CAUTIs and CLABSIs: Do Physicians REALLY Know What They Are?

Background: The incidences of hospital-acquired conditions, such as catheter-associated urinary tract infections (CAUTIs) and central line-associated blood stream infections (CLABSIs) are being used to compare quality at institutions and determine reimbursements. These data come from the University HealthSystem Consortium (UHC) administrative database that relies almost exclusively on physician documentation as opposed to objective U.S. Centers for Disease Control and Prevention (CDC) guidelines. We hypothesize that the UHC-identified rates of CAUTIs and CLABSIs are inaccurate compared with the CDC definitions for these infections.

Methods: We performed a retrospective study from January 2012 through September 2013 comparing the incidences of CLABSIs and CAUTIs, as identified through our UHC database to those identified by the Department of Epidemiology using strict CDC guidelines. We performed subset analysis on those infections identified by UHC but not CDC to determine the causes for these discrepancies.

Results: There were a total of 221 CAUTIs and 238 CLABSIs identified during this time frame. Of these, 16 CAUTIs (7.2%) and 44 (18.5%) CLABSIs were detected by both UHC and CDC. 72.4% (42/58) of the CAUTIs and 52.7% (49/93) of the CLABSIs identified by UHC were not identified by CDC. 91% (163/179) of the CAUTIs and 77% (145/189) of the CLABSIs identified by CDC were not identified by UHC. The cause of these differences in identification included lack of culture data, lack of positive cultures, and catheters present on admission.

Conclusions: There is a major disconnect between identification of infections depending on what process is used. This can lead to inappropriate treatment and inaccurate institutional comparisons that impact reimbursements. Because UHC identification of infections are primarily based on physician documentation, educating providers should result in more accurate recognition of infections thereby ensuring appropriate use of therapy.