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. 2013 Dec;41(12):1173-7.
doi: 10.1016/j.ajic.2013.05.024. Epub 2013 Sep 5.

Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection

Fadi Al-Qas Hanna  1 , Oksana Sambirska, Sugantha Iyer, Susanna Szpunar, Mohamad G Fakih
Affiliations

Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection

Fadi Al-Qas Hanna et al. Am J Infect Control. 2013 Dec.

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).

Conclusion: NHSN CAUTI definition did not reflect clinician or ID consultant practices. Our findings reflect the differences between surveillance definitions and clinical practice.

Keywords: Device; Health care-associated infection; Infection diagnosis; Urinary catheters.

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