Att G.3_Catheter-Associated UTI

Device-associated Module
CAUTI

Urinary Tract Infection (Catheter-Associated Urinary Tract Infection
[CAUTI] and Non-catheter-associ ated Urinary Tract Infection [UTI]
and Other Urinary System Infection [USI] Events
Introduction: Urinary tract infections (UTIs) are tied with pneumonia as the second
most common type of healthcare-associated infection, second only to SSIs. UTIs account
for more than 15% of infections reported by acute care hospitals1. Virtually all
healthcare-associated UTIs are caused by instrumentation of the urinary tract.
CAUTI can lead to such complications as cystitis, pyelonephritis, gram-negative
bacteremia, prostatitis, epididymitis, and orchitis in males and, less commonly,
endocarditis, vertebral osteomyelitis, septic arthritis, endophthalmitis, and meningitis in
all patients. Complications associated with CAUTI cause discomfort to the patient,
prolonged hospital stay, and increased cost and mortality2. Each year, more than 13,000
deaths are associated with UTIs.3
Prevention of CAUTIs is discussed in the CDC/HICPAC document, Guideline for
Prevention of Catheter-associated Urinary Tract Infection4.
Settings: Surveillance will occur in any inpatient locations where denominator data can
be collected, which may include critical intensive care units (ICU), specialty care areas
(SCA), step down units, and long term care wards. Neonatal ICUs may participate, but
only off plan (not as a part of their monthly reporting plan). A complete listing of
inpatient locations and instructions for mapping can be found in CDC Locations and
Descriptions chapter.
NOTE: It is not required to monitor for CAUTIs after the patient is discharged from the
facility. However, if discovered, any CAUTI with the date of event on the day of
discharge or the next day should be reported to NHSN; day of discharge is considered
Day 1. No additional indwelling catheter days are reported.
Requirements: Surveillance for HAI CAUTI is performed in at least one inpatient
location in the healthcare institution for at least one calendar month as indicated in the
Patient Safety Monthly Reporting Plan (CDC 57.106).
Definitions:
Present on Admission (POA): Infections that are POA, as defined in Chapter 2, are not
considered HAIs and therefore are never reported to NHSN.
Healthcare-associated infections (HAI): All NHSN site specific infections must first meet
the HAI definition as defined in Chapter 2 before a site specific infection (e.g., CAUTI)
can be reported to NHSN.
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Urinary tract infections (UTI) are defined using Symptomatic Urinary Tract Infection
(SUTI) criteria, Asymptomatic Bacteremic UTI (ABUTI), or Urinary System Infection
(USI) criteria (Table 1).
Date of event: For a UTI the date of event is the date when the first element used to meet
the UTI infection criterion occurred. Synonym: infection date.
Indwelling catheter: A drainage tube that is inserted into the urinary bladder through the
urethra, is left in place, and is connected to a drainage bag (including leg bags). These
devices are also called Foley catheters. Condom or straight in-and-out catheters are not
included nor are nephrostomy tubes or suprapubic catheters unless a Foley catheter is
also present. Indwelling urethral catheters that are used for intermittent or continuous
irrigation are included in CAUTI surveillance.
Catheter-associated UTI (CAUTI): A UTI where an indwelling urinary catheter was in
place for >2 calendar days on the date of event, with day of device placement being Day
1,
and
an indwelling urinary catheter was in place on the date of event or the day before. If an
indwelling urinary catheter was in place for > 2 calendar days and then removed, the date
of event for the UTI must be the day of discontinuation or the next day.
NOTE: Indwelling urinary catheters that are removed and reinserted: If, after
indwelling urinary catheter removal, the patient is without an indwelling urinary catheter
for at least 1 full calendar day (NOT to be read as 24 hours), then the urinary catheter day
count will start anew. If instead, a new indwelling urinary catheter is inserted before a
full calendar day without an indwelling urinary catheter has passed, the urinary catheter
day count will continue.
EXAMPLE: A patient has a Foley catheter inserted on an inpatient unit and the
following morning is the date of event for a UTI. Because the catheter has not been in
place >2 calendar days on the date of event, this is not a CAUTI.
NOTE: SUTI 1b and USI, cannot be catheter-associated.
Location of attribution: The inpatient location where the patient was assigned on the date
of the UTI event, which is further defined as the date when the first element used to meet
the UTI criterion occurred (see exception below).

