In January 2015, the burden of mandated public reporting of catheter-associated urinary tract infections (CAUTIs) increased for infection preventionists (IPs) to include non-intensive care unit patients. For many IPs working in community and academic acute care facilities, this enhanced surveillance substantially impacts the time spent on reviewing urine culture data, defining patients with a positive culture and the presence of a urinary catheter and performing chart review for clinical signs and symptoms of infection. Notably, the majority of this surveillance is performed as a manual process.
The SHEA white paper on data requirements for electronic surveillance of healthcare-associated infections (HAIs)1 identified the key electronic data elements for the NHSN surveillance metrics. For CAUTI, the elements mentioned include ADT (admissions, discharge, transfer), vital signs (fever), microbiology cultures (urine only), urinalysis and urinary catheter presence. The authors cite the difficulty to extract other clinical symptoms such as frequency, dysuria, suprapubic tenderness and costovertebral angle pain or tenderness from the electronic medical record as a barrier to fully electronic surveillance (FES) for CAUTI. I would propose that with the 2015 CAUTI definition, which does not allow the use of these subjective symptoms when a catheter is present, FES for CAUTI is on the horizon.
A recent paper by Hsu and colleagues2 describes an electronic surveillance tool for CAUTI in adult ICUs based on the 2012 NHSN definition that was highly sensitive. These authors used 4 methods for identifying CAUTIs: 1) traditional surveillance (TS) based on manual chart review by IPs, 2) an electronic surveillance tool (ES), 3) augmented electronic surveillance (AES) – ES with chart review of a subset of cases and 4) reference standard (RS) which consisted of a subset of CAUTIs originally identified through TS or ES confirmed by two study investigators certified in NHSN surveillance. Performance of TS, ES and AES was compared to the RS. Of 175 CAUTIs selected for review, 32 confirmed CAUTIs in 22 patients became the RS. AES achieved 100% sensitivity and specificity when compared to RS and more than doubled the positive predictive value of TS. It was noted that during the 6-month study period, the IPs evaluated a total of 10,397 urine cultures and manually cross-checked these cultures with patients’ urinary catheter status. The ES system would have decreased by 25-fold the number of urine cultures the IPs needed to review.
What more do we need to hear? The time has come for automation of CAUTI surveillance.
1 Woeltje KF, Yin MY, Klompas M, Wright MO, et al. Data Requirements for Electronic Surveillance of Healthcare-Associated Infections. Infect Control Hosp Epidemiol 2014;35(9):1083-1091.
2Hsu HE, Shenoy ES, Kelbaugh K, Ware W, et al. An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units. Am J Infect Control 2015;43:592-9.