Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals

Bardossy, Ana C.; Williams, Takiah; Jones, Karen; Szpunar, Susan; Zervos, Marcus; Alangaden, George; Reyes, Katherine; Fakih, Mohamad G.

doi:10.1017/ice.2018.251

Cited by 6 publications

(11 citation statements)

References 9 publications

(14 reference statements)

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“…The NHSN CAUTI definition is more dependent on culturing practices and the preexisting prevalence of bacteriuria and is less susceptible to device maintenance. [18][19][20] Plausible explanations for these findings include different hospitalized patient populations (more COVID-19; fewer surgical and elective admissions), increases in antimicrobial use resulting in the suppression of bacteriuria, and a reduction in inappropriate triggers to ordering urine cultures (eg, urine color or turbidity) 21 in an effort to minimize contact between healthcare workers and patients. Finally, we used the risk-adjusted dSIR and pSIR to evaluate the changes in CLABSIs and CAUTIs between the 2 periods.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts

Fakih

Bufalino

Sturm

et al. 2021

Infect. Control Hosp. Epidemiol.

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150

139

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Background: The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on US hospitalizations, affecting processes and patient population. Methods: We evaluated the impact of COVID-19 pandemic in 78 US hospitals on central line associated bloodstream infections (CLABSI) and catheter associated urinary tract infections (CAUTI) events 12 months pre-COVID-19 and 6 months during COVID-19 pandemic. Results: There were 795,022 central line-days and 817,267 urinary catheter-days over the two study periods. Compared to pre-COVID-19 period, CLABSI rates increased during the pandemic period from 0.56 to 0.85 (51.0%) per 1,000 line-days (p<0.001) and from 1.00 to 1.64 (62.9%) per 10,000 patient-days (p<0.001). Hospitals with monthly COVID-19 patients representing >10% of admissions had a NHSN device standardized infection ratio for CLABSI that was 2.38 times higher compared to those with <5% prevalence during the pandemic period (p=0.004). Coagulase-negative staphylococcus CLABSI increased by 130% from 0.07 to 0.17 events per 1,000 line-days (p<0.001), and Candida sp. by 56.9% from 0.14 to 0.21 per 1,000 line-days (p=0.01). In contrast, no significant changes were identified for CAUTI (0.86 vs. 0.77 per 1,000 catheter-days; p=0.19). Conclusions: The COVID-19 pandemic was associated with substantial increases in CLABSI but not CAUTI events. Our findings underscore the importance of hardwiring processes for optimal line care, and regular feedback on performance to maintain a safe environment.

show abstract

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts

Fakih

Bufalino

Sturm

et al. 2021

Infect. Control Hosp. Epidemiol.

Self Cite

150

139

View full text Add to dashboard Cite

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“…12 Such practices may eclipse process improvement initiatives, centered on proper device need and care. 15,16 Additionally, the national focus has been on preventing NHSN CAUTI events rather than catheter-related harm. Noninfectious catheter complications, such as urethral injury, pain, or inadvertent catheter removal, have received limited attention.…”

Section: Nhsn Cauti As a Surrogate Of Catheter Harmmentioning

confidence: 99%

“…Noninfectious catheter complications, such as urethral injury, pain, or inadvertent catheter removal, have received limited attention. 16,17 The catheter also limits patient mobility and increases the risk of falling because it acts as a "1-point restraint." 18 In a recent study of patient-reported outcomes after urinary catheter insertions, noninfectious complications were 5 times more likely than infectious complications.…”

Section: Nhsn Cauti As a Surrogate Of Catheter Harmmentioning

confidence: 99%

“…Hence, these metrics risk shifting the emphasis from processes focused on reducing catheter harm toward reducing surveillance CAUTIs. 16 Appropriate performance metrics should capture clinically significant catheter harm and provide meaningful information to facilities to improve outcomes. We propose 3 key metrics to align outcomes with interventions: the standardized utilization ratio (SUR), population SIR, and CA bacteriuria.…”

Section: Aligning Outcomes With Interventions and Seeking More Inclusmentioning

confidence: 99%

See 1 more Smart Citation

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

Advani

Fakih

2019

Infect. Control Hosp. Epidemiol.

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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.

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“…This is in contrast to the clinical definition, where CAUTI is considered a diagnosis of exclusion. Hence, the practice of pan-culturing can increase the diagnosis of NHSN CAUTIs and negatively impact an institution’s Hospital Acquired Condition Reduction Program (HAC) score [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Practices of Physicians and Nurses Related to Urine Cultures in Catheterized Patients: An Assessment of Adherence to IDSA Guidelines

Advani

Gao

Datta

et al. 2019

Open Forum Infectious Diseases

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Background A positive urine culture often drives initiation of antimicrobials even in the absence of symptoms. Our objectives were to evaluate the knowledge and practice patterns related to ordering urine cultures in patients with indwelling urinary catheters. Methods We performed chart reviews of catheter-associated urinary tract infections (CAUTIs) at our academic health care system between October 1, 2015, and September 30, 2017, to assess practice patterns related to the assessment of potential CAUTIs. Following this, we surveyed physicians and nurses about indications for ordering urine cultures in catheterized patients between January 11, 2018, and April 17, 2018. The accuracy of these indications was assessed based on Infectious Diseases Society of America CAUTI and asymptomatic bacteriuria guidelines. Results On chart review, we identified 184 CAUTIs in 2 years. In 159 episodes (86%), urine cultures were ordered inappropriately. In 114 episodes (62%), CAUTI criteria were met by “pan-culturing” rather than symptom-directed testing. Twenty cases (11%) experienced partial or delayed management of other infections, drug adverse events, and Clostridioides difficile infections (CDIs). On our survey, we received 405 responses, for a response rate of 45.3%. Mean scores varied by occupation and level of training. Nurses were more likely than physicians to consider change in appearance (61% vs 23%; P < .05) and odor (74% vs 42%; P < .05) of urine as indications to order urine cultures. Conclusions Our data reveal specific knowledge gaps among physicians and nurses related to ordering urine cultures in catheterized patients. The practice of pan-culturing and inappropriate urine culture orders may contribute to overdiagnosis of surveillance CAUTIs, delay in diagnosis of alternative infections, and excess CDIs.

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Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals

Cited by 6 publications

References 9 publications

Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts

Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts

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

Knowledge and Practices of Physicians and Nurses Related to Urine Cultures in Catheterized Patients: An Assessment of Adherence to IDSA Guidelines

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