Definitional Change in NHSN CAUTI Was Associated with an Increase in CLABSI Events: Evaluation of a Large Health
Mohamad G Fakih1, Clariecia Groves1, Angelo Bufalino1
1Care Excellence,Ascension Health,St. Louis,Missouri.
Insights
A revised definition for catheter-associated urinary tract infections (CAUTI) led to fewer reported CAUTIs but increased central-line-associated bloodstream infections (CLABSI). This impacts how infection control successes are measured.
Area of Science:
- Healthcare epidemiology
- Infectious disease surveillance
- Clinical microbiology
Background:
- The National Healthcare Safety Network (NHSN) updated its definition for catheter-associated urinary tract infection (CAUTI) in 2015.
- The revision excluded funguria and lowered bacteriuria thresholds for CAUTI classification.
Purpose of the Study:
- To evaluate the impact of the revised NHSN CAUTI definition on central-line-associated bloodstream infection (CLABSI) outcomes.
- To assess changes in infection rates, causative organisms, and standardized infection ratios (SIR) for both CAUTI and CLABSI.
Main Methods:
- A comparative analysis of NHSN-defined CAUTI and CLABSI outcomes.
- Data collected from adult intensive care units (ICUs) across 65 hospitals within a single health system.
- Comparison of outcomes between calendar years 2014 and 2015.
Main Results:
- The CAUTI standardized infection ratio (SIR) significantly decreased by 44.2% (1.04 to 0.58), with CAUTI event rates dropping by 44.8%.
- The CLABSI SIR increased by 30.6% (0.36 to 0.47), and CLABSI event rates rose by 27.1%.
- Notable increases were observed in Candida-associated CLABSI (+91.1%) and Enterococcus-associated CLABSI (+121.6%).
Conclusions:
- The revised CAUTI definition resulted in a substantial decrease in reported CAUTI cases.
- This definitional change led to a corresponding increase in cases classified as CLABSI, particularly those involving Candida and Enterococcus.
- These findings highlight the critical importance of standardized definitions in accurately assessing infection control program effectiveness.
Abstract:
BACKGROUND The National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) definition was revised as of January 2015 to exclude funguria and lower bacteriuria levels. We evaluated the effect of the CAUTI definition change on NHSN-defined central-line-associated bloodstream infection (CLABSI) outcomes. METHODS We compared CAUTI and CLABSI NHSN-defined outcomes for calendar years 2014 and 2015 in the adult intensive care units (ICUs) of a single large health system. Changes in the event rates, the associated organisms, and the standardized infection ratio (SIR) were evaluated. RESULTS The study included 137 adult ICUs from 65 hospitals. The CAUTI SIR dropped from 1.04 in 2014 to 0.58 in 2015 (-44.2%), while the CLABSI SIR increased from 0.36 in 2014 to 0.47 in 2015 (+30.6%). CAUTI rates dropped 44.8% from 2.09 to 1.15 events per 1,000 device days (P<.001). Gram-positive-associated CAUTI rates dropped 36.7% from 0.34 to 0.22 per 1,000 device days (P=.007). CLABSI rates increased 27.1% from 0.71 to 0.90 per 1,000 device days (P=.027). Candida-associated CLABSI increased by 91.1% from 0.104 to 0.198 per 1,000 device days (P=.012), and Enterococcus-associated CLABSI increased by 121.6% from 0.071 to 0.16 per 1,000 device days (P=.008). CONCLUSIONS The revised CAUTI definition led to a large reduction in CAUTI rates and, in turn, an increase in candidemia and enterococcemia cases classified as CLABSI events. These findings have important implications on the perceived successes or failures to eliminate both infections. Infect Control Hosp Epidemiol 2017;38:685-689.
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