2015 NHSN CAUTI Definition Change and Its Impact on CLABSI Rates at an Academic Medical Center

Abstract The National Healthcare Safety Network (NHSN) revised their catheter-associated urinary tract infection (CAUTI) definition in January 2015 to exclude funguria. This definition change led to an increase in diagnosis of catheter-related fungemia in other health systems, due to the exclusion of CAUTI as an attributable source. We evaluated the effect of the NHSN CAUTI definition change on central line-associated blood stream infection (CLABSI) rates at our hospital. This is a retrospective study that was conducted at an 1,154-bed academic medical center. We looked at the trend of our house-wide and intensive care unit (ICU) CLABSI and CAUTI incidence rates (IR) from January 2013 to December 2016. Our institutional vascular access policy was updated in 2016 to revise insertion and maintenance practices and introduce new guidelines for drawing blood cultures in setting of central lines. With the 2015 CAUTI definition, our house-wide CAUTI IR decreased by > 75% from 2014 to 2015 (3.42 to 0.92 per 1,000 catheter days (CD) P < 0.05). Conversely, there was an initial increase in our house-wide CLABSI IR from 2014 to 2015 (1.34 to 2.1 per 1,000 CD, P < 0.05), followed by a significant decline to 1.31 per 1,000 CD in 2016 (P < 0.05). Similarly, our ICU CLABSI IR increased slightly in 2015 (1.59 to 1.83 per 1,000 CD, P = 0.1) followed by a significant decline in 2016 (1.83 to 0.91 per 1,000 CD, P < 0.05, Table 1). This initial increase in our CLABSI IR in 2015 was mainly driven by gram-positive organisms. Despite exclusion of yeast as pathogens from the 2015 CAUTI definition, our rates of catheter-related fungemia remained relatively stable (Figure 1). The 2015 NHSN CAUTI definition resulted in a significant decline in our CAUTI rates. We did not see a sustained increase in our CLABSI rates as reported by other health systems. In fact, our CLABSI rates and catheter--related fungemia rates decreased in 2016. This could be related to implementation of new vascular access guidelines and CLABSI prevention efforts.Table 1: Incidence rates (IR) per 1000 catheter days using applicable NHSN definitionYearHouse-wide CAUTI IRHouse-wide CLABSI IRICU CAUTI IRICU CLABSI IR20134.951.543.752.0220143.421.342.541.5920150.922.10.781.8320160.801.311.060.91 All authors: No reported disclosures.

Duke Scholars

Author Sonali Advani Medicine, Infectious Diseases