Urinary Catheter Infections: Clinical Assessment vs National Safety Network Definition

MedicalResearch.com Interview with:
Mohamad Fakih, MD, MPH
Medical Director, Infection Prevention and Control
St John Hospital and Medical Center

MedicalResearch.com: What are the main findings of the study?

Dr. Fakih: Urinary catheters are commonly used in the hospital.  Although they help in the management of the sickest patients, they also present a risk for infection and other harms to the patient. The Centers for Medicaid and Medicare Services (CMS) have made catheter associated urinary tract infections (CAUTI) publicly reportable, and no longer reimburse hospitals for these infections if they occur in hospital setting. The definition of CAUTI is based on the surveillance definition of the National Healthcare Safety Network (NHSN) by the Centers for Disease Control and Prevention (CDC). We looked at clinician practice, including the Infectious Diseases specialist’s impression and compared them to the NHSN definition. We found a significant difference between what clinicians think is a urinary catheter infection and give antibiotics for it compared to the NHSN definition. The NHSN definition predicted clinical infection by the Infectious Diseases specialist in only about a third of the cases. We also found that Infectious Disease specialists considered patients to have true CAUTI in only half of what clinicians treated as CAUTI.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Fakih: The NHSN definition is heavily influenced by the presence of a positive urine culture of more than a 100,000 colony forming units and the presence of a fever (temperature > 38 degrees celsius). Patients may have asymptomatic bacteriuria and a fever from another source and still be identified as CAUTI using the NHSN definition. A very important result from our study is that the NHSN CAUTI definition does not reflect well the clinical practice of neither the clinicians nor the Infectious Diseases specialists, although it is used for public reporting of CAUTI by hospitals.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Fakih: When approached by infection prevention or other members from quality, the clinician may not agree with the diagnosis based on the NHSN definition because it does not mirror the clinical diagnosis. Furthermore, patients may be viewing data that do not accurately reflect the clinical disease related to CAUTI. They would need to be cognizant that the CDC NHSN definition is a surveillance definition and not a clinical definition, and that it has its limitations. Finally, clinicians overtreat patients for CAUTI.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Fakih: These findings have significant policy implications that potentially will impact both quality improvement efforts and financial reimbursements by CMS. Other hospitals are encouraged to evaluate whether our findings are generalizable to their settings. Related to policy implications, we suggest to consider additional measures to evaluate patient harm related to the urinary catheter, including urinary catheter utilization based on the different intensive care or non-intensive care units involved.

Check out how to prevent catheter-associated urinary tract infections: www.catheterout.org


Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection  

Fadi Al-Qas Hanna, Oksana Sambirska, Sugantha Iyer, Susanna Szpunar, Mohamad G. Fakih 

AJIC: American Journal of Infection Control – 09 September 2013 (10.1016/j.ajic.2013.05.024)