A Descriptive Analysis of CRUTIs Over a 6 Month Period in a Large Tertiary Care Facility

Background:

Catheter related urinary tract infections (CRUTIs) are the most common hospital-acquired infection, accounting for approximately 30% of infections reported by acute care hospitals.  The daily risk associated with having an indwelling urinary catheter (IUC) ranges from 3% to 7% percent.  CRUTIs are associated with an increase in morbidity, mortality, hospital costs, and length of stay (LOS).

Objective:

To provide a descriptive analysis of CRUTIs that occurred over a 6 month period at Memorial Hermann Hospital (MHH) in 7 intensive care units including Neurosurgical/Neurotrauma (NICU/NIMU),  Medicine (MICU/MIMU), Transplant (TSICU/TSIMU), Cardiovascular (CVICU/CVIMU), Cardiac Care (CCU/CIMU), Burn, Shock Trauma (STICU/SIMU) and their respective intermediate care units (IMUs). 

Methods:

CRUTI surveillance is conducted on all patients with an IUC according to the National Healthcare Safety Network guidelines.  A line listing of cases was compiled over a 6 month period that included CRUTIs occurring from 3/2010 to 8/2010.  A descriptive analysis was done using Microsoft Office Excel—variables included date of admission and discharge, unit the infection was attributed to, LOS, sex, trauma status, IUC insertion location, number of attempts at insertion of IUC, date of positive culture, and organism. 

Results:

From 3/2010 to 8/2010, 39 CRUTIs occurred in 6 ICUs and 4 IMUs.  NICU accounted for 14 cases (36%), CVICU with 7 cases (18%), STICU with 5 cases (13%), and MICU and TSICU with 1 case each (3%).   NIMU accounted for 5 cases (13%), MIMU with 2 cases (5%), and CVIMU and CIMU with 1 case each (3%).  Females accounted for 26 cases (67%) and males with 13 cases (33%).  5/39 cases were polymicrobial.  Organisms isolated include Candida species (13), GNRs (24), and GPC (7).  IUC insertion occurred in the ER for 17/39, the unit for 13/39, the OR for 7/39, and 2/39 in the Cath Lab and an outside facility.  Average time to infection post insertion was 8.6 days (range: 2 to 22 days).  Average time to infection for an ER inserted IUC was 8 days, 8.3 days for an OR insertion, and 7.8 days for a unit insertion.  Possible insertion related CRUTIs occurred in 13/39 (33%) and possible maintenance related CRUTIs occurred in 26/39 (67%).  The average LOS for a patient who developed a CRUTI was 29 days (range: 4 to 74 days).  Number of insertion attempts was found to be rarely documented—only documented as “multiple” in 2 cases.  Trauma patients accounted for 6 cases.

Conclusions:

CRUTIs occurred predominantly in the female population.  Maintenance related CRUTIs comprise most of the infections, which points toward the need for reeducation of staff with regard to the maintenance of and indications for IUCs.  The neurosurgical/neurotrauma patient population accounted for 49% (ICU and IMU combined) of the CRUTIs.  This highlights the need to take a more focused look at this patient population (i.e. IUC utilization ratios, indications for IUCs, alternatives to IUCs).