Urinary catheter-associated urinary tract infection for intensive care unit (ICU) patients (NQF 0138)

eMeasure Name Urinary catheter-associated urinary tract infection for intensive care unit (ICU) patients eMeasure Id 90DE3529-C9F6-4EC4-A6AA-359CDAB58A91
Version number 1 eMeasure Set Id 3AC94B7E-38CB-4384-B449-B12B28140D80
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Centers for Disease Control and Prevention
Endorsed by National Quality Forum
Description Standardized Infection Ratio (SIR) of healthcare-associated, catheter-associated urinary tract infections (CAUTI) among patients in intensive care units (ICUs), excluding patients in neonatal ICUs (NICUs).
Copyright
Measure scoring Ratio
Measure type Outcome
Stratification
The stratification section lists the 19 individual ICU types by which results should be stratified.
Risk Adjustment
None
Data Aggregation
NQF-endorsed version: This measure is reported as a rate comprised of the number of catheter-associated urinary tract infections per 1,000 urinary catheter days for each hospital unit location included in scope for the measure.
  
Updated version undergoing endorsement evaluation: This measure is reported as a ratio of the observed rate of catheter-associated urinary tract infections per 1,000 urinary catheter days to the predicted rate of catheter-associated urinary tract Infections per 1,000 urinary catheter days calculated for each hospital unit location in scope for the measure and summarized across all locations.
Rationale
CAUTI is the most common type of healthcare-associated infection, accounting for more than 30% of acute care hospital infections. 
There are 13,000 deaths associated with UTIs each year, an estimated 449,334 CAUTIs/yr, and a medical cost of $758/CAUTI. Total of >$340 million attributable to CAUTI in U.S. each year.
Clinical Recommendation Statement
Virtually all healthcare-associated urinary tract infections (UTIs) are caused by instrumentation of the urinary tract. CAUTI can lead to such complications as cystitis, pyelonephritis, gram-negative bacteremia, prostatitis, epididymitis, and orchitis in males, and, less commonly, endocarditis, vertebral osteomyelitis, septic arthritis, endophtalmitis, and meningitis in all patients.  Complications associated with CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality.
Improvement notation
It is envisioned that the use of this measure will promote CAUTI prevention activities which will lead to improved patient outcomes. Such activities include reducing the number of unnecessary indwelling catheters inserted, removing indwelling catheters at their earliest, clinically-appropriate time; avoiding patient exposures to antibiotics; reducing avoidable medical costs, and patient morbidity and mortality.
Reference
Klevens RM, Edwards JR, et al. Estimating healthcare-associated infection and deaths in U.S. hospitals, 2002. Public Health Reports 2007: 122:160-166.
Reference
Scott, RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. http://www.cdc.gov/ncidod/dhqp/Scott_CostPaper.pdf assessed April 12, 2010.
Definition
Urinary tract infections (UTI) are defined using symptomatic urinary tract infection (SUTI) criteria or Asymptomatic Bacteremic UTI (ABUTI) criteria. 

indwelling catheter: a drainage tube that is inserted into the urinary bladder through the urethra, is left in place, and is connected to a closed collection system; also called a Foley catheter; does not include straight in-and-out catheters
.
Definition
Initial Patient Population(s): All patients with an indwelling urinary catheter, (as defined by the CDC/National Healthcare Safety Network [NHSN]) in intensive care units (ICUs).
Definition
Denominator(s): The expected number of urinary tract infections for the facility location.
Definition
Denominator Population(s): The expected number of urinary tract infections for the facility location calculated by multiplying the total number of catheter days by the applicable referent CAUTI population rate for each facility location. Applicable CAUTI referent rates are determined by using the CAUTI data reported to NHSN in 2009 and are published in AJIC 201;39:349-67 and  can be found at http://www.cdc.gov/nhsn/PDFs/dataStat/2010NHSNReport.pdf
Definition
Denominator Exclusion(s): Patients in neonatal intensive care units (NICUs). NICU patients are not included in the initial patient population and no specific logic is needed to exclude them in this section.
Definition
Numerator(s): The number of patients who develop a catheter-associated urinary tract infection (as defined by the CDC/NHSN) during the measurement period.
Definition
Numerator Exclusion(s): N/A
Guidance
For the determination of a symptomatic urinary tract infection, the signs or symptoms observed should not be attributed to another recognized cause.

The measure enumerates catheter days for each patient. Implementers are advised to specify their queries such that the device presence is determined for each day of the month, at the same time each day, defined by the local institution. The same time must be used throughout the institution to avoid double counting a device day.
For urine cultures to meet criteria for this measure no more than two species can be present in the culture result..  For patients with asymptomatic bacteremic urinary tract infection (ABUTI)  the urine microorganism must be one of those defined as a uropathogen. For the ABUTI numerator criteria, the patient must have a positive urine culture of greater than or equal to 100,000 CFU/mL with no more than two species of uropathogen microorganisms AND a positive blood culture with at least one matching uropathogen microorganism to the urine culture. The statement in the Numerator portion of the Population Criteria section, AND: "Laboratory Test, Result: Blood culture for CAUTI" contains "Laboratory Test, Result: Urine Culture (result value: 'uropathogens')" is intended to capture the positive blood culture with at least one matching uropathogen microorganism to the urine culture. Urine cultures with more than two uropathogens do not meet criteria for this measure.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Reporting Stratification

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012