AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
1. Bacteria in the urine does not necessarily mean a catheter-associated urinary tract infection (CAUTI) is present.
Bacteriuria is the term used to describe a positive urine culture, the presence of bacteria in the urine. This could point to either asymptomatic bacteriuria or to CAUTI. People can have bacteria in the urine that do not cause symptoms or harm; asymptomatic bacteriuria is not a urinary tract infection.
2. Chronically catheterized residents have bacteriuria 99% of the time.
Inappropriate triggers for urine cultures include—
- Urine color
- Urine smell
- Urine sediment
- Cloudy urine
- White blood cells in the urine
- Positive dipstick
3. Urine culturing can actually harm residents who have no CAUTI symptoms.
4. Urine cultures should only be ordered if one or more CAUTI symptoms are present.
The presence of cloudy, odorous urine with sediments does not alone indicate a CAUTI. CAUTI signs and symptoms are the following:
- Fever (even if the resident has another possible cause for the fever such as pneumonia)*
- Rigors.
- New confusion or functional decline (with NO alternative diagnosis AND leukocytosis).
- New suprapubic pain or costovertebral angle pain or tenderness.
- New, very low blood pressure (with no alternate noninfectious cause).
- Acute pain, swelling or tenderness of testes, epididymis, or prostate.
- Pus around the catheter.
* Go to CDC's January 2016 "Urinary Tract Infection (UTI) Event for Long-term Care Facilities," listed below.
References
- Al Qas‐Hanna F, Sambirska O, Iyer S, et al. Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection. Am J Infect Control. 2013 Dec;41(12):1173‐7. PMID: 24011555.
- Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections, 2009. Infect Control Hosp Epidemiol. 2010 Apr;31(4):319- 26. PMID: 20156062.
- Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. Centers for Disease Control and Prevention; January 2016. Accessed June 8, 2016.
- Urinary Tract Infection (UTI) Event for Long-term Care Facilities. NHSN Long-term Care Facility Component Urinary Tract Infection. Centers for Disease Control and Prevention; January 2016. Accessed June 8, 2016.
- Nicolle LE, Bradley S, Colgan, R, et al. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clin Inf Dis. 2005;40:643‐54.
- Stone ND, Ashraf MS, Calder J. Surveillance definitions of infections in long‐term care facilities: Revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33(10):965‐77.
