title: An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units.
abstract: BACKGROUND
  Traditional methods of surveillance of catheter-associated urinary tract infections (CAUTIs) are error-prone and resource-intensive. To resolve these issues, we developed a highly sensitive electronic surveillance tool.
  
  
  OBJECTIVE
  To develop an electronic surveillance tool for CAUTIs and assess its performance.
  
  
  METHODS
  The study was conducted at a 947-bed tertiary care center. Patients included adults aged ≥18 years admitted to an intensive care unit between January 10 and June 30, 2012, with an indwelling urinary catheter during their admission. We identified CAUTIs using 4 methods: traditional surveillance (TS) (ie, manual chart review by ICPs), an electronic surveillance (ES) tool, augmented electronic surveillance (AES) (ie, ES with chart review on a subset of cases), and reference standard (RS) (ie, a subset of CAUTIs originally ascertained by TS or ES, confirmed by review). We assessed performance characteristics to RS for reviewed cases.
  
  
  RESULTS
  We identified 417 candidate CAUTIs in 308 patients; 175 (42.0%) of these candidate CAUTIs were selected for review, yielding 32 confirmed CAUTIs in 22 patients (RS). Compared with RS, the sensitivities of TS, ES, and AES were 43.8% (95% confidence interval [CI], 26.4%-62.3%), 100.0% (95% CI, 89.1%-100.0%), and 100.0% (95% CI, 89.1%-100.0%). Specificities were 82.5% (95% CI, 75.3%-88.4%), 2.8% (95% CI, 0.8%-7.0%), and 100.0% (95% CI, 97.5%-100.0%).
  
  
  CONCLUSIONS
  Electronic CAUTI surveillance offers a streamlined approach to improve reliability and resource burden of surveillance.
authors.affiliation: Harvard Medical School, Boston, MA; Boston Combined Residency Program in Pediatrics, Boston Children's Hospital and Boston Medical Center, Boston, MA.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Hsu
authors.affiliation: Harvard Medical School, Boston, MA; Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA; Infection Control Unit, Massachusetts General Hospital, Boston, MA; Medical Practices Evaluation Center, Massachusetts General Hospital, Boston, MA. Electronic address: eshenoy@mgh.harvard.edu.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Shenoy
authors.affiliation: Partners Information Systems, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, MA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Kelbaugh
authors.affiliation: Clinical Care Management Unit, Massachusetts General Hospital, Boston, MA.
authors.forename: Winston
authors.initials: W
authors.lastname: Ware
authors.affiliation: Harvard Medical School, Boston, MA; Department of Biostatistics, Massachusetts General Hospital, Boston, MA.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, Massachusetts General Hospital, Boston, MA.
authors.forename: Pearl
authors.initials: P
authors.lastname: Zakroysky
authors.affiliation: Harvard Medical School, Boston, MA; Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA; Infection Control Unit, Massachusetts General Hospital, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
authors.affiliation: Harvard Medical School, Boston, MA; Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA; Medical Practices Evaluation Center, Massachusetts General Hospital, Boston, MA.
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D014552:Urinary Tract Infections / Q000453:epidemiology*
keywords: CAUTI; ICU; Infection control; NHSN; Resources
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