Catheter Related Urinary Tract Infections 2015 Physician Education

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

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 100.3 F (new or worsening) Flank pain, pelvic discomfort, or costovertebral tenderness If Foley removed in previous 48 hr: Urgency Dysuria Suprapubic pain

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

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)

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

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

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

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; 50:625-663 CDC/NHSN Manual – Patient Safety Component: Device- associated module; Catheter Associated Urinary Tract Infection 2015