Catheter Associated Urinary Tract Infection Surveillance Dr Jodie McCoubrey

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Catheter Associated Urinary Tract Infection
SurveillanceDr Jodie McCoubrey
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Overview ..

• The extent of the problem of CAUTI
• SSHAIP CAUTI surveillance programme
• Data definitions of CAUTI
• Data collection process

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HAI Background .

• 100, 000 patients affected per year
• 5,000 deaths per year

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Cost of HAI to NHS ..
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Current Climate ..

• Public Concern
• Quality Issues
• Clinical Governance
• Clinical Standards
• Accountability Reviews
• Performance Assessment Framework

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Learning Outcomes

• To describe the epidemiology of CAUTI
• To overview the SSHAIP CAUTI surveillance
  programme
• To apply the data definitions for CAUTI correctly
• To evaluate the data collection processes
  available
• To maximise the potential for reduction of HAI
  through surveillance activities

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Background to CAUTI surveillanceWhat is the
problem?

• Most common infection in acute hospitals and
  long-term care facilities
• 2.5 of hospital patients acquire a UTI
• ? Length of hospitalisation (average 5-6 days)
• (Plowman et al, 1999)
• Cost to the patient
• Pain and discomfort
• Complicated upper urinary tract infection
• Bacteraemias

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The extent of the problem.
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Background to CAUTI surveillanceRisk Factors

• Major predisposing factor
• indwelling urinary catheter
• average of 26 of hospitalised patients are
  catheterised (Glynn et al, 1997)
• risk of CAUTI is 1-2 per procedure
• Risk ? for each additional day of catheterisation
• Common in long-term catheterised patients

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Associated Risk Factors

• A history of previous catheter use
• Duration the catheter is in situ
• Length of stay in hospital prior to catheter
  insertion
• Location of catheter insertion

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SSHAIP CAUTI SURVEILLANCE PROGRAMME
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Surveillance .
Surveillance is the ongoing systematic
collection, analysis, and interpretation of
health data essential to the planning,
implementation, and evaluation of public health
practice, closely integrated with the timely
dissemination of these data to those who need to
know. The final link of the surveillance chain is
the application of these data to prevention and
control. (Centers for Disease Control and
Prevention 1988)
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Why CAUTI surveillance?
The HAI Task Force have prioritised urinary
catheterisation

• Best Practice Statement
• Prepared by NHS Quality Improvement Scotland
• CAUTI Surveillance
• Carried out by SCIEH

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Aims of CAUTI Surveillance

• Collect surveillance data and describe trends in
  catheter use and CAUTI
• Evaluate the impact of Best Practice in terms
  of
• patient practice
• infection rates
• Assist hospitals in ? of CAUTI

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Essential elements of a successful HAI
surveillance system

• Defining what outcomes to measure
• Ensuring everyone involved is aware of the
  outcomes
• Reliably collecting the data in a
  standardised/defined manner
• Analysing data for comparison
• Using the data locally in a timely manner to
  improve quality of care
  Gaynes and Solomon. J Quality Improvement
  (1996) 22457-67

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Patient Population

• 17 specialties have been chosen for CAUTI
  surveillance
• Each participating hospital will chose ONE of the
  listed specialties for surveillance
• Specialities represent
• Medicine
• Surgery
• Gynaecology Obstetrics
• Primary care
• Paediatrics are included

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Who is included?

• Patients with a urinary catheter inserted in the
• chosen specialty
• emergency room
• theatre

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Who is excluded?

• Patients are excluded if
• The indwelling urethral catheter was inserted
  before the start of the UTI surveillance period
• Catheter is in situ on admission to the hospital
  (e.g. from the community or transferred from
  another hospital).

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Exclusions cntd

• Patients are excluded if
• The indwelling catheter is inserted in a
  specialty out with the chosen specialty
  (with the exception
  of the operating theatre and emergency
  department)
• They are nursed on wards not allocated to that
  specialty
• They are not from the chosen specialty but are
  nursed in a ward designated to the chosen
  specialty

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Exclusions cntd

• Patients are excluded if
• They have a single in-and-out catheter
• The indwelling catheter has been in place for
  less than 6 hours
• The catheterisation is intermittent (i.e.
  insertion and removal of a catheter into the
  bladder every 3-6 hours for the drainage of
  urine)
• They have suprapubic catheterisation

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Exclusions cntd

• Patients are excluded if
• They are undergoing treatment for a UTI when the
  catheter is inserted
• They are nursed on an ICU/HDU associated with the
  specialty, unless the patient population has been
  defined to include these wards when the
  surveillance started