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EXCEPTION TO LOCATION OF ATTRIBUTION:
Transfer Rule: If the date of event for a CAUTI is on the date of transfer or discharge, or
the next day, the infection is attributed to the transferring/discharging location. Receiving
facilities should share information about such HAIs with the transferring location or
facility to enable reporting. This is called the Transfer Rule and examples are shown
below:
 Patient with a Foley catheter in place in the SICU is transferred to the surgical ward.
The next day, suprapubic tenderness occurs and UTI criteria are met. This is reported
to NHSN as a CAUTI for the SICU.
 Patient is transferred in the morning to the medical ward from the MSICU after
having the Foley catheter removed. Later that night, the patient experiences urinary
frequency and the next day, UTI criteria are met. This is reported to NHSN as a
CAUTI for the MSICU as the date of event (date of first element of UTI criteria) was
the day after transfer from that location.
 On Monday, patient with a Foley catheter in place is transferred from the medical
ward to the coronary care ICU (CCU). Wednesday in the CCU, patient has a fever
and other UTI criteria are met. This is reported to NHSN as a CAUTI for the CCU, as
the UTI event date is LATER THAN the day after transfer.
 Patient on the urology ward of Hospital A had the Foley catheter removed after it had
been in place for 5 days and is discharged home a few hours later. The IP from
Hospital B calls the next day to report that this patient has been admitted to Hospital
B with urinary urgency and meeting UTI criteria. This CAUTI should be reported to
NHSN for Hospital A and attributed to the urology ward.


NOTE: Example of multiple transfers within the transfer rule time-frame:
3.22
Patient in Unit A

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Patient transferred from
Unit A to Unit B.
Later that day, patient
transferred from Unit B to
Unit C.
(day of transfer)

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Patient transferred from Unit C to
Unit D.
This is also the date of event for a
CAUTI. CAUTI is attributed to
Unit A since Unit A was the
original unit initiating the transfer
in the 2 day time-frame.
(day after transfer)

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Table 1. Urinary Tract Infection Criteria
Criterion

1a
Catheterassociated
Urinary
Tract
Infection
(CAUTI)

January 2014

Urinary Tract Infection (UTI)
Symptomatic UTI (SUTI)
Must meet at least 1 of the following criteria:
Patient had an indwelling urinary catheter in place on the date of event and the
catheter had been in place for >2 calendar days, on that date ( day of device
placement = Day 1),
And
patient has at least one of the following:
a. positive dipstick for leukocyte esterase and/or nitrite
b. pyuria (urine specimen with ≥10 white blood cells [WBC]/mm3 of
unspun urine or >5 WBC/high power field of spun urine)
c. microorganisms seen on Gram’s stain of unspun urine
d. No urinalysis performed for leukocyte esterase, pyuria (as defined
above), or nitrites.
And
at least 1 of the following signs or symptoms: fever (>38.0°C); suprapubic
tenderness*; costovertebral angle pain or tenderness*, purulence around urinary
catheter, or swelling or tenderness of epididymis, testes, or prostate
And
a positive urine culture of≥ 103 colony-forming units (CFU)/ml and with no
more than 2 species of microorganisms. Elements of the criterion must occur
within a timeframe that does not exceed a gap of 1 calendar day between two
adjacent elements.
----------------------------------------------------OR----------------------------------------Patient had an indwelling urinary catheter in place on the date of event and the
catheter had been in place for >2 calendar days, on that date ( day of device
placement = Day 1),
And
Urinalysis is negative for all of the following:
a. dipstick for leukocyte esterase and/or nitrite
b. pyuria (urine specimen with ≥10 white blood cells [WBC]/mm3 of
unspun urine or >5 WBC/high power field of spun urine)
c. microorganisms seen on Gram’s stain of unspun urine
And
Patient is neutropenic as defined by total WBC or ANC <500 cells/mm3on at
least 2 days within the 3 days before the negative U/A and the 3 days after the
negative U/A
And
at least 1 of the following signs or symptoms: fever (>38.0°C); suprapubic
tenderness*; costovertebral angle pain or tenderness*, purulence around urinary
catheter, or swelling or tenderness of epididymis, testes, or prostate
And
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Criterion

