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Definitional Change in NHSN CAUTI Was Associated with an Increase in CLABSI Events: Evaluation of a Large Health System

Published online by Cambridge University Press:  23 March 2017

Mohamad G. Fakih ,
Clariecia Groves ,
Angelo Bufalino ,
Lisa K. Sturm  and
Ann L. Hendrich
Mohamad G. Fakih*
Affiliation:
Care Excellence, Ascension Health, St. Louis, Missouri
Clariecia Groves
Affiliation:
Care Excellence, Ascension Health, St. Louis, Missouri
Angelo Bufalino
Affiliation:
Care Excellence, Ascension Health, St. Louis, Missouri
Lisa K. Sturm
Affiliation:
Care Excellence, Ascension Health, St. Louis, Missouri
Ann L. Hendrich
Affiliation:
Care Excellence, Ascension Health, St. Louis, Missouri
*
Address correspondence to Mohamad G. Fakih, MD, MPH, Senior Medical Director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention, 19251 Mack Ave, Suite 190, Grosse Pointe Woods, MI 48236 ([email protected]).
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Abstract

BACKGROUND

The National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) definition was revised as of January 2015 to exclude funguria and lower bacteriuria levels. We evaluated the effect of the CAUTI definition change on NHSN-defined central-line–associated bloodstream infection (CLABSI) outcomes.

METHODS

We compared CAUTI and CLABSI NHSN-defined outcomes for calendar years 2014 and 2015 in the adult intensive care units (ICUs) of a single large health system. Changes in the event rates, the associated organisms, and the standardized infection ratio (SIR) were evaluated.

RESULTS

The study included 137 adult ICUs from 65 hospitals. The CAUTI SIR dropped from 1.04 in 2014 to 0.58 in 2015 (−44.2%), while the CLABSI SIR increased from 0.36 in 2014 to 0.47 in 2015 (+30.6%). CAUTI rates dropped 44.8% from 2.09 to 1.15 events per 1,000 device days (P<.001). Gram-positive–associated CAUTI rates dropped 36.7% from 0.34 to 0.22 per 1,000 device days (P=.007). CLABSI rates increased 27.1% from 0.71 to 0.90 per 1,000 device days (P=.027). Candida-associated CLABSI increased by 91.1% from 0.104 to 0.198 per 1,000 device days (P=.012), and Enterococcus-associated CLABSI increased by 121.6% from 0.071 to 0.16 per 1,000 device days (P=.008).

CONCLUSIONS

The revised CAUTI definition led to a large reduction in CAUTI rates and, in turn, an increase in candidemia and enterococcemia cases classified as CLABSI events. These findings have important implications on the perceived successes or failures to eliminate both infections.

Infect Control Hosp Epidemiol 2017;38:685–689

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 685 - 689
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: These data were presented on May 18, 2016, at the SHEA Spring 2016 conference in Atlanta, Georgia (Abstract #520). This abstract was selected as 1 of 23 outstanding abstracts for the SHEA Top Poster Abstract Award.

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