title: Challenges and proposed improvements for reviewing symptoms and catheter use to identify National Healthcare Safety Network catheter-associated urinary tract infections.
abstract: BACKGROUND
  Retrospective medical record review is used to categorize urinary tract infections (UTIs) as symptomatic, catheter-associated, and/or healthcare-associated to generate National Healthcare Safety Network (NHSN) surveillance and claims data. We assessed how often patients with UTI diagnoses in claims data had a catheter in place, had documented symptoms, or met the NHSN criteria for catheter-associated UTI (CAUTI).
  
  
  METHODS
  Two physicians retrospectively reviewed medical records for 294 randomly selected patients hospitalized with UTI as a secondary diagnosis, discharged between October 2008 and September 2009 from the University of Michigan. We applied a modification of recent NHSN criteria to estimate how often UTIs in claims data may be an NHSN CAUTI.
  
  
  RESULTS
  The 294 patients included 193 women (66%). The mean patient age was 63 years, and the median length of hospital stay was 7.5 days. Catheter use was noted for 216 of 294 postadmission records (74%), including 126 (43%) with a Foley catheter. NHSN symptoms were noted in 113 records (38%); 62 (21%) had symptoms other than fever. Of 136 hospitalizations meeting urine culture criteria, 17 (5.8%) met the criteria for a potential NHSN CAUTI.
  
  
  CONCLUSIONS
  Retrospective medical record review to identify symptoms and catheter use is complicated and resource-intensive. Requiring standard documentation of symptoms and catheter status when ordering urine cultures could simplify and improve CAUTI surveillance and its fidelity as a hospital quality indicator.
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI. Electronic address: Meddings@umich.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Meddings
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Heidi
authors.initials: H
authors.lastname: Reichert
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI.
authors.forename: Laurence F
authors.initials: LF
authors.lastname: McMahon
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D058996:Quality Improvement; D011897:Random Allocation; D012189:Retrospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects; D062885:Urinary Catheters / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control
keywords: Device; Healthcare-associated infection; Infection diagnosis; Urinary catheter