title: Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection.
abstract: BACKGROUND
  The National Healthcare Safety Network (NHSN) definition for catheter-associated urinary tract infection (CAUTI) is used to evaluate improvements in CAUTI prevention efforts. We assessed whether clinician practice was reflective of the NHSN definition.
  
  
  METHODS
  We evaluated all adult inpatients hospitalized between July 2010 and June 2011, with a first positive urine culture > 48 hours of admission obtained while catheterized or within 48 hours of catheter discontinuation. Data comprised patients' signs, symptoms, and diagnostic tests; clinician's diagnosis; and the impression of the infectious diseases (ID) consultant. The clinician's practice was compared with the NHSN definition and the ID consultant's impression.
  
  
  RESULTS
  Antibiotics were initiated by clinicians to treat CAUTI in 216 of 387 (55.8%) cases, with 119 of 387 (30.7%) fitting the NHSN CAUTI definition, and 63 of 211 (29.9%) considered by ID to have a CAUTI. The sensitivity, specificity, and positive and negative predictive values of a clinician diagnosis of CAUTI were 62.2%, 47%, 34.3%, and 73.7% when compared with NHSN CAUTI definition (n = 387) and 100%, 57.4%, 50%, and 100% when compared with the ID consultant evaluation (n = 211), respectively. The positive predictive value of the NHSN CAUTI definition was 35.1% when compared with the ID consultant's impression (n = 211).
  
  
  CONCLUSIONS
  NHSN CAUTI definition did not reflect clinician or ID consultant practices. Our findings reflect the differences between surveillance definitions and clinical practice.
authors.affiliation: Department of Medicine, St John Hospital and Medical Center, Detroit, MI.
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Qas Hanna
authors.forename: Oksana
authors.initials: O
authors.lastname: Sambirska
authors.forename: Sugantha
authors.initials: S
authors.lastname: Iyer
authors.forename: Susanna
authors.initials: S
authors.lastname: Szpunar
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000175:diagnosis*; D015510:Clinical Medicine / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000175:diagnosis*
keywords: Device; Health care-associated infection; Infection diagnosis; Urinary catheters