Urinary Tract Infection (UTI)
a positive urine culture of≥ 103 colony-forming units (CFU)/ml and with no
more than 2 species of microorganisms. Elements of the criterion must occur
within a timeframe that does not exceed a gap of 1 calendar day between two
adjacent elements.
----------------------------------------------------OR----------------------------------------Patient had an indwelling urinary catheter which was in place for >2 calendar
days and which was removed on the day of or the day before the date of
event
And
at least 1 of the following signs or symptoms: fever (>38°C); urgency*;
frequency*; dysuria*; suprapubic tenderness*; costovertebral angle pain or
tenderness*, purulence around urinary catheter, or swelling or tenderness of
epididymis, testes, or prostate
And
patient has at least one of the following:
a. positive dipstick for leukocyte esterase and/or nitrite
b. pyuria (urine specimen with ≥10 white blood cells [WBC]/mm3 of
unspun urine or >5 WBC/high power field of spun urine)
c. microorganisms seen on Gram’s stain of unspun urine
d. No urinalysis performed for leukocyte esterase, pyuria (as defined
above), or nitrites.
And
a positive urine culture of ≥103 colony-forming units (CFU)/ml and with no
more than 2 species of microorganisms. Elements of the criterion must occur
within a timeframe that does not exceed a gap of 1 calendar day between two
adjacent elements.
*With no other recognized cause
----------------------------------------------------OR----------------------------------------Patient had an indwelling urinary catheter which was in place for >2 calendar
days and which was removed on the day of or the day before the date of
event
And
at least 1 of the following signs or symptoms: fever (>38°C); urgency*;
frequency*; dysuria*; suprapubic tenderness*; costovertebral angle pain or
tenderness*, purulence around urinary catheter, or swelling or tenderness of
epididymis, testes, or prostate
And
Urinalysis is negative for all of the following:
a. dipstick for leukocyte esterase and/or nitrite
b. pyuria (urine specimen with ≥10 white blood cells [WBC]/mm3 of
unspun urine or >5 WBC/high power field of spun urine)
c. microorganisms seen on Gram’s stain of unspun urine
And

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Criterion

Urinary Tract Infection (UTI)
Patient is neutropenic as defined by total WBC or ANC <500 cells/mm3on at
least 2 days within the 3 days before the negative U/A and the 3 days after the
negative U/A
And
a positive urine culture of ≥103 colony-forming units (CFU)/ml and with no
more than 2 species of microorganisms. Elements of the criterion must occur
within a timeframe that does not exceed a gap of 1 calendar day between two
adjacent elements.
*With no other recognized cause

