A three year review of catheter-associated urinary tract infections reported to the national healthcare safety network at a tertiary care hospital

摘要

Background: Catheter-associated urinary tract infections (CAUTI) are one of the most common hospital-associated infections. Recent efforts to characterize the etiology and reduce incidence of CAUTIs have been spurred by the Centers for Medicare and Medicaid Services (CMS) decision to cease reimbursement for CAUTI. To have a national standardized definition for CAUTI for national improvement efforts and public reporting, many agencies including CMS, have opted to use the National Healthcare Safety Network (NHSN) CAUTI definition. The NHSN CAUTI definition was developed for surveillance efforts and therefore does not necessarily reflect clinical practice. Objectives: The objective of this study is to determine the extent to which NHSN reported CAUTI events correspond with clinician diagnosis of CAUTI at a University-Affiliated Tertiary Care Hospital. Methods: This study is a retrospective chart review analysis of all CAUTI events reported to NHSN from July 1, 2010 through June 30, 2013. Patient medical records were reviewed to determine clinician and Infectious Disease (ID) consultant CAUTI diagnosis. Results: A total of 102 NHSN CAUTI events were reported over the 3-year period. Of these, 66.67% meet the clinician CAUTI diagnosis and 41.67% meet the ID consult CAUTI diagnosis. udConclusions: These results suggest a poor correlation between NHSN reported CAUTI events and actual clinical practice, with only two thirds of the NHSN reported CAUTI events being diagnosed by a clinician and only 42% being diagnosed by an Infectious Disease consultant. As long as the NSHN-CAUTI definition is used for public reporting, it is important to realize that the reported rates are not necessarily reflective of infectious complications of urinary catheters or clinical diagnosis. Instead, these rates should be evaluated to identify areas for improvement within the reporting facilities and when addressing national improvement efforts. Public Health Significance: The NHSN CAUTI definition was developed for surveillance purposes and is therefore very broad to capture all possible CAUTI events. Since the NHSN surveillance definition is being used for public reporting, the reported CAUTI rates may be artificially inflated and thus may not truly reflect patient care at any given hospital. This makes it difficult for a consumer to legitimately compare hospitals when determining where to receive care, as the rate may be more reflective of the frequency of obtaining urine cultures than of actual CAUTI events. ud