CAUTI:

* most common site of ____.

* nearly all caused by ____________.

* numerous complications

* more than _____ deaths

most common site of HAI

nearly all caused by instrumentation

complications are w/in the GU and outside

13,000 deaths plus prolonged stay, etc.

Review Device-associated Module:

* CLABSI

*CAUTI

*VAP

*DE

*CLIP

*central line assoc bl infection

*catheter assoc uti

*ventilator assoc pneumonia

*dialysis event

*central line assoc procedure

Surveillance for CAUTI includes:

* active

*patient based

*prospective

(define each)

active = lPs look for, multiple sources

pt-based = not only lab data; risk factors and spec. procedures looked at

prospective = monitor dur'g hosp/not retro

Key terms defined

CAUTI:

an indwelling urethral catheter in place

at the time of, or, within ___ hrs

prior to infection onset

catheter in place

at the time of,

or within 48 hrs

prior to sx/infection onset

SUTI 1 B AND 2 B

AND OTHER UTI (OUTI)

CAN/CANNOT

BE CATHETER-ASSOCIATED

SUTI 1 B AND 2 B

AND OUTI

CANNOT

BE

CATHETER-ASSOCIATED

DEFINE INDWELLING CATHETER:

TUBE IN BLADDER THRU THE

_________,

CONNECTED TO A CLOSED DRAINAGE SX. 

DOES NOT INCL. _______________

TUBE IN BLADDER

THRU THE URETHRA

DOES NOT INCL

STRAIGHT IN/OUT CATHETERS

CAUTI

TRANSFER RULE

IF A CAUTI DEVELOPS W/IN

48 HRS OF TRANSFER,

EITHER TO ANOTHER UNIT

OR TO OUTSIDE THE FACILITY

IT BELONGS TO THE TRANSF. UNIT

WHAT SHOULD BE DONE

IF A PT DEVELOPS A CAUTI

WITHIN 48 HRS OF

DISCHARGE FROM

YOUR FACILITY?

REPORT IT TO NHSN.

NO ADD'L INDWELLING CATH. DAYS

ARE RECORDED

THERE ARE 4 CRITERIA

THAT CAN BE APPLIED

FOR IDENTYFING

CATHETER-ASSOC. SYMPTOMATIC

UTI (SUTI)

THESE COMBINE

S/SX

CULTURE RESULTS

URINALYSIS RESULTS

(SUTI 2A, 2B, 4)

SUTI CRITERION 1A

HAD AN INDWELLING CATHETER IN PLACE

AT THE TIME OF SPECIMEN COLLECTION

OR

INDWELLING CATHETER IN PLACE

AT THE TIME OF

ONSET

OF S/SX

SUTI CRITERION #1A

S/SX INCLUDE

FEVER

SUPRAPUBIC TENDERNESS

OR _____________

FEVER

SUPRAPUBIC TENDERNESS

OR

COSTOVERTEBRAL ANGLE PAIN/

TENDERNESS

SUTI CRITERION #1A

INCLUDES

A POSITIVE UR CX OF

>/= ___COLONY FORMING UNITS

W/NO MORE THAN ___ SP

10 TO THE 5TH COLONY

FORMING UNITS;

NO MORE THAN 2 SPECIES

OF

MICROORGANISMS

CAUTI

CRITERION 1A:

CATHETER REMOVED W/IN __ HRS

PRIOR TO SPEC COLLECT OR

ONSET OF S/SX

48 HOURS.

IF THE CATH. WAS REMOVED W/IN

48 HRS PRIOR,

ADD'L S/SX (URGENCY, FREQ., DYSUR.)

CAN BE APPLIED TO SUTI 1A

CAUTI

SUTI CRITERION 1B:

PT DID/DID NOT HAVE A CATH IN PLACE AT TIME OF, OR W/IN 48 HRS PRIOR TO, SPEC COLLECT OR ONSET S/SX

DID NOT HAVE A CATH IN

MUST ALSO HAVE AT LEAST

1 S/SX OF INFECTION

AND

POS UR CX >10-5 CFU

NO MORE THAN 2 SP OF MICRO

IF NO CATHETER IS IN PLACE

AND PT DEVELOPS A UTI

IS IT A CAUTI?

NO.

BUT, IT CAN MEET THE CRITERIA FOR

HA UTIS

AND IS REPORTED TO NHSN

CAUTI

SUTI CRITERION 2A:

CATHETER AT TIME OF S/SX ONSET

S/SX INFECTION

POSITIVE URINALYSIS (AND ...)

