1. Using NHSN Definitions for Surveillance: Urinary Tract Infection (UTI) STANLEY OSTRAWSKI, MS, RN, MT(ASCP), CIC Infection Preventionist Consultant

2. Objectives Explain how to calculate a CAUTI rate Explain how to complete NHSN UTI forms using CDC definitions and protocols Apply case definitions of Urinary Catheter- associated infections to case studies

3. Introduction – Urinary Tract Infections and Indwelling Urinary Catheters The urinary tract is the most common site of HAI Almost all UTIs are directly related to catheterization of the urinary tract CAUTI can lead to complications such as pyelonephritis or bacteremia,

4. CAUTI –Terms and Definitions Use CDC Definitions for the following: –CAUTI –Indwelling catheter –SUTI –ABUTI –OUTI

5. Definition: CAUTI CAUTI is a urinary tract infection (UTI) that occurs in a patient who had an indwelling urinary catheter in place within the 48- hour period before the onset of the UTI NOTE: There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter-associated

6. Definition: Indwelling Catheter A drainage tube that is inserted into the urinary bladder through the urethra, is left in place, and is connected to a closed collection system. – Also called a Foley catheter – Does not include straight in and out catheters – Does not include suprapubic or nephrostomy catheters

9. Rm # NameAg e DiagnosisCatheterIVResp PICU - Monday, October 31, 2011 1:00 PM 106Brandon Smith6InfluenzaPICCIPPB q 6 hr 107Nicole Brown18 mos. Pneumonia Otitis Media CVC – Femoral 108Aamina Bidouk3Status epilepticusFoley to ddSwan ganz PICC Tracheostomy, ventilator 109Robin White6Viral meningitisPIV X 2 110David Cranshaw10Asthmatic bronchitis PIV right antecub CVC Jugular Ventilator – weaning off 111Susanna Solomon7 mosRSV pneumoniaCath for spec. PIV right antecubIPPB q 6 hr 112Davey Blue4PneumoniaCVC – SubclavianVent cont. 113Amy O’Donnell – transferred to Surgical Peds Ward at 11AM 6Repair – congenital heart defect Foley out @ 10:30AM PICCVent. Extubated at 10:30 am – on room air 114Brie Bennett2Anaphalaxis to bee sting Foley to ddSwan ganz CVC subclavian Vent cont. 115Harrison Black – admitted from ED @ 9 am 14 mos RSV pneumonia/congen ital heart disease PICCIntubated in ED– on vent cont.

27. Specimen Collection Urine specimens for culture should be processed as soon as possible, preferably within 1 to 2 hours. If urine specimens cannot be processed within 30 minutes of collection, they should be refrigerated, or inoculated into primary isolation medium before transport, or transported in an appropriate urine preservative. Refrigerated specimens should be cultured within 24 hours.

28. Calculating the CAUTI Rate *Stratify by location type – ICU or other location

29. 2009 NHSN Report Edwards JR, et al. Am J Infect Control 2009;37:783-805

30. 2011 NHSN Report

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35. Turning Data into Knowledge Have a plan to share the data with those individuals who can make a difference: Nursing Staff Medical staff Administration Board of Directors Performance Improvement department Patient safety leaders