Editor's Commentary - Reporting catheter-associated urinary tract infections: Denominator matters

BERKELEY, CA (UroToday.com) - A hospital-wide surveillance program for tracking CAUTIs usually includes monitoring the UTI rate and device days.

An electronic medical record or physician order-entry system with automatic stop-orders can benefit CAUTI reduction initiatives. Staff reminders for discontinuation or “stop-orders” can also be helpful. Improved performance by reduction in IUC use is associated with improved patient outcomes (lower CAUTI rate).

The National Healthcare Safety Network (NHSN) surveys symptomatic bacteriuria and the ascertainment of catheter device-days and patient-days. According to the NHSN, device utilization is calculated as a ratio of device-days to patient-days, while rates of infection are expressed as infections per 1,000 catheter-days to reflect the population at risk. Measures of device associated infection rates utilize device-days as the denominator. But Wright and colleagues (2011) argue that current NHSN reporting techniques may not be the best method for measuring improvement of a specific program put in place to reduce UTI rates. The authors describe a CAUTI quality improvement project implemented at 3 hospitals (N= 24 units) in NorthShore Chicago that focused on reducing IUC use. It included:

  • A physician order for placement or continued use of catheters present on admission with documented rationale for use
  • Daily nursing assessment of all catheterized patients for continued need and recommendations to discontinue as warranted
  • Physician reminder and required renewal with rationale every 48 hours, and
  • Discouraging of unnecessary catheterization by targeting education in high-use areas (e.g., IUC, ER)


Infect Control Hosp Epidemiol. 2011 Jul;32(7):635-40


PubMed Abstract
PMID: 21666391


UroToday.com Infections Section