infection control & hospital epidemiology july 2018, vol. 39, no. 7 concise communication
The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center
Sonali D. Advani, MD, MPH;1 Rachael A. Lee, MD;2 Martha Long, MSN, RN, CIC;3 Mariann Schmitz, MPH, CIC;3 Bernard C. Camins, MD, MSc2
The 2015 changes in the catheter-associated urinary tract infection definition led to an increase in central line-associated bloodstream infections (CLABSIs) and catheter-related candidemia in some health systems due to the change in CLABSI attribution. However, our rates remained unchanged in 2015 and further declined in 2016 with the implementation of new vascular-access guidelines.
Infect Control Hosp Epidemiol 2018;39:878–880
updated early 2016 to improve insertion and maintenance practices. In addition, new guidelines for drawing blood cultures in the setting of central lines were introduced. These included recommendations to stop surveillance blood cultures in asymptomatic patients and to refrain from drawing blood cultures through central venous catheters.
Data Collection
This retrospective study included CAUTI and CLABSI surveillance data from January 1, 2013 to December 30, 2016. This surveillance program was performed by trained infection preventionists using the applicable NHSN definitions. The UAB Institutional Review Board deemed this study exempt from review.
Statistical Analysis
Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) account for significant morbidity, mortality, and financial costs in hospitalized patients.1–4 The National Healthcare Safety Network (NHSN) provides standardized surveillance defini- tions for CLABSI and CAUTI.5 CLABSI attribution often relies on the exclusion of other sources; for example, bacteremia is
considered central-line associated if no other source is identi- fied. The NHSN CAUTI definition was revised in January 2015 to exclude yeast as a pathogen and to increase the urine culture bacterial threshold to ≥105 colony-forming units per milliliter (CFU/mL). This revised CAUTI definition resulted in a large reduction in nationwide CAUTI rates.6,7 However, it also led to an increase in CLABSI rates in some health systems due to the exclusion of CAUTI secondary to Candida as an attributable source for candidemia.8 We evaluated the effect of the 2015 NHSN changes in CAUTI definition on our CLABSI and catheter-related candidemia rates and the impact of CLABSI prevention efforts at our academic medical center.
methods Setting
This study was conducted in all inpatient units at the University of Alabama at Birmingham (UAB) Hospital, a 1,157-bed academic medical center, between January 2013 to December 2016. Our institutional vascular access policy was
We analyzed both the reportable hospital-wide and the intensive care unit (ICU) CLABSI and CAUTI rates. We performed a review of organisms causing CLABSIs and CAUTIs from 2013 to 2016 and compared them for changes after the 2015 NHSN definition change. Descriptive statistics were calculated per 1,000 catheter days (CD). Changes in event rates were compared using the Z test, and a P value of<.05was considered statistically significant. Data analyses were performed using Stata version 12.0 software (StataCorp, College Station, TX).
results
With the 2015 NHSN CAUTI definition, our hospital-wide CAUTI incidence rate (IR) decreased by>75% from 2014 to 2015: from 3.42 to 0.92 per 1,000 CD (P<.05) (Table 1). This IR remained low in 2016: 0.80 per 1,000 CD. Our ICU CAUTI IR also decreased significantly from 2014 to 2015: from 2.54 to 0.78 per 1,000 CD (P<.05) (Table 1). Our hospital-wide CAUTI rates decreased by 3.5% secondary to gram-positive bacteria and by 7.8% secondary to gram-negative bacteria in 2015 (Table 2). In addition, our ICU device utilization ratio decreased from 2013 to 2016,without any significant change in the number of urine cultures ordered (data previously reported).6 With the 2015 definition change, there was an initial increase
in our hospital-wide CLABSI IR from 2014 to 2015: from 1.34 to 2.1 per 1,000 CD (P<.05). However, this increase was followed by a significant decline from 2015 to 2016: from 2.1 to 1.31 per 1,000 CD (P<.05) (Table 1). At the same time, a nonsignificant increase occurred in our ICU CLABSI IR from 2014 to 2015: from1.59 to 1.83 per 1,000CD(P=.10) (Table 1).However, our CLABSI IR decreased significantly from 2015 to 2016: from 1.83 to 0.91 per 1,000 CD (P<.05) (Table 1).
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