Catheter Associated Catheter Associated Urinary Tract Infection Urinary Tract Infection Surveillance Surveillance Dr Jodie McCoubrey Dr Jodie McCoubrey
Mar 31, 2015
Catheter Associated Catheter Associated Urinary Tract Infection Urinary Tract Infection
SurveillanceSurveillance
Dr Jodie McCoubreyDr Jodie McCoubrey
Overview …..Overview …..
The extent of the problem of CAUTI
SSHAIP CAUTI surveillance programme
Data definitions of CAUTI
Data collection process
HAI Background …….HAI Background …….
100, 000 patients affected per year
5,000 deaths per year
Cost of HAI to NHS …..Cost of HAI to NHS …..
Current Climate ……..Current Climate ……..
Public Concern
Quality Issues
– Clinical Governance
– Clinical Standards
– Accountability Reviews
– Performance Assessment Framework
Learning Outcomes 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
Background to CAUTI surveillance
What 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
HAI Proportion of all HAI
(%)
Proportion of extra bed days(%)
Proportion of extra cost
(%)
Proportionpreventable?
(%)
UTI 45 11 13 38
SSI 29 57 42 35
Pneumonia 19 24 39 Sur27; Med13
Bloodstream 2 4 3 35
Other 6 4 3 N/A
HAI Cost (£pp) Nat Burden*(£M)
UTI 2955 123.89
•in-patient only
Source: Plowman et al. Socio-Economic Burden of HAI
The extent of the problem…….
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
Background to CAUTI surveillanceRisk Factors
Associated Risk FactorsAssociated 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
SSHAIP SSHAIP CAUTI SURVEILLANCE CAUTI SURVEILLANCE
PROGRAMMEPROGRAMME
Surveillance ……….Surveillance ……….
““Surveillance is the ongoing systematic Surveillance is the ongoing systematic collection, analysis, and interpretation of collection, analysis, and interpretation of
health data essential to the planning, health data essential to the planning, implementation, and evaluation of public implementation, and evaluation of public
health practice, closely integrated with the health practice, closely integrated with the timely dissemination of these data to those timely dissemination of these data to those
who need to know. The final link of the who need to know. The final link of the surveillance chain is the application of surveillance chain is the application of these data to prevention and control”.these data to prevention and control”.
(Centers for Disease Control and Prevention (Centers for Disease Control and Prevention 1988)1988)
Why CAUTI Why CAUTI surveillance?surveillance?
Best Practice StatementPrepared by NHS Quality Improvement
Scotland
CAUTI Surveillance Carried out by SCIEH
The HAI Task Force have prioritised urinary
catheterisation
Aims of CAUTI Aims of CAUTI SurveillanceSurveillance
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
Essential elements of a Essential elements of a successful HAI surveillance successful HAI surveillance
systemsystem 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) 22:457-67
Patient PopulationPatient 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
Who is included? Who is included?
Patients with a urinary catheter inserted in the•chosen specialty•emergency room•theatre
Who is excluded?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).
Exclusions cntd………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
Exclusions cntd……………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
Exclusions cntd……………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
Patient Pathways for CAUTI surveillance
Admission to chosen specialty
Catheter Inserted
End of Surveillance
Transfer
DeathCatheter in-situ to day 30
Catheter removed
3-day follow-up
Discharge
Catheter inserted in
theatre or A&E
Admission to chosen specialty
UTI
Data collection Data collection methodsmethods
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 databaseOR Data entered to database at local level
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
Data collection Data collection methodsmethods
Data collection- What?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
Data collection- How?Data collection- How?
Admission data–System of your choice
• Medical Records•Ward Admission worksheet
Admission Data
Q1. Hospital Code
Q2. Specialty Name
Q2. Ward Code/Name
Q2. Surveillance Period(MONTH)
Catheter-Associated UTI Surveillance
Ward Admission Worksheet
No. of patients in the wardeach day
TOTAL
Day ofmonth
No. of new patients admitted to the ward each
day each day
Day ofmonth
TOTAL
Month
1
23
45
6
7
8
910
1112
13
14
15
1617
18
1920
2122
2324
25
26
27
282930
31
2930
31
Month
1
23
45
6
7
8
910
1112
13
14
15
16
17
18
19
20
2122
23
24
25
26
27
28
APPENDIX VWARD ADMISSION
WORKSHEET
Admission
Data
Worksheet
Data collection- How?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
CAUTI CAUTI DATA DEFINITIONSDATA DEFINITIONS
CAUTI Data DefinitionsCAUTI Data DefinitionsA 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)
AND
The first positive urine specimen is taken or the
physician makes a diagnosis more than 48 hours after the
catheter was inserted
For patient’s with an indwelling catheter in situ
AND≥104 micro-organisms per ml from a
catheter specimen of urine AND
CAUTICAUTICriterion 1 DefinitionCriterion 1 Definition
CAUTI Data DefinitionsCAUTI Data Definitions
CAUTI Criterion 1 cntd….CAUTI Criterion 1 cntd….ONE or more of the following with no otherrecognised cause:
Loin Pain Loin or suprapubic tenderness Fever (≥38oC skin temp) Pyuria (≥104WBC per ml)
CAUTI Data DefinitionsCAUTI Data Definitions
CAUTI Criterion 1 cntd….CAUTI Criterion 1 cntd….
OR…..
The physician diagnoses UTI, institutes antibiotic therapy
AND
CAUTI Data DefinitionsCAUTI Data Definitions
The patient has TWO or more of thefollowing with no other recognised cause:
Loin Pain Loin or suprapubic tenderness Fever (≥380C skin temp) Pyuria (≥104WBC per ml)
CAUTI Data DefinitionsCAUTI Data Definitions
CAUTI Criterion 1 cntd….CAUTI Criterion 1 cntd….
CAUTICAUTICriterion 2 DefinitionCriterion 2 Definition
For patient’s who had catheter removal within 3 days before the onset of CAUTI
AND
≥ 105 micro-organisms from a mid stream specimen
AND
CAUTI Data DefinitionsCAUTI Data Definitions
CAUTI Criterion 2 cntd….CAUTI Criterion 2 cntd….
ONE or more of the following with no otherrecognised cause:
Urgency Frequency Dysuria Loin Pain Loin or suprapubic tenderness Fever (≥ 38oC skin temp) Pyuria (≥ 104WBC per ml)
CAUTI Data DefinitionsCAUTI Data Definitions
CAUTI Criterion 2 cntd….CAUTI Criterion 2 cntd….
OR……..
The physician diagnoses UTI, institutesantibiotic therapy
AND
CAUTI Data DefinitionsCAUTI Data Definitions
CAUTI Criterion 2 cntd….CAUTI Criterion 2 cntd….
The patient has TWO or more of thefollowing with no other recognised cause:
Urgency Frequency Dysuria Loin Pain Loin or suprapubic tenderness Fever (≥ 38oC skin temp) Pyuria (≥ 104WBC per ml)
CAUTI Data DefinitionsCAUTI Data Definitions
CAUTI DefinitionsCAUTI 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
Definitions state that quantitativebacterial counts should be recorded.
“Light, Medium or Heavy Growth” may
be recorded if these terms are defined
to SSHAIP prior to starting surveillance.
In conclusionIn 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
SummarySummaryDescribed the epidemiology of CAUTI
Overviewed the SSHAIP CAUTI surveillance programme
Overviewed the importance of data definitions for CAUTI
Discussed the data collection processes
Any Questions?Any Questions?