Catheter Associated Urinary
Tract Infection Surveillance
Dr Jodie McCoubrey
Overview …..

The extent of the problem of CAUTI

SSHAIP CAUTI surveillance programme

Data definitions of CAUTI

Data collection process
HAI Background …….

100, 000 patients
affected per year

5,000 deaths per
year
Cost of HAI to NHS …..
Current Climate ……..

Public Concern

Quality Issues
– Clinical Governance
– Clinical Standards
– Accountability Reviews
– Performance Assessment
Framework
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
The extent of the problem…….
HAI
Proportion of Proportion of Proportion of Proportion
all HAI
extra bed
extra cost
preventable?
days(%)
(%)
(%)
(%)
UTI
45
11
13
38
SSI
29
57
42
35
Pneumonia
19
24
39
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
Sur 27; Med13
Background to CAUTI surveillance
Risk Factors

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
Associated 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
CAUTI SURVEILLANCE
PROGRAMME
Surveillance ……….
“Surveillance is the ongoing systematic
collection, analysis, and interpretation of
health data essential to the planning,
implementation, and evaluation of public
health practice, closely integrated with the
timely dissemination of these data to those
who need to know. The final link of the
surveillance chain is the application of these
data to prevention and control”.
(Centers for Disease Control and Prevention
1988)
Why CAUTI surveillance?
The HAI Task Force have prioritised
urinary catheterisation
Best Practice Statement
 Prepared by NHS Quality Improvement Scotland
CAUTI Surveillance
 Carried out by SCIEH
Aims of CAUTI Surveillance

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 successful
HAI surveillance system





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 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?
Patients with a urinary catheter inserted in the
• chosen specialty
• emergency room
• theatre
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………
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……………
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……………
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 in
theatre or A&E
Catheter Inserted
Catheter
removed
UTI
Admission to chosen specialty
Catheter in-situ
to day 30
Discharge
Transfer
3-day
follow-up
End of Surveillance
Death
Data collection methods

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
database
OR
 Data entered to database at local level

Data collection methods
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- 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?
 Admission data
–System of your choice
• Medical Records
• Ward Admission worksheet
Admission
Data
APPENDIX V
WARD ADMISSION Catheter-Associated UTI Surveillance
WORKSHEET
Ward Admission Worksheet
Q1. Hospital Code
Q2. Specialty Name
Q2. Ward Code/Name
Q2. Surveillance Period
(MONTH)
Admission
Data
No. of new patients
admitted to the ward each
day each day
Day of
month
1
2
3
4
5
6
7
8
9
10
11
12
Worksheet
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL
Month
No. of patients in the ward
each day
Day of
month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL
Month
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
DATA DEFINITIONS
CAUTI Data Definitions
A 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
CAUTI Data Definitions
CAUTI
Criterion 1 Definition
For patient’s with an indwelling catheter
in situ
AND
≥104 micro-organisms per ml from a
catheter specimen of urine
AND
CAUTI Data Definitions
CAUTI Criterion 1 cntd….
ONE or more of the following with no other
recognised cause:
Loin Pain
 Loin or suprapubic tenderness
 Fever (≥38oC skin temp)
 Pyuria (≥104WBC per ml)

CAUTI Data Definitions
CAUTI Criterion 1 cntd….
OR…..
The physician diagnoses UTI, institutes
antibiotic therapy
AND
CAUTI Data Definitions
CAUTI Criterion 1 cntd….
The patient has TWO or more of the
following with no other recognised cause:
Loin Pain
 Loin or suprapubic tenderness
 Fever (≥380C skin temp)
 Pyuria (≥104WBC per ml)

CAUTI Data Definitions
CAUTI
Criterion 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 Definitions
CAUTI Criterion 2 cntd….
ONE or more of the following with no other
recognised cause:
Urgency
 Frequency
 Dysuria
 Loin Pain
 Loin or suprapubic tenderness
 Fever (≥ 38oC skin temp)
 Pyuria (≥ 104WBC per ml)

CAUTI Data Definitions
CAUTI Criterion 2 cntd….
OR……..
The physician diagnoses UTI, institutes
antibiotic therapy
AND
CAUTI Data Definitions
CAUTI Criterion 2 cntd….
The patient has TWO or more of the
following with no other recognised cause:







Urgency
Frequency
Dysuria
Loin Pain
Loin or suprapubic tenderness
Fever (≥ 38oC skin temp)
Pyuria (≥ 104WBC per ml)
CAUTI 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 quantitative
bacterial counts should be recorded.
“Light, Medium or Heavy Growth” may
be recorded if these terms are defined
to SSHAIP prior to starting surveillance.
In 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
Summary

Described 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?