Patient did not have an indwelling urinary catheter that was both:
in place on the date of event or the day before AND
Nonhad been in place for >2 calendar days on the date of event
CatheterAnd
associated
has at least 1 of the following signs or symptoms: fever (>38°C) in a patient that
Urinary
is ≤65 years of age; urgency*; frequency*; dysuria*; suprapubic tenderness*;
Tract
costovertebral angle pain or tenderness**, purulence around urinary catheter, or
Infection
swelling or tenderness of epididymis, testes, or prostate
(NonCAUTI) And
patient has at least one of the following:
a. positive dipstick for leukocyte esterase and/or nitrite
b. pyuria (urine specimen with ≥10 white blood cells [WBC]/mm3 of
unspun urine or >5 WBC/high power field of spun urine)
c. microorganisms seen on Gram’s stain of unspun urine
d. No urinalysis performed for leukocyte esterase, pyuria (as defined
above), or nitrites.
And
1b

a positive urine culture of ≥103 CFU/ml and with no more than 2 species of
microorganisms. Elements of the criterion must occur within a timeframe that
does not exceed a gap of 1 calendar day between two adjacent elements.
*With no other recognized cause
----------------------------------------------------OR----------------------------------------Patient did not have an indwelling urinary catheter that was both:
in place on the date of event or the day before AND
had been in place for >2 calendar days on the date of event
And
has at least 1 of the following signs or symptoms: fever (>38°C) in a patient that
is ≤65 years of age; urgency*; frequency*; dysuria*; suprapubic tenderness*;
costovertebral angle pain or tenderness**, purulence around urinary catheter, or
swelling or tenderness of epididymis, testes, or prostate
And
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Criterion

Urinary Tract Infection (UTI)
Urinalysis is negative for all of the following:
a. dipstick for leukocyte esterase and/or nitrite
b. pyuria (urine specimen with ≥10 white blood cells [WBC]/mm3 of
unspun urine or >5 WBC/high power field of spun urine)
c. microorganisms seen on Gram’s stain of unspun urine
And
Is neutropenic as defined by total WBC or ANC <500 cells/mm3on at least 2
days within the 3 days before the negative U/A and the 3 days after the negative
U/A
And
a positive urine culture of ≥103 CFU/ml and with no more than 2 species of
microorganisms. Elements of the criterion must occur within a timeframe that
does not exceed a gap of 1 calendar day between two adjacent elements.
*With no other recognized cause

3

Criterion

January 2014

Patient ≤1 year of age with˅ or without an indwelling urinary catheter has at least
1 of the following signs or symptoms: fever (>38.0°C core); hypothermia
(<36.0°C core); apnea*; bradycardia*; *; lethargy*; vomiting*, suprapubic
tenderness* purulence around urinary catheter, or swelling or tenderness of
epididymis, testes, or prostate,
And
a positive urine culture of ≥103 CFU/ml and with no more than 2 species of
microorganisms. Elements of the criterion must occur within a timeframe that
does not exceed a gap of 1 calendar day between two adjacent elements.
*With no other recognized cause
˅
If patient had an indwelling urinary catheter in place for >2 calendar days, and
catheter was in place on the date of event or the previous day the CAUTI criterion
is met. If no such indwelling urinary catheter was in place, UTI (non-catheter
associated) criterion is met .
Asymptomatic Bacteremic Urinary Tract Infection (ABUTI)
Patient with* or without an indwelling urinary catheter has no signs or symptoms
(i.e., for any age patient, no fever (>38°C); urgency; frequency; dysuria;
suprapubic tenderness; costovertebral angle pain or tenderness OR for a patient
≤1 year of age; no fever (>38°C core); hypothermia (<36°C core); apnea;
bradycardia; dysuria; lethargy; or vomiting)
and
a positive urine culture of ≥105 CFU/ml and with no more than 2 species of
uropathogen microorganisms** (see Comments section below)
and
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a positive blood culture with at least 1 matching uropathogen microorganism to
the urine culture, or at least 2 matching blood cultures drawn on separate
occasions if the matching pathogen is a common skin commensal. Elements of the
criterion must occur within a timeframe that does not exceed a gap of 1 calendar
day between two adjacent elements.
*Patient had an indwelling urinary catheter in place for >2 calendar days, with
day of device placement being Day 1, and catheter was in place on the date of
event.
**Uropathogen microorganisms are: Gram-negative bacilli, Staphylococcus spp.,
yeasts, beta-hemolytic Streptococcus spp., Enterococcus spp., G. vaginalis,
Aerococcus urinae, and Corynebacterium (urease positive)+.
+
Report Corynebacterium (urease positive) as either Corynebacterium species
unspecified (COS) or as C. urealyticum (CORUR) if so speciated.
(See complete list of uropathogen microorganisms at
http://www.cdc.gov/nhsn/XLS/master-organism-Com-CommensalsLists.xlsx#uropathogens)
Comments  Laboratory cultures reported as “mixed flora” represent at least 2 species of
organisms. Therefore an additional organism recovered from the same culture,
would represent >2 species of microorganisms. Such a specimen cannot be
used to meet the UTI criteria.
 Urinary catheter tips should not be cultured and are not acceptable for the
diagnosis of a urinary tract infection.
 Urine cultures must be obtained using appropriate technique, such as clean
catch collection or catheterization. Specimens from indwelling catheters
should be aspirated through the disinfected sampling ports.
 In infants, urine cultures should be obtained by bladder catheterization or
suprapubic aspiration; positive urine cultures from bag specimens are
unreliable and should be confirmed by specimens aseptically obtained by
catheterization or suprapubic aspiration.
 Urine specimens for culture should be processed as soon as possible,
preferably within 1 to 2 hours. If urine specimens cannot be processed within
30 minutes of collection, they should be refrigerated, or inoculated into
primary isolation medium before transport, or transported in an appropriate
urine preservative. Refrigerated specimens should be cultured within 24 hours.
 Urine specimen labels should indicate whether or not the patient is
symptomatic.
 Report only pathogens in both blood and urine specimens for ABUTI.
 Report Corynebacterium (urease positive) as either Corynebacterium species
unspecified (COS) or as C. urealyticum (CORUR) if speciated.

Criterion

Urinary System Infection (USI) (formerly OUTI) (kidney, ureter, bladder,

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urethra, or tissue surrounding the retroperitoneal or perinephric space)
Other infections of the urinary tract must meet at least 1 of the following
criteria:
1.

Patient has microorganisms isolated from culture of fluid (not
urine) or tissue from affected site.

2.

Patient has an abscess or other evidence of infection seen on direct
examination, during an invasive procedure, or during a
histopathologic examination.

3.

Patient has at least 2 of the following signs or symptoms: fever
(>38°C), localized pain/tenderness*, at the involved site*

and
at least 1 of the following:
a.purulent drainage from affected site
b. organisms cultured from blood and imaging test evidence of
infection (e.g., ultrasound, CT scan, magnetic resonance imaging
[MRI], or radiolabel scan [gallium, technetium]).
* With no other recognized cause
4.

Patient <1 year of age has at least 1 of the following signs or
symptoms: fever (>38°C core), hypothermia (<36°C core), apnea*,
bradycardia*, lethargy*, or vomiting*

and
at least 1 of the following:
a. purulent drainage from affected site
b. organisms cultured from blood and imaging test evidence of
infection, (e.g., ultrasound, CT scans, magnetic resonance
imaging [MRI], or radiolabel scan [gallium, technetium]).
* With no other recognized cause
Comment

January 2014



Report infections following circumcision in newborns as SST-CIRC.

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

If patient meets USI criteria and they also meet UTI criteria, report
UTI only, unless the USI is a surgical site organ/space infection, in
which case, only USI should be reported.

Numerator Data: The Urinary Tract Infection (UTI) form is used to collect and report
each CAUTI that is identified during the month selected for surveillance. The
Instructions for Completion of Urinary Tract Infection form include brief instructions for
collection and entry of each data element on the form. The UTI form includes patient
demographic information and information on whether or not an indwelling urinary
catheter was present. Additional data include the specific criteria met for identifying the
UTI, whether the patient developed a secondary bloodstream infection, whether the
patient died, and the organisms isolated from cultures and their antimicrobial
susceptibilities.
REPORTING INSTRUCTIONS:
 If no CAUTIs are identified during the month of surveillance, the Report No Events
box must be checked on the appropriate denominator summary screen, e.g.,
Denominators for Intensive Care Unit (ICU)/Other Locations (Not NICU or
SCA/ONC).
Denominator Data: Device days and patient days are used for denominators (See Key
Terms chapter). Indwelling urinary catheter days, which are the number of patients with
an indwelling urinary catheter device, are collected daily, at the same time each day,
according to the chosen location using the appropriate form (CDC 57.117 and 57.118).
These daily counts are summed and only the total for the month is entered into NHSN.
Indwelling urinary catheter days and patient days are collected separately for each of the
locations monitored. When denominator data are available from electronic databases,
these sources may be used as long as the counts are not substantially different (+/- 5%)
from manually collected counts, pre-validated for a minimum of 3 months.
Data Analyses: The Standardized Infection Ratio (SIR) is calculated by dividing the
number of observed infections by the number of predicted infections. The number of
predicted infections is calculated using CAUTI rates from a standard population during a
baseline time period, which represents a standard population’s CAUTI experience.5
NOTE: The SIR will be calculated only if the number of expected HAIs (numExp) is ≥1
to help enforce a minimum precision criterion.
NOTE: In the NHSN application, “predicted” is referred to as “expected”.
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SIR = Observed (O) HAIs
Expected (E) HAIs

While the CAUTI SIR can be calculated for single locations, the measure also allows you
to summarize your data by multiple locations, adjusting for differences in the incidence
of infection among the location types. For example, you will be able to obtain one
CAUTI SIR adjusting for all locations reported. Similarly, you can obtain one CAUTI
SIR for all specialty care areas in your facility.
NOTE: Only those locations for which baseline data have been published will be
included in the SIR calculations.
The CAUTI rate per 1000 urinary catheter days is calculated by dividing the number of
CAUTIs by the number of catheter days and multiplying the result by 1000. The Urinary
Catheter Utilization Ratio is calculated by dividing the number of urinary catheter days
by the number of patient days. These calculations will be performed separately for the
different types of ICUs, specialty care areas, and other locations in the institution, except
for neonatal locations.
Descriptive analysis options of numerator and denominator data are available in the
NHSN application, such as line listings, frequency tables, and bar and pie charts. SIRs
and CAUTI rates and run charts are also available. Guides on using NHSN analysis
features are available from: http://www.cdc.gov/nhsn/PS-Analysis-resources/referenceguides.html.
1

Magill SS, Hellinger W, et al. Prevalence of healthcare-associated infections in acute care facilities. Infect
Control Hosp Epidemiol. 2012;33:283-91.
2

Scott Rd. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits
of Prevention, 2009. Division of Healthcare Quality Promotion, National Center for Preparedness,
Detection, and Control of Infectious Diseases, Coordinating Center for Infectious Diseases, Centers for
Disease Control and Prevention, February 2009.
3

Klevens RM, Edward JR, et al. Estimating health care-associated infections and deaths in U.S. hospitals,
2002. Public Health Reports 2007;122:160-166.
4

Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheterassociated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31:319-26.
5Dudeck MA, Horan TC, Peterson KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module, issued January
2011. Am J Infect Control 2011;39:349-67.

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Instructions for Completion of Urinary Tract Infection
(UTI) Form (CDC 57.114)
Data Field
Facility ID
Event #
Patient ID

Social Security #
Secondary ID
Medicare #
Patient name
Gender
Date of birth
Ethnicity
Race

Event type
Date of event

Post-procedure UTI

Date of procedure
NHSN procedure code
January 2014

Instructions for Data Collection/Entry
The NHSN-assigned facility ID will be auto-entered by the
computer.
Event ID number will be auto-entered by the computer.
Required. Enter the alphanumeric patient ID number. This is
the patient identifier assigned by the hospital and may consist of
any combination of numbers and/or letters.
Optional. Enter the 9-digit numeric patient Social Security
Number.
Optional. Enter the alphanumeric ID number assigned by the
facility.
Optional. Enter the patient’s Medicare number.
Optional. Enter the last, first, and middle name of the patient.
Required. Check Female, Male, or Other to indicate the gender
of the patient.
Required. Record the date of the patient birth using this format:
MM/DD/YYYY.
Optional. Specify if the patient is either Hispanic or Latino, or
Not Hispanic or Not Latino.
Optional. Specify one or more of the choices below to identify
the patient’s race:
American Indian/Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
White
Required. UTI.
Required. The date when the first element used to meet the UTI
infection criterion occurred. Enter date of this event using this
format: MM/DD/YYYY. NOTE: If a device has been pulled on
the first day of the month in a location where there are no other
device days in that month, and a device-associated infection
develops after the device is pulled, use the last day of the
previous month as the Date of Event.
Optional. Check Y if this event occurred after an NHSN-defined
procedure but before discharge from the facility, otherwise
check N.
Conditionally required. If Post-procedure UTI = Y, enter the
date the procedure was done.
Conditionally required. If Post-procedure UTI = Y, enter the
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Data Field

ICD-9-CM procedure
code

MDRO Infection
Surveillance

Location

Date admitted to
facility

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Instructions for Data Collection/Entry
appropriate NHSN procedure code.
NOTE: A UTI cannot be “linked” to an operative procedure
unless that procedure has already been added to NHSN. If the
procedure was previously added, and the “Link to Procedure”
button is clicked, the fields pertaining to the operation will be
auto-entered by the computer.
Optional. The ICD-9-CM code may be entered here instead of
(or in addition to) the NHSN Procedure Code. If the ICD-9-CM
code is entered, the NHSN code will be auto-entered by the
computer. If the NHSN code is entered first, you will have the
option to select the appropriate ICD-9-CM code. In either case,
it is optional to select the ICD-9-CM code. Only those ICD-9CM codes identified in Table 1 of the Surgical Site Infection
Event Chapter (Chapter 9 of NHSN Manual: Patient Safety
Component Protocol) are allowed.
Required. Enter “Yes”, if the pathogen is being followed for
Infection Surveillance in the MDRO/CDI Module in that
location as part of your Monthly Reporting Plan: MRSA, MSSA
(MRSA/MSSA), VRE, CephR-Klebsiella, CRE-E. coli, CREEnterobacter, CRE-Klebsiella, MDR-Acinetobacter or C.
difficile.
If the pathogen for this infection happens to be an MDRO but
your facility is not following the Infection Surveillance in the
MDRO/CDI Module in your Monthly Reporting Plan, answer
“No” to this question.
Required. Enter the inpatient location to which the patient was
assigned on the date of the UTI event. If the date of the UTI
occurs on the day of transfer or discharge or the next day,
indicate the transferring/discharging location, not the current
location of the patient, in accordance with the Transfer Rule
(see Key Terms section).
Required. Enter date patient admitted to facility using this
format: MM/DD/YYYY. An NHSN Inpatient is defined as a
patient whose date of admission to the healthcare facility and the
date of discharge are different calendar days. When determining a
patient’s admission dates to both the facility and specific
inpatient location, the NHSN user must take into account all
such days, including any days spent in an inpatient location as
an “observation” patient before being officially admitted as an
inpatient to the facility, as these days contribute to exposure
risk. Therefore, all such days are included in the counts of
admissions and patient days for the facility and specific
location, and facility and admission dates must be moved back
to the first day spent in the inpatient location.
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Data Field

Risk factor:
Urinary catheter status
when all elements of
the UTI criterion were
first present together

Location of device
insertion
Date of device
insertion
Event details:
Specific event: UTI
Event details: UTI
Specify criteria used
Event Details:
Secondary
bloodstream infection

