1. Catheter Related Urinary Tract Infections
2015 Physician Education

2. Overview CAUTI
CAUTI are the most common healthcare associated infection
Up to 70% are preventable
Published practice guidelines indicate that there is antimicrobial overuse for misdiagnosed UTI
Asymptomatic bacteruria/candiduria is common with foley catheter use and does not require treatment + is not reportable to NHSN
CAUTI in ICU patients became publically reported data to CMS beginning Jan. 2012

3. Diagnosing CAUTI in adults
Patient has at least one of the following signs or symptoms with no other recognized cause:
Fever > 38.0 C or F (new or worsening)
Flank pain, pelvic discomfort, or costovertebral tenderness
If Foley removed in previous 48 hr:
Urgency
Dysuria
Suprapubic pain

4. Diagnosis - cont If patient meets criteria on previous slide AND
has a positive Urine Culture ( defined as > 105
micro-organisms per cc of urine with no > 2 bacteria species)
Then patient meets criteria for UTI
OTHER
Neither presence of pyuria nor cloudy or odorous urine in a catheterized patient should be interpreted as a need for urine culture or antimicrobial therapy
Criteria based on IDSA 2005 and 2010 guidelines and CDC NHSN definitions

5. Asymptomatic Bacteriuria (ASB) in Adults
Patients without symptoms of a urinary tract infection AND have a positive urine culture (per definition on slide 3)
Screening for ASB or CA-ASB is usually reserved for pregnant women or those patients who will be undergoing invasive urologic procedures
Asymptomatic patients with bacteruria/ candiduria do NOT require treatment regardless of the urine colony count or degree of pyuria (exception – pregnant women or patient will be undergoing invasive urologic procedures)

6. Prevention Strategies
Limit use of Foley Catheters per CDC recommendations:
Hospice or terminally ill
Bladder outlet obstruction/Neurogenic bladder/GU surgery
Stage III or IV pressure ulcer
Unstable pelvis/Acute pelvic fx/Acute hip fx
Hourly I & O for critically ill patient
Daily assessment of continued Foley catheter need
Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009; Center for Disease Control

7. Prevention Strategies (cont)
Prompt removal of Foley catheters
Nurse driven protocol or reminders for Foley removal
Remove asap in peri-op period; preferably in OR or PACU
Use of alternative strategies for Foleys
Condom catheters
Intermittent straight catheterization
Bladder scanners
Frequent toileting

8. Comparing Coding to Infection Prevention Dx of CA-UTI
Definitions differ between CMS coded cases (HAC’s – Healthcare Acquired Conditions) and the CDC/NHSN definitions that the Infection Preventionists must use for CAUTI for public reporting to CMS
Coders utilize physician documentation to make a decision
Infection Preventionists use clinical data, lab data and CDC algorithms to make decisions
Statistics between coders and IP’s will never agree
Biggest discrepancy is probably physician dictation calling asymptomatic bacteruria a UTI

9. References
Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009; Healthcare Infection Control Practices Advisory Committee; Centers for Disease Control
Diagnosis, Prevention and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Disease Society of America. Clinical Infectious Diseases 2010; 50:
CDC/NHSN Manual – Patient Safety Component: Device- associated module; Catheter Associated Urinary Tract Infection 2015