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The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics?

Published online by Cambridge University Press:  27 March 2019

Sonali D. Advani Open the ORCID record for Sonali D. Advani [Opens in a new window]  and
Mohamad G. Fakih Open the ORCID record for Mohamad G. Fakih [Opens in a new window]
Sonali D. Advani*
Affiliation:
Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut
Mohamad G. Fakih
Affiliation:
Care Excellence, Ascension Health, St Louis, Missouri Wayne State University School of Medicine, Detroit, Michigan
*
Author for correspondence: Sonali D. Advani, Email: [email protected]
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Abstract

Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 6 , June 2019 , pp. 681 - 685
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle Scholar
Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of health care-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.10.1056/NEJMoa1801550CrossRefGoogle Scholar
Calderon, LE, Kavanagh, KT, Rice, MK. Questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing. Am J Infect Control 2015;43:1050–1052.10.1016/j.ajic.2015.05.024CrossRefGoogle ScholarPubMed
Advani, SD, Lee, RA, Schmitz, M, Camins, BC. Impact of changes to the National Healthcare Safety Network (NHSN) definition on catheter-associated urinary tract infection (CAUTI) rates in intensive care units at an academic medical center. Infect Control Hosp Epidemiol 2017;38:621–623.CrossRefGoogle ScholarPubMed
Press, MJ, Metlay, JP. Catheter-associated urinary tract infection: does changing the definition change quality? Infect Control Hosp Epidemiol 2013;34:313–315.CrossRefGoogle ScholarPubMed
Hospital-Acquired Condition Reduction Program (HACRP). Center for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Published 2018. Accessed August 1, 2018.Google Scholar
The NHSN standardized infection ratio (SIR): A guide to the SIR. Center for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf. Published March 2018. Accessed June 18, 2018.Google Scholar
Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) and other urinary system infection [USI]) events. Center for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf. Published 2018. Accessed June 17, 2018.Google Scholar
Fakih, MG, Groves, C, Bufalino, A, Sturm, LK, Hendrich, AL. Definitional change in NHSN CAUTI was associated with an increase in CLABSI events: evaluation of a large health system. Infect Control Hosp Epidemiol 2017;38:685–689.CrossRefGoogle ScholarPubMed
Bardossy, AC, Jayaprakash, R, Alangaden, AC, et al. Impact and limitations of the 2015 National Health and Safety Network case definition on catheter-associated urinary tract infection rates. Infect Control Hosp Epidemiol 2017;38:239–241.CrossRefGoogle ScholarPubMed
Al-Qas Hanna, F, Sambirska, O, Iyer, S, Szpunar, S, Fakih, MG. Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection. Am J Infect Control 2013;41:1173–1177.10.1016/j.ajic.2013.05.024CrossRefGoogle Scholar
Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1, 497 catheterized patients. Arch Intern Med 2000;160:678–682.Google ScholarPubMed
Kizilbash, QF, Petersen, NJ, Chen, GJ, Naik, AD, Trautner, BW. Bacteremia and mortality with urinary catheter-associated bacteriuria. Infect Control Hosp Epidemiol 2013;34:1153–1159.CrossRefGoogle ScholarPubMed
Mullin, KM, Kovacs, CS, Fatica, C, et al. A multifaceted approach to reduction of catheter-associated urinary tract infections in the intensive care unit with an emphasis on “stewardship of culturing.” Infect Control Hosp Epidemiol 2017;38:186–188.10.1017/ice.2016.266CrossRefGoogle ScholarPubMed
Bardossy, AC, Williams, T, Jones, K, et al. Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: the tale of two teaching hospitals. Infect Control Hosp Epidemiol 2018;39:1494–1496.CrossRefGoogle ScholarPubMed
Fakih, MG, Gould, CV, Trautner, BW, et al. Beyond infection: device utilization ratio as a performance measure for urinary catheter harm. Infect Control Hosp Epidemiol 2016;37:327–333.CrossRefGoogle ScholarPubMed
Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.CrossRefGoogle ScholarPubMed
Saint, S, Trautner, BW, Fowler, KE, et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med 2018;178:1078–1085.CrossRefGoogle ScholarPubMed
Finucane, TE. “Urinary tract infection”—requiem for a heavyweight. J Am Geriatr Soc 2017;65:1650–1655.CrossRefGoogle ScholarPubMed
Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.CrossRefGoogle Scholar
Garibaldi, RA, Mooney, BR, Epstein, BJ, Britt, MR. An evaluation of daily bacteriologic monitoring to identify preventable episodes of catheter-associated urinary tract infection. Infect Control 1982;3:466–470.CrossRefGoogle ScholarPubMed
Warren, JW, Tenney, JH, Hoopes, JM, Muncie, HL, Anthony, WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982;146:719–723.CrossRefGoogle ScholarPubMed
Hooton, TM, Bradley, SF, Cardenas, DD, et al. 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;50:625–663.CrossRefGoogle ScholarPubMed
Livorsi, DJ, Perencevich, EN. CAUTI surveillance: opportunity or opportunity cost? Infect Control Hosp Epidemiol 2015;36:1335–1336.CrossRefGoogle ScholarPubMed
Meddings, J, Rogers, MA, Krein, SL, Fakih, MG, Olmsted, RN, Saint, S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:277–289.CrossRefGoogle ScholarPubMed