Event Details:
Died
Event Details:
UTI contributed to
death
Event Details:
Discharge date
Event Details:
Pathogens identified

Pathogen # for
specified Grampositive Organisms,
January 2014

Instructions for Data Collection/Entry
NOTE Recently Discharged Patients: If a previously unreported
UTI is identified on the day of discharge or the day after
discharge, enter the previous date of admission.
Required. Check one of the following
 “In place” if urinary catheter that had been in place for more
than 2 days was in place on the date of event
 “Removed” if a urinary catheter that had been in place for
more than 2 calendar days was removed the day of or the
day before the date of event
 “Neither” if no urinary catheter was in place on the day of or
the day before the date of event OR the urinary catheter
was not in place for more than2 calendar days on the date
of event. Date of insertion = Day 1.

Optional. Enter the patient location where the indwelling
urethral catheter was inserted.
Optional. Enter the date the indwelling urethral catheter was
inserted.
Required. Check Symptomatic UTI (SUTI), Asymptomatic
Bacteremic UTI (ABUTI), or Urinary System Infection (USI),
for the specific event type you are reporting.
Required. Check each of the elements of the criteria that were
used to identify the specific type of UTI being reported.
Required. Check Y if there is a culture-confirmed bloodstream
infection (BSI) and a related UTI, otherwise check N. For
detailed instructions on identifying whether the blood culture
represents a secondary BSI, refer to the Secondary BSI Guide
(Appendix 1 of the BSI chapter).
Required. Check Y if patient died during the hospitalization,
otherwise check N.
Conditionally required. If patient died, check Y if the UTI
contributed to death, otherwise check N.
Optional. Date patient discharged from facility.
Required. Enter Y if pathogen identified, N if otherwise. If Y,
specify organism name on reverse. For SUTI with secondary
BSI and ABUTI, enter only the matching organism(s) identified
in both urine and blood cultures. For ABUTI, the organism
listed as pathogen number 1, must be a uropathogen (See
ABUTI criterion).
Up to three pathogens may be reported. If multiple pathogens
are identified, enter the pathogen judged to be the most
important cause of infection as #1, the next most as #2, and the
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Device-associated Module
CAUTI

Data Field
Gram-negative
Organisms, Fungal
Organisms, or Other
Organisms

Antimicrobial agent
and susceptibility
results

Instructions for Data Collection/Entry
least as #3 (usually this order will be indicated on the laboratory
report). If the species is not given on the lab report or is not
found on the NHSN organism list, then select the “spp” choice
for the genus (e.g., Bacillus natto is not on the list so would be
reported as Bacillus spp.).
If the event reported is an ABUTI, then pathogen #1 must be a
uropathogen. (Uropathogen microorganisms are: Gram-negative
bacilli, Staphylococcus spp., yeasts, beta-hemolytic
Streptococcus spp., Enterococcus spp., G. vaginalis,
Aerococcus urinae, and Corynebacterium (urease positive)*.
*Report Corynebacterium (urease positive) as either
Corynebacterium species unspecified (COS) or as C.
urealyticum (CORUR) if speciated.
Conditionally required if Pathogen Identified = Y.
 For those organisms shown on the back of an event
form, susceptibility results are required only for the
agents listed.


Custom Fields

Comments

January 2014

For organisms that are not listed on the back of an event
form, the entry of susceptibility results is optional.

Circle the pathogen’s susceptibility result using the codes on the
event forms.
Additional antimicrobial agents and susceptibility results may
be reported for up to a total of 20 agents.
Optional. Up to 50 fields may be customized for local or group
use in any combination of the following formats: date
(MM/DD/YYYY), numeric, or alphanumeric.
NOTE: Each Custom Field must be set up in the
Facility/Custom Options section of the application before the
field can be selected for use.
Optional. Enter any information on the event.

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