Eliminating CAUTI: Interim Data Report

Data Sources

This report uses data stored in the MHA Care Counts database created and maintained by MHA Keystone Center in Lansing, Michigan. Data submission consists of nine periods over three phases throughout participation in the 18-month cohort. The three phases, including corresponding data collection periods, are baseline (three data collection periods, BL1, BL2, and BL3), implementation (two post-baseline data collection periods, P1 and P2), and sustainability (four post-baseline data collection periods, P3, P4, P5, and P6).  During each of these periods, registered hospital units provide the number of catheter and patient days and CAUTIs observed, collectively referred to as "outcome" data in this project. In addition, units submit the number of patients and catheters, as well as the indications for the catheters, known in this project as "process" data. Process data are also collected during baseline implementation and sustainability phases of the project; however, process data are collected only within specific days for each of these periods—that is, 15 days during baseline periods one through three, 16 days during post-baseline periods one and two, and 5 days for each of the four remaining post-baseline periods. Units must submit process data directly into the Care Counts database, but outcome data may be entered into the CDC's National Healthcare Safety Network (NHSN) and then transferred into the Care Counts database at the State level. Two patient safety culture measures are collected, the Hospital Survey on Patient Safety Culture (HSOPS) and the Team Checkup Tool (TCT). The HSOPS survey is used to assess change in the system and unit patient safety culture over time and is collected both at the start of project participation and one year post baseline. The TCT is used to provide continual team feedback of barriers to unit safety culture and is intended to be completed quarterly.

Of note, the process measure for catheter insertion "appropriateness" was required at the launch of the project in November 2010; however, the NPT has determined, following review of the data, that this measure will be optional for the remaining project cohorts 5–7. Initial evaluation of appropriateness data has shown very high levels of reported appropriateness, with marginal variability and therefore limited opportunities for improvement. Following this investigation, it was determined that the measure should be changed from mandatory to optional. The catheter appropriateness tool and data collection system are still strongly recommended for use to identify barriers to CAUTI reduction. Measurement is critical for assessing success; however, measurement systems should continually be reviewed to limit data burden wherever possible in order to balance required resources with the value of return.

Currently, 39 sponsors have recruited six cohorts, representing units in 37 States, the District of Columbia, and Puerto Rico. These cohorts entered the project at different times; therefore, not all cohorts are included in each of the nine periods of data collection across the three phases of baseline, implementation, and sustainability.

All analyses in this report are based on data drawn from the Care Counts database as of July 15, 2013, which includes outcome and process data submitted through May 2013. Units that have formally withdrawn from the project are removed from these analyses. The project periods by cohort are detailed in Table 1 and Table 2. Of note, in early fall 2011, after observing data submission rates, the NPT decided to offer units the opportunity to restart their data collection efforts. Nineteen units from cohort 2 opted to start over. The intervention date and data collection periods for these 19 units have been shifted to cohort 2b to accommodate the new start date.

A complete list of hospitals that have contributed to the national project database can also be found on the project Web site at www.onthecuspstophai.org.  

Hospital and Unit Characteristics

To more fully assess hospital characteristics, registered information provided by unit team leaders was linked to data from the annual American Hospital Association (AHA) 2010 National Survey results. This additional coordination of efforts reduced the data burden on hospital staff and provided an opportunity to make similar comparisons across hospitals and unit types, an important objective of national process improvement efforts.

Table 1. Project Outcome Data by Cohort^a

^a. This table represents the expected data provided in the July 15, 2013, data extract. Unit teams are given 45 days from the end of a measurement period listed in the table above to enter outcome data.
^b. Number of registered units.

Table 2. Project Process Data by Cohort^a

^a. This table represents the expected data provided in the July 15, 2013, data extract. Unit teams are given 2 weeks from the end of a measurement period to enter process data.
^b. Number of registered units.

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Measures

The project measurement goals are to establish CAUTI rates, monitor catheter utilization and appropriateness rates, and assess team safety culture. These areas will be measured in the On the CUSP: Stop CAUTI project (outcome, process, and culture). Outcome and process measures are described throughout the remainder of this report. Process measures related to safety culture (specifically unit teamwork and communication) are being collected and will be incorporated into future data analyses.

To assess project success, the following three measures are captured and tracked: CAUTI NHSN rate, CAUTI population rate, and catheter utilization ratio. To be included in CAUTI rate and catheter utilization ratio calculations, participating units are required to submit data for at least one of three baseline data periods and at least one post-baseline data collection period. As a result, units may be missing some baseline or post-baseline data but still be included in the analyses.

CAUTI Rates

CAUTI rates were calculated using two methods. First, CAUTI rates were measured using the CDC NHSN methodology.³ The NHSN measure accounts for the risk of infection for patients with an indwelling catheter. A CAUTI rate is calculated using the NHSN definition by dividing the total number of CAUTI episodes within a specific time period by the total number of catheter days within the same time period, then multiplying by 1,000 (Equation 1).

Equation 1. CAUTI Rate Using NHSN Calculation

CAUTI Rate = CAUTI Episodes / Catheter Days X 1,000

The CAUTI rate was also estimated using a population-based denominator.⁴ Because the target of many CAUTI interventions is reducing the number of catheter days, this measure has been shown to be more sensitive in intervention studies,⁵ as it is standardized by the population, which is typically relatively constant, unlike the number of catheter days, which typically decreases during an intervention. A population CAUTI rate is calculated by dividing the total number of CAUTI episodes within a specific time period by the total number of patient days within the same time period, then multiplying by 10,000 (Equation 2).

Equation 2. Population CAUTI Rate

Population CAUTI Rate = CAUTI Episodes / Patient Days X 10,000

 

Catheter Utilization Ratio

A catheter utilization ratio was calculated to assess more closely the relationship between changes in catheter utilization and patient volume. Because the target of many CAUTI interventions is decreasing the number of catheter days, this measure assesses if a reduction in catheter days is the result of a decrease in utilization (i.e., ratio decrease with time) or a decrease in patient volume (i.e., ratio remains relatively constant).

Catheter utilization is calculated by dividing the total number of catheter days in a given time period by the total number of patient days in the corresponding time period and reflected as a percent (Equation 3).

Equation 3. Catheter Utilization Ratio

Catheter Utilization Ratio = Catheter Days / Patient Days

 

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³ Dudeck MA, Horan TC, Peterson KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control 2011 Dec; 39(10): 798-816. PMID: 22133532.

⁴ Fakih, MG, Greene, MT, Kennedy EH, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012 May; 40(4): 359-64. PMID: 21868133.

⁵ Wright M-O, Kharasch M, Beaumont JL, et al. Reporting catheter-associated urinary tract infections: denominator matters. Infect Control Hosp Epidemiol 2011 Jul;32(7):635-640. PMID: 21666391.