POS. UR CX OF >/=10-3 & >/=10-5

POSITIVE URINALYSIS DEMONSTRATED BY AT LEAST ONE OF THE FOLLOWING:

A.  POS DIPSTICK FOR ESTERASE OR NITRITE

B.  PYURIA

C. MICROORG SEEN ON GM STAIN

uropathogens are

gm neg b_____

staphylococcus

y______

beta-hemolytic s_____

gm neg bacilli

staphyloccocus spp

yeasts

beta-hemolytic streptococcus spp

uropathogens are also

enterococcus spp

g. v________

aerococcus u______

cor_______ (urease positive)

enterococcus spp

g. vaginalis

aerococcus urinae

corynebacterium (urease positive)

Asymptomatic bacteremic UTI

(ABUTI):

report corynebacterium (urease pos.) as either ...

corynebacterium spec. unspecified (COS)

or

c. urelyticum (CORUR) if so speciated

abuti

asymptomatic bacteremic uti

does the pt have s/sx of

infection?

no,

but does have a pos. ur. cx.

>/= 10 to the 5th

colony forming units

w/ no more than 2 species of

uropathogens and pos bc

abuti

asymptomatic ur tract inf

pos blood cx

define pos blood cx

1 matching uropathogen to the ur cx

at least 2 matching BC drawn

on separate occasions

if the matching pathogen is a

common skin contaminant

specimen collection for cauti:

urinary catheter tips ?

urine cx:  CCMS or cath?

in infants:  cath?  bag?  suprapubic?

no catheter tips

CCMS or cath, properly collected

(disinfect sampling port, no bag, eg)

infants:  bladder or suprapubic

only

urine cx

should be processed

within __ minutes of collection

if cannot process w/in 30 mins of collection,

they shd be refrigerated, cx w/in 24 hrs

urine cx for CAUTI:

reported as "mixed flora"

represent at least __ species

of organisms

2 species of organisms

An add'l organism recovered

wd represent >2 species of organisms

this does not represent the UTI criteria

specimen collection for cauti:

urine spec labels shd indicate

whether or not

the pt is ...

UTI

data collection

has the same 3 required fields

what are they?

patient ID

gender

DOB

CAUTI data collection:

inpatient

outpatient

or both?

inpatient location;

ie,

where denominator data

can be collected

CAUTI data collection:

the "date of event" represents what?

the date that the first s/sx of UTI

were identified

or

the date the ur spec was obtained,

whichever comes first

CAUTI

Event Information:  MDRO Infection:

Name at least 3 MDROs that may

be a part of your

Monthly Reporting Plan

MRSA; MSSA

VRE; CephR-Klebsiella

CRE-E. coli; CRE-Klebsiella

MDR-Acinetobacter; C. diff.

In what two cases

would you not report

pathogen/location

for a CAUTI

CAUTI events are not monitored

in NICUs.

The pathogen is a MDRO,

but your facility is not following the

MDRO/CDI Module

in your monthly reporting plan.

CAUTI

RISK FACTORS:

urinary catheter in place ... when?

at the time of the specimen collection

at the time of onset of s/sx

if the catheter had been removed

48 hours prior

no catheter in place, nor w/in 48 hrs prior

Define

OUTI:

associated w/ a urinary catheter?

show a positive urine cx?

is used when collecting data for CAUTI?

OUTI:

other UTI

not assoc. w/ a urin. cath.

does not show a pos. ur. cx.

not used when collect'g data for CAUTI

CAUTI

and secondary BSI:

t or f:  when the event is ABUTI,

secondary BSI must be answered

"yes"

Collecting denominators for

CAUTI:

for all locations, count at the same time each day ...

a.  number of patients

b.  number of pts w/ a urin. cath. at that same time

Calculating the CAUTI rate:

it is an ____________ density rate,

and is calculated with

a formula

#cautis id/#indwelling cath days

X 1000

cauti rate is an incidence density rate

#cauti's identified/#indwelling cath days

x 1000

cauti rates are

stratified

by ...

cauti standardized infection rate

(sir)

is calculated

by the following formula

SIR = observed/expected

HAIs

Complete this:

The SIR will be calculated only if the

number of expected HAIs (numExp)

is _____ 1.

CAUTI

Device Utilization Ratio

What does this measure?

measures the proportion of pt days

in which urin caths were used

a measure of the risk assoc w/

the location

How do you calculate the

Device Utilization (DU)

Ratio

for urinary catheters?

indwelling cath du ratio =

#cath days/#pt days

no multiplier

Interpret data so it is meaningful to your audience.

The p value indicates that the device

utilization, in a given location,

is statistically higher or lower

Ongoing surveillance:

- to determine if a decrease in rates has been sustained over time

- to evaluate _____ of interventions

- to give f_____ to caregivers, admin

- areas to focus on for new interventn

evaluate effectiveness

give feedback

sustained decrease in rates

new areas of focus for intervention