title: An electronic catheter-associated urinary tract infection surveillance tool.
abstract: OBJECTIVE
  To develop and validate an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  413-bed university-affiliated urban teaching hospital.
  
  
  METHODS
  An electronic surveillance tool was developed for CAUTI and urinary catheter utilization based on the objective components of the National Healthcare Safety Network (NHSN) definitions including fever, urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP).
  
  
  RESULTS
  During January and February 2010, 204 positive urine cultures (≥10(3) colony-forming units/mL) were identified in 136 patients with indwelling urinary catheters during their hospitalization. The electronic surveillance tool detected 60 CAUTI cases and 7,098 catheter-days, yielding a CAUTI incidence rate of 8.5 per 1,000 catheter-days. Urinary catheter utilization ratios (Foley-days/patient-days) were: acute care units, 0.27 (3,637 of 13,229); intensive care units, 0.77 (3,461 of 4,469); and overall, 0.40 (7,098 of 17,698). In comparison, the IP identified 59 cases by manual review with a sensitivity of 51 of 59 (86.4%), specificity 136 of 145 (93.8%), and negative predictive value of 136 of 144 (94.4%). Fever was present in 54 of 59 (91.5%) of CAUTI cases identified manually, while subjective criteria were documented in only 6 of 59 (10.2%) infections. Agreement between the electronic surveillance and manual IP review was assessed as very good (κ, 0.80; 95% confidence interval, 0.71-0.89).
  
  
  CONCLUSIONS
  We report an attempt at automating surveillance for CAUTI. With a high negative predictive value, the electronic tool allows for more efficient CAUTI surveillance and facilitates housewide trending of rates and catheter utilization. This approach should be validated in different patient populations.
authors.affiliation: Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington 98104, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Choudhuri
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Pergamit
authors.forename: Jeannie D
authors.initials: JD
authors.lastname: Chan
authors.forename: Astrid B
authors.initials: AB
authors.lastname: Schreuder
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McNamara
authors.forename: John B
authors.initials: JB
authors.lastname: Lynch
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Dellit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D057286:Electronic Health Records; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D014861:Washington; D055815:Young Adult