Att G4_Catheter-Associated Urinary Tract Infection

Device-associated Module
CAUTI

Urinary Tract Infection (Catheter-Associated Urinary Tract Infection
[CAUTI] and Non-Catheter-Associated 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 and 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 prostatitis, epididymitis, and orchitis in males, and
cystitis, pyelonephritis, gram-negative bacteremia, 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. It has been estimated that each year, more than 13,000 deaths are associated with
UTIs.3
Prevention of CAUTI is discussed in the CDC/HICPAC document, Guideline for Prevention
of Catheter-associated Urinary Tract Infection4.
Settings: Surveillance may occur in any inpatient location(s) where denominator data can be
collected, such as critical intensive care units (ICU), specialty care areas (SCA), step- down
units, wards, inpatient rehabilitation locations, and long term acute care locations. 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 the 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. No additional indwelling catheter days are
reported.

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
(See Table 1 and Figure 3).
Date of event (DOE): For a UTI, the date of event is the date when the first element used to
meet the UTI infection criterion occurred for the first time within the 7-day Infection
Window Period. Synonyms: infection date, event 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, ileoconduits, 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 for the UTI to be
catheter-associated.
Example of Associating Catheter Use to UTI:
A patient in an inpatient unit has a Foley catheter inserted and the following day 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. However, depending on the date of admission, this may be a
healthcare-associated UTI.
Notes:
 SUTI 1b and USI cannot be catheter-associated.
 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 has passed without an indwelling urinary catheter being present, the
urinary catheter day count will continue.

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Figure 1: Associating Catheter Use to UTI

Patient A

Patient B

March 31
(Hospital day 3)
Foley
Day 3

April 1

April 2

April 3

April 4

April 5

April 6

Foley
Day 4

Foley
removed
Day 8

No
Foley

Foley
Day 4

Foley
replaced
(Foley
Day 6)
No Foley

Foley
Day 7

Foley
Day 3

Foley
removed
(Foley
Day 5)
Foley
removed
(Foley
Day 5)

Foley
replaced
(Foley
Day 1)

Foley Day
2

Foley
Day 3

Rationale: NHSN surveillance for infection is not aimed at a specific device. Instead
surveillance is aimed at identifying risk to the patient that is the result of device use in
general.
 In the examples above, Patient A is eligible for a CAUTI beginning on March 31,
through April 6th, since a Foley was in place for some portion of each calendar day
until April 6th. A UTI with date of event on April 6th would be a CAUTI since the
catheter had been in place greater than 2 days and was removed the day before the
date of event.


Patient B is eligible for a CAUTI on March 31 (Foley Day 3) through April 3. The
catheter had been in place > 2 days and an HAI occurring on the day of device
discontinuation or the following calendar day is considered a device-associated
infection.

Location of attribution: The inpatient location where the patient was assigned on the date of
the UTI event. See Date of Event definition (above). See Exception to Location of
Attribution (below).
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. This is called the
Transfer Rule and examples are shown below. Receiving facilities should share information
about such HAIs with the transferring location or facility to enable reporting.

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Examples of the Transfer Rule:
 Patient in the SICU with a Foley catheter, which has been in place for 5 days, is
transferred to a surgical ward. The next day is determined to be the date of event for a
CAUTI. 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, which had been in place for 6 days. Later that night, the
patient experiences urinary frequency and the next day, all other UTI criteria are met.
This is reported to NHSN as a CAUTI for the MSICU as the date of event (date when the
first element of UTI criteria, first appeared during the infection window) was the day of
transfer from that location.
 On Monday, patient with a Foley catheter in place is transferred from the medical ward to
the coronary care unit (CCU). Wednesday in the CCU, patient has a fever and urine
culture collected that day is positive for 100,000 CFU/ml of E. coli. This is reported to
NHSN as a CAUTI for the CCU, as the UTI event date is LATER THAN the day after
transfer.
 A patient has a Foley catheter removed on catheter day 5 and is discharged the same day
from hospital A’s urology ward. The next day, the IP from Hospital B calls to report that
this patient has been admitted to Hospital B meeting UTI criteria. This CAUTI should be
reported to NHSN for Hospital A and attributed to the urology ward.
Multiple Transfers
In instances where a patient has been transferred to more than one location on the date of a
UTI, or the day before, attribute the UTI to the first location in which the patient was housed
the day before the UTI’s date of event.

