Measures to Prevent and Control Vancomycin-Resistant Enterococci: Do They Really Matter?

Abstract

present. Contaminated urine cultures (≥3 organisms present) were misclassified as infections in 6 of 58 cases (10.3%), and in 5 of 58 cases (8.6%), no urine culture was obtained. Lastly, in 15 of 58 cases (25.9%), bacteriuria was present (1 or 2 organisms), but the colony count did not reach the NHSN metric threshold of ≥ 100,000 CFU/mL. The study period comprised 233,921 patient days. The CAUTI rate was 0.24 CAUTIs per 1,000 patient days using the ICD-10-CM metric; this rate was 0.18 when POA cases were eliminated. The CAUTI rate was 0.20 per 1,000 patient days using the NHSN metric. The NHSN CAUTI metric and the ICD-10-CM CAUTI-like code produce widely discrepant results. Even when ICD-10 cases that were POA were removed to better align with the NHSN criteria, the sensitivity of the ICD-10 metric was only 2.4%. Importantly, no patient safety indicator from AHRQ is available for CAUTI as there is for central venous catheterrelated bloodstream infection. This was the primary reason that we used the administrative code (ICD-10-CM) to compare to NHSN surveillance data for detecting CAUTI. Our results demonstrate that updating ICD-9-CMwith more codes to produce ICD-10-CM did not improve the ability of administrative data to identify CAUTIs. The date of the event is an important element used to meet an NHSN site-specific infection criterion, including CAUTI, and that is one reason that administrative data fail to accurately identify cases of HAI. This study has several limitations. First, it was performed in a single medical center. In addition, we did not review the negative cases via either method, and we assumed that traditional surveillance (NHSN) is the gold standard surveillance method. Therefore, it was not possible to calculate the specificity because our aim was to compare only NHSN and ICD-10-CM CAUTI identified cases. Given that CAUTI is a relatively rare event, we can assume that the specificity of the ICD-10-CM metric is high. In summary, we found that ICD-10-CM has an extremely low sensitivity for detecting CAUTI cases; it failed to detect 98.3% of the infections at our institution. Almost all cases identified via ICD-10-CM did not fulfill the NHSN criteria. Thus, administrative coding for this HAI is not a useful tool for use as a surveillance method.