CDC considers changes to CAUTI and bloodstream infection reporting methods

The Centers for Disease Control and Prevention (CDC) is attempting to develop better methods of measuring and reporting data on healthcare-associated infections rates (HAIs.) Two papers so far have been published as part of this improvement effort, looking into the reliability of data on catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSI) rates.

Reducing CAUTI rates was the subject of The Joint Commission’s proposed National Patient Safety Goal for 2017, with prepublication standards released for hospitals, critical access hospitals, and nursing care centers. Currently, most HAI measurements are done manually using processes and definitions from the National Healthcare Safety Network (NHSN). However, researchers found that there are several limitations with the NHSN’s current CAUTI surveillance definition despite it being the most frequently used. Some of the limitations are:
•    Limited clinical correlation
•    Potential for underreporting of CAUTI events due to the subjective nature of manual surveillance
•    CAUTI events may be influenced by the prevalence of fever and the frequency of urine culture collection in a given location, both of which are elements of case-finding
•    Reliance on the use of catheter days, as the CAUTI rate denominator makes it challenging to measure the impact of quality improvement initiatives focused on catheter avoidance

Researchers noted that the most effective way of reducing CAUTIs is by decreasing the number of days that patient is catheterized. With that in mind, they suggested that facilities use urinary catheter device utilization ratio (DUR) as a quality measure instead. DUR is found by dividing catheter days by patient days, and can be adjusted for variables like hospital demographics, size, teaching status, and unit type. Furthermore, DUR data can be gathered with existing data in most electronic medical records.

The second paper looked at replacing CLABSI rates with hospital-onset bacteremia (HOB) rates as a quality measure. HOB rates use blood culture to determine if patients have more, less, or an equal amount of bacteria after 48 hours of being admitted. The authors state that HOB is, “objective, simple to understand, easily automated, easier to collect, time saving, and is a more inclusive measure because it incorporates bacteremia as a result of any HAI and not just CLABSI.”

The CDC is also trying to improve data reliability by improving how NHSN methods are applied, automating infection detection, and providing more education to infection preventionists.