title: Implementation of electronic surveillance of catheter use and catheter-associated urinary tract infection at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals.
abstract: BACKGROUND
  Manual surveillance of indwelling urinary catheters (IUCs) and catheter-associated urinary tract infections (CAUTIs) is resource intense.
  
  
  METHODS
  We implemented electronic surveillance in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Capacity was created centrally to analyze data collected electronically or manually at each site. We measured the average IUC duration and proportion of patients with IUC duration <3 days. CAUTIs were identified using a validated algorithm based on the Centers for Disease Control and Prevention definition and used to calculate rates and standardized incidence ratios (SIRs).
  
  
  RESULTS
  Electronic surveillance was implemented in 25 units at 20 NICHE hospitals. Full automation was achieved at 15 of 16 sites with electronic health records (EHRs). Electronic surveillance challenges included EHR data element formats and IUC documentation. Study units reported on 4,574 patients for 16,105 IUC days over a 6-month period. The mean of the unit-level average IUC duration was 3.2 ± 2.6 days, mean proportion of patients with IUC duration <3 days was 52.4% ± 50%, and mean CAUTI SIR was 0.14 ± 0.31.
  
  
  CONCLUSIONS
  A centralized electronic surveillance strategy for CAUTI is feasible and sustainable. Baseline performance of participating sites was exemplary, with very low SIRs at baseline.
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO. Electronic address: Heidi.wald@ucdenver.edu.
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Brian
authors.initials: B
authors.lastname: Bandle
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Richard
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Sung-Joon
authors.initials: SJ
authors.lastname: Min
authors.affiliation: Hunter-Bellevue School of Nursing, Hunter College of the City University of New York, New York, NY.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Capezuti
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology*; D057286:Electronic Health Records; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D009816:Office Automation; D058996:Quality Improvement; D014546:Urinary Catheterization / Q000009:adverse effects; D062885:Urinary Catheters / Q000009:adverse effects / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology*
keywords: Catheter-associated urinary tract infections; Healthcare-associated infection; Surveillance; Urinary catheter