consequently, we examined our rate of candiduria from 2012 to 2014. We determined that 15.1% of CAUTIs identified were attributable to Candida. The 2015 CAUTI counts were increased by 15.1% to account for this change (adjusted CAUTI count). Rates were compared with a z-score for person-time data. Results. In 2012, IHC reported 299 CAUTI infections in 96691 catheter days (CAUTI rate 3.09 per 1000 catheter-days). In 2015, ICH reported 148 in 88273 catheter-days 2015. Adjusted for definition change, this is estimated to be 170 CAUTIs (a reduction of 129 infections, or 43.1%, CAUTI rate 1.67 per 1000 catheter-days). IHC demonstrated a significant reduction in CAUTI rates between 2012 and 2015, despite the definition change: Rate ratio 0.57 (0.48, 0.69, p = 0.0000001). Conclusion. A significant reduction in CAUTIs was accomplished at IHC between 2012 and 2015. The 2015 definition change does result in a significant reduction in CAUTI rate, and should be addressed when evaluating CAUTI interventions. Disclosures. K. Dascomb, Medicines Company: Investigator, Research grant; S. D. Firth, Medicines Company: Investigator, Research grant

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.263