Catheter Associated Urinary Tract Infection Surveillance Dr Jodie McCoubrey.

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 Criterion 1 cntd….CAUTI Criterion 1 cntd….

OR…..

The physician diagnoses UTI, institutes antibiotic therapy

AND


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)



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



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)



OR……..

The physician diagnoses UTI, institutesantibiotic therapy

AND



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 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?

Catheter Associated Urinary Tract Infection Surveillance Dr Jodie McCoubrey.

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