using nhsn definitions for surveillance: urinary tract infection (uti) stanley ostrawski, ms, rn,...

Using NHSN Definitions for Surveillance: Urinary Tract Infection (UTI)

STANLEY OSTRAWSKI, MS, RN, MT(ASCP), CICInfection Preventionist Consultant

Objectives• Explain how to calculate a CAUTI rate• Explain how to complete NHSN UTI forms using CDC

definitions and protocols• Apply case definitions of Urinary Catheter-

associated infections to case studies

Introduction – Urinary Tract Infections and Indwelling Urinary Catheters

• The urinary tract is the most common site of HAI

• Almost all UTIs are directly related to catheterization of the urinary tract

• CAUTI can lead to complications such as pyelonephritis or bacteremia,

CAUTI –Terms and Definitions

Use CDC Definitions for the following: – CAUTI– Indwelling catheter– SUTI– ABUTI– OUTI

Definition: CAUTI

CAUTI is a urinary tract infection (UTI) that occurs in a patient who had an indwelling urinary catheter in place within the 48-hour period before the onset of the UTI

NOTE: There is no minimum period of time that the catheter must be in

place in order for the UTI to be considered catheter-associated

Definition: Indwelling Catheter

• A drainage tube that is inserted into the urinary bladder through the urethra, is left in place, and is connected to a closed collection system.– Also called a Foley catheter– Does not include straight in and

out catheters– Does not include suprapubic or

nephrostomy catheters

Rm #

Name Age

Diagnosis Catheter IV Resp

PICU - Monday, October 31, 2011 1:00 PM

106 Brandon Smith 6 Influenza PICC IPPB q 6 hr

107 Nicole Brown 18 mos.

PneumoniaOtitis Media

CVC – Femoral

108 Aamina Bidouk 3 Status epilepticus Foley to dd Swan ganzPICC

Tracheostomy, ventilator

109 Robin White 6 Viral meningitis PIV X 2

110 David Cranshaw 10 Asthmatic bronchitis

PIV right antecubCVC Jugular

Ventilator – weaning off

111 Susanna Solomon 7 mos RSV pneumonia Cath for spec.

PIV right antecub IPPB q 6 hr

112 Davey Blue 4 Pneumonia CVC – Subclavian Vent cont.

113 Amy O’Donnell – transferred to Surgical Peds Ward at 11AM

6 Repair – congenital heart defect

Foley out @ 10:30AM

PICC Vent . Extubated at 10:30 am – on room air

114 Brie Bennett 2 Anaphalaxis to bee sting

Foley to dd Swan ganzCVC subclavian

Vent cont.

115 Harrison Black – admitted from ED @ 9 am

14 mos

RSV pneumonia/congenital heart disease

PICC Intubated in ED– on vent cont.

2

Specimen CollectionUrine specimens for culture should be processed as soon as possible, preferably within 1 to 2 hours. If urine specimens cannot be processed within 30 minutes of collection, they should be refrigerated, or inoculated into primary isolation medium before transport, or transported in an appropriate urine preservative. Refrigerated specimens should be cultured within 24 hours.

Calculating the CAUTI Rate

*Stratify by location type – • ICU or other location

2009 NHSN Report

Edwards JR, et al. Am J Infect Control 2009;37:783-805

2011 NHSN Report

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Turning Data into Knowledge

Have a plan to share the data with those individuals who can make a difference:• Nursing Staff• Medical staff• Administration• Board of Directors• Performance Improvement department• Patient safety leaders

Questions?