The current trajectory of mandated public reporting of healthcare-associated infection (HAI) rates to the CDC National Healthcare Safety Network (NHSN) has resulted in a plethora of data that has been collected and analyzed using standardized methodologies and definitions. This data provides information about the changing patterns of HAIs, allows tracking of progress against national and state benchmarks, identifies performance improvement opportunities, and allows for the assessment of reduction efforts.
Additionally, surveillance networks allow for the examination of data to assess the impact of changes to HAI case finding methods and definitions. On January 1, 2015, the NHSN definition for UTI was modified to exclude yeast as a urinary pathogen. As yeast rarely causes true infection but is a frequently recovered organism in high colony counts in some ICU patients - thereby meeting the CAUTI definition, many experts proposed the exclusion. So the question in many of our minds has been: What impact will the exclusion of funguria have on publicly reported CAUTI data?
Dicks and colleagues1 performed a retrospective analysis of prospectively collected CAUTI data from 30 acute care, community hospitals participating in the Duke Infection Control Outreach Network (DICON). They compared CAUTI rates with and without yeast isolates collected from January 1 – December 31, 2013 data. A total of 313 CAUTIs were identified during 271,118 urinary catheter days for a rate of 1.15 per 1000 urinary catheter days. Yeast species caused 70 (22%) of these infections and when removed from the number of CAUTIs reduced the rate to 0.90 per 1000 urinary catheter days. This resulted in an absolute incidence rate reduction of 25%. A similar analysis performed on data from a tertiary-care, academic medical center reduced the CAUTI rate by 28%.
The authors concluded that facilities with yeast CAUTIs will see decreases of similar magnitude. Although this will lead to a more clinically relevant metric, it will be imperative to account for this definitional change when comparing 2015 CAUTI data with historical data.
1Dicks KV, Baker AW, Durkin MJ, Lewis SS, Moehring RW, Anderson DJ, et al. The Potential Impact of Excluding Funguria from the Surveillance Definition of Catheter-Associated Urinary Tract Infection. Infect Control Hosp Epidemiol 2015;36(4):467-469.