Saint, S, Greene, MT, Kowalski, CP, Watson, SR, Hofer, TP, Krein, SL. Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med 2013;173:874–879.CrossRefGoogle ScholarPubMed
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;35:449–455.CrossRefGoogle ScholarPubMed
Fakih, MG, Watson, SR, Greene, MT, et al. Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med 2012;172:255–260.10.1001/archinternmed.2011.627CrossRefGoogle ScholarPubMed
Fakih, MG, George, C, Edson, BS, Goeschel, CA, Saint, S. Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies. Infect Control Hosp Epidemiol 2013;34:1048–1054.CrossRefGoogle ScholarPubMed
Saint, S, Greene, MT, Krein, SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med 2016;374:2111–2119.CrossRefGoogle ScholarPubMed
Fakih, MG, Greene, MT, Kennedy, EH, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012;40:359–364.CrossRefGoogle ScholarPubMed
Wright, MO, Kharasch, M, Beaumont, JL, Peterson, LR, Robicsek, A. Reporting catheter-associated urinary tract infections: denominator matters. Infect Control Hosp Epidemiol 2011;32:635–640.CrossRefGoogle ScholarPubMed
Epstein, L, Edwards, JR, Halpin, AL, et al. Evaluation of a novel intervention to reduce unnecessary urine cultures in intensive care units at a tertiary care hospital in Maryland, 2011–2014. Infect Control Hosp Epidemiol 2016;37:606–609.CrossRefGoogle Scholar
Stovall, RT, Haenal, JB, Jenkins, TC, et al. A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit. J Am Coll Surg 2013;217:162–166.CrossRefGoogle ScholarPubMed
Humphries, RM, Dien Bard, J. Point–counterpoint: reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections. J Clin Microbiol 2016;54:254–258.CrossRefGoogle ScholarPubMed
Tambyah, PA, Maki, DG. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160:673–677.CrossRefGoogle ScholarPubMed
Cope, M, Cevallos, ME, Cadle, RM, Darouiche, RO, Musher, DM, Trautner, BW. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis 2009;48:1182–1188.CrossRefGoogle Scholar
Trautner, BW. Asymptomatic bacteriuria: when the treatment is worse than the disease. Nat Rev Urol 2011;9:85–93.10.1038/nrurol.2011.192CrossRefGoogle ScholarPubMed
Fakih, MG, Khatib, R. Improving the culture of culturing: critical asset to antimicrobial stewardship. Infect Control Hosp Epidemiol 2017;38:377–379.CrossRefGoogle ScholarPubMed
O’Grady, NP, Barie, PS, Bartlett, JG, et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 2008;36:1330–1349.CrossRefGoogle ScholarPubMed
Keller, SC, Feldman, L, Smith, J, Pahwa, A, Cosgrove, SE, Chida, N. The use of clinical decision support in reducing diagnosis of and treatment of asymptomatic bacteriuria. J Hosp Med 2018;13:392–395.Google ScholarPubMed
Advani, S, Smith, C, Fisher, A-L, et al. Reducing catheter-associated urinary tract infections using an evidence-based urine culture algorithm at an academic medical center. Open Forum Infect Dis 2018;5 Suppl 1:S622–S623.CrossRefGoogle Scholar
Morgan, DJ, Malani, P, Diekema, DJ. Diagnostic stewardship-leveraging the laboratory to improve antimicrobial use. JAMA 2017;318:607–608.CrossRefGoogle Scholar
Krein, SL, Damschroder, LJ, Kowalski, CP, Forman, J, Hofer, TP, Saint, S. The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study. Soc Sci Med 2010;71:1692–1701.CrossRefGoogle ScholarPubMed
Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA, Healthcare Infection Control Practices Advisory C. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31:319–326.CrossRefGoogle Scholar
Gray, M, Skinner, C, Kaler, W. External collection devices as an alternative to the indwelling urinary catheter: evidence-based review and expert clinical panel deliberations. J Wound Ostomy Continence Nurs 2016;43:301–307.CrossRefGoogle ScholarPubMed
Abrantes-Figueiredo, JI, Ross, JW, Banach, DB. Device Utilization ratios in infection prevention: process or outcome measure? Curr Infect Dis Rep 2018;20:8.CrossRefGoogle ScholarPubMed
The NHSN standardized utilization ratio (SUR): a guide to the SUR. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sur-guide-508.pdf. Published 2018. Accessed July 18, 2018.Google Scholar
Daneman, N, Bronskill, SE, Gruneir, A, et al. Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents. JAMA Intern Med 2015;175:1331–1339.CrossRefGoogle ScholarPubMed
Naik, AD, Skelton, F, Amspoker, AB, Glasgow, RA, Trautner, BW. A fast and frugal algorithm to strengthen diagnosis and treatment decisions for catheter-associated bacteriuria. PLoS One 2017;12:e0174415.10.1371/journal.pone.0174415CrossRefGoogle ScholarPubMed
Spivak, ES, Burk, M, Zhang, R, et al. Management of bacteriuria in Veterans Affairs hospitals. Clin Infect Dis 2017;65:910–917.CrossRefGoogle ScholarPubMed
van Santen, KL, Edwards, JR, Webb, AK, et al. The standardized antimicrobial administration ratio: a new metric for measuring and comparing antibiotic use. Clin Infect Dis 2018;67:179–185.CrossRefGoogle ScholarPubMed
Flanders, SA, Saint, S. Why does antimicrobial overuse in hospitalized patients persist? JAMA Intern Med 2014;174:661–662.CrossRefGoogle ScholarPubMed
Magill, SS, Klompas, M, Balk, R, et al. Developing a new national approach to surveillance for ventilator-associated events: executive summary. Am J Infect Control 2013;41:1096–1099.10.1016/j.ajic.2013.07.001CrossRefGoogle ScholarPubMed