Appendix I. National Healthcare Safety Network (NHSN) Definition CAUTI Criteria Pocket Card

Slide 1: Appendix I.

National Healthcare Safety Network (NHSN) Definition CAUTI Criteria Pocket Card

The National Healthcare Safety Network (NHSN) Definition CAUTI Criteria Pocket Card is a tool to help frontline and clinical long-term care staff identify catheter-associated urinary tract infections (CAUTIs) based on the Centers for Disease Control and Prevention's NHSN criteria. Frontline staff can use the pocket card while caring for residents to assess for signs and symptoms of CAUTI. Also, clinicians can use it when evaluating residents for signs and symptoms of CAUTI.

References

Adapted from the Centers for Disease Control and Prevention, Urinary Tract Infection (UTI) Event protocol for Long-term Care Facilities (LTCF), January 2016.

Detailed CAUTI protocol is available on the CDC/NHSN website.

Stone ND, Ashraf MS, Calder J, et al. Surveillance definitions of infections in long-term care facilities: Revisiting the McGeer criteria. Infect Control Hosp Epidemiology. 2012;33:965-977.

Slide 2: Pocket card side 1

Catheter-Associated Urinary Tract Infection

Criteria for defining CAUTI in long-term care residents:

One or more of the following, with no alternate source:

• Fever*
• Rigors (shaking chills).
• New onset hypotension with no alternate non-infectious cause.
• New onset confusion/functional decline AND increased leukocytosis*
• New costovertebral angle pain or tenderness.
• New or increased suprapubic pain or tenderness.
• Acute pain, tenderness, or swelling of the testes, epididymis, or prostate.
• Pus around the catheter insertion site.

AND

Any of the following:

If catheter removed within past 2 calendar days:

• Clean catch (voided) urine culture with no more than 2 species of microorganisms, at least 1 of which is bacteria of 100,000 or more colonies (≥10⁵ CFU/ml)
• In/Out catheter urine culture with any number of microorganisms, at least 1 of which is bacteria of 100 or more colonies (≥10² CFU/ml)

If indwelling urinary catheter in place:

• Positive urine culture with any number of microorganisms, at least 1 of which is bacteria of 100,000 colonies or more (≥10⁵ CFU/ml)

Slide 3: Pocket card side 2

*Constitutional Criteria for Long-Term Care Residents:

Fever+

Must have one of the following:

• Single oral temperature >100°F (37.8°C)
• Repeated oral temperature >99°F (37.2°C)
• Repeated rectal temperature >99.5°F (37.5°C)
• Single temperature >2°F (1.1°C) over baseline for oral or rectal

+Presence of fever, even if due to another cause, should still be counted as part of meeting an infection definition.

Leukocytosis

Must have one of the following:

• >14,000 white blood cells (leukocytes)/mm³
• Increase in immature white blood cells (Left Shift) with >6% bands or >1,500 bands/mm³

Acute Change in Mental Status (within last 7 days)

All components must be present:

• Confusion (with no alternate diagnosis and leukocytosis)
• Fluctuating Behavior (comes and goes, or changes in severity)
• Inattention (difficulty focusing and cannot maintain attention)
• Disorganized thinking (thinking is incoherent or hard to follow)

  OR

  Altered level of consciousness (change is different from baseline, may be sleepy, lethargic, difficult to arouse)

Acute Functional Decline

• New 3-point increase in total activities of daily living (ADL) score from baseline (range: 0-28)
  Each ADL scored from 0 (independent) to 4 (totally dependent), including: bed mobility, transfer, locomotion within facility, dressing, toilet use, personal hygiene, and eating