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Patient Pathways for CAUTI surveillance
Catheter inserted in theatre or AE
Admission to chosen specialty
Catheter Inserted
Admission to chosen specialty
Transfer
Catheter in-situ to day 30
Catheter removed
Discharge
UTI
Death
3-day follow-up
End of Surveillance
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Data collection methods

• Electronic data collection on Tablet PC or laptop
• An electronic data collection tool for CAUTI
  surveillance has been developed
• Paper data collection
• Paper forms sent to SCIEH for scanning and entry
  to database
• OR
• Data entered to database at local level

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Data collection methods

• Data collection- Who?
• Designated data collector
• e.g. ICN surveillance nurse member of ICT or
  trained ward staff
• Data transferred by data collector or data
  manager/IT staff

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Data collection- What?

• What data?
• Admission data
• Total no. of admissions to chosen specialty in
  the surveillance period
• Total number of patient days
• Catheter use
• Total number of catheter days
• Infection details
• onset date/symptoms and signs/causative organism
  and risk factors

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Data collection- How?

• Admission data
• System of your choice
• Medical Records
• Ward Admission worksheet

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Admission Data
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Admission Data Worksheet
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Data collection- How?

• Catheter use (identify patients eligible for
  surveillance)
• Daily
• Visit wards and identify catheterised patients
  from nursing records, medical records and ward
  staff
• CAUTI details
• Daily
• Check urine microbiology reports for specialty
  under surveillance
• Review medical and nursing records temperature
  and treatment charts

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CAUTI DATA DEFINITIONS
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CAUTI Data Definitions

• A healthcare associated UTI considered to be
• catheter associated if
• An indwelling catheter is in situ at time of
  onset of UTI (Criterion 1)
• OR
• An indwelling catheter was removed within 3 days
  prior to the onset of UTI (Criterion 2)

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• AND
• The first positive urine specimen is taken or the
  physician makes a diagnosis more than 48 hours
  after the catheter was inserted

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CAUTICriterion 1 Definition
CAUTI Data Definitions

• For patients with an indwelling catheter in situ
• AND
• 104 micro-organisms per ml from a catheter
  specimen of urine
• AND

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CAUTI Criterion 1 cntd.
CAUTI Data Definitions

• ONE or more of the following with no other
• recognised cause
• Loin Pain
• Loin or suprapubic tenderness
• Fever (38oC skin temp)
• Pyuria (104WBC per ml)

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CAUTI Criterion 1 cntd.
CAUTI Data Definitions

• OR..
• The physician diagnoses UTI, institutes
  antibiotic therapy
• AND

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CAUTI Criterion 1 cntd.
CAUTI Data Definitions

• The patient has TWO or more of the
• following with no other recognised cause
• Loin Pain
• Loin or suprapubic tenderness
• Fever (380C skin temp)
• Pyuria (104WBC per ml)

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CAUTICriterion 2 Definition
CAUTI Data Definitions

• For patients who had catheter removal within 3
  days before the onset of CAUTI
• AND
• 105 micro-organisms from a mid stream specimen
• AND

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CAUTI Criterion 2 cntd.
CAUTI Data Definitions

• ONE or more of the following with no other
• recognised cause
• Urgency
• Frequency
• Dysuria
• Loin Pain
• Loin or suprapubic tenderness
• Fever ( 38oC skin temp)
• Pyuria ( 104WBC per ml)

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CAUTI Criterion 2 cntd.
CAUTI Data Definitions

• OR..
• The physician diagnoses UTI, institutes
• antibiotic therapy
• AND

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CAUTI Criterion 2 cntd.
CAUTI Data Definitions

• The patient has TWO or more of the
• following with no other recognised cause
• Urgency
• Frequency
• Dysuria
• Loin Pain
• Loin or suprapubic tenderness
• Fever ( 38oC skin temp)
• Pyuria ( 104WBC per ml)

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CAUTI Definitions

• CAUTI must meet one of the criteria 1 or 2 as
  described
• Patients with asymptomatic bacteriuria/bacteria
  in their urine are NOT considered to have a CAUTI

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• Definitions state that quantitative
• bacterial counts should be recorded.
• Light, Medium or Heavy Growth may
• be recorded if these terms are defined
• to SSHAIP prior to starting surveillance.

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In conclusion

• What am I looking for?
• Does the patient have an indwelling catheter?
• Does the patient have a CAUTI?
• Are there defined signs and symptoms?
• What is the infection onset date?
• Signs and symptoms should be recorded on form
  when first noticed

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Summary

• Described the epidemiology of CAUTI
• Overviewed the SSHAIP CAUTI surveillance
  programme
• Overviewed the importance of data definitions for
  CAUTI
• Discussed the data collection processes

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Any Questions?