Figure 2: Multiple Transfers within the Transfer Rule Time Frame
Locations in
which
patient was
housed

3/22
Unit A

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3/23
Unit A
Unit B
Unit C

3/24
Unit C
Unit D
This is also the date of event for a
CAUTI. CAUTI is attributed to Unit A
since Unit A was the first location in
which the patient was housed the day
before the date of event.

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Table 1: Urinary Tract Infection Criteria

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Criterion

Urinary Tract Infection (UTI)
Symptomatic UTI (SUTI)
Must meet at least one of the following criteria:

SUTI 1a

Patient must meet 1, 2, and 3 below:

Catheterassociated
Urinary
Tract
Infection
(CAUTI)

1. Patient had an indwelling urinary catheter that had been in place for > 2
days on the date of event (day of device placement = Day 1) AND was
either:
 Still present on the date of event†, OR
 Removed the day before the date of event‡
2. Patient has at least one of the following signs or symptoms:
• fever (>38.0°C)
• suprapubic tenderness*
• costovertebral angle pain or tenderness*
• urinary urgency*
• urinary frequency*
• dysuria*
3. Patient has a urine culture with no more than two species of organisms,
at least one of which is a bacteria of ≥105 CFU/ml. All elements of the
UTI criterion must occur during the Infection Window Period (See
Definition Chapter 2 Identifying HAIs in NHSN).
†

When entering event into NHSN choose “INPLACE” for Risk Factor for
Urinary Catheter
‡ When entering event into NHSN choose “REMOVE” for Risk Factor for
Urinary Catheter
*With no other recognized cause (see Notes below)
Notes:
 An indwelling urinary catheter in place would constitute “other recognized
cause” for patient complaints of “frequency” “urgency” or “dysuria” and
therefore these cannot be used as symptoms when catheter is in place.


Fever and hypothermia are non-specific symptoms of infection and cannot
be excluded from UTI determination because they are clinically deemed due
to another recognized cause.

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SUTI 1b
NonCatheterassociated
Urinary
Tract
Infection
(NonCAUTI)

Patient must meet 1, 2, and 3 below:
1. One of the following is true:
 Patient has/had an indwelling urinary catheter but it has/had not been
in place >2 calendar days on the date of event†
OR
 Patient did not have a urinary catheter in place on the date of event
nor the day before the date of event‡
2. Patient has at least one of the following signs or symptoms:
•
•
•
•
•
•
3.

fever (>38°C) in a patient that is ≤ 65 years of age
suprapubic tenderness*
costovertebral angle pain or tenderness*
urinary frequency*
urinary urgency*
dysuria*

Patient has a urine culture with no more than two species of organisms,
at least one of which is a bacteria of ≥105 CFU/ml. All elements of the
SUTI criterion must occur during the Infection Window Period (See
Definition Chapter 2 Identifying HAIs in NHSN).

†

When entering event into NHSN choose “NEITHER” for Risk Factor for
Urinary Catheter
*With no other recognized cause (see Notes below)

Notes:
 An indwelling urinary catheter in place would constitute other
recognized cause for patient complaints of “frequency” “urgency” or
“dysuria” and therefore these cannot be used as symptoms when catheter
is in place.


Fever and hypothermia are non-specific symptoms of infection and
cannot be excluded from UTI determination because they are clinically
deemed due to another recognized cause.

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SUTI 2
CAUTI or
NonCAUTI in
patients 1
year of
age or
less-

Patient must meet 1, 2, and 3 below:
1. Patient is ≤1 year of age (with‡ or without an indwelling urinary
catheter)
2. Patient has at least one of the following signs or symptoms:
• fever (>38.0°C)
• hypothermia (<36.0°C)
• apnea*
• bradycardia*
• lethargy*
• vomiting*
• suprapubic tenderness*
3. Patient has a urine culture with no more than two species of organisms,
at least one of which is a bacteria of ≥105 CFU/ml. All elements of the
SUTI criterion must occur during the Infection Window Period (See
Definition Chapter 2 Identifying HAIs in NHSN).

*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 (noncatheter associated) criterion is met.
Note: Fever and hypothermia are non-specific symptoms of infection and
cannot be excluded from UTI determination because they are clinically deemed
due to another recognized cause.

Asymptomatic Bacteremic Urinary Tract Infection (ABUTI)

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Patient must meet 1, 2, and 3 below:
1. Patient with* or without an indwelling urinary catheter has no signs or
symptoms of SUTI 1 or 2 according to age (Note: Patients > 65 years of
age with a non-catheter-associated ABUTI may have a fever and still
meet the ABUTI criterion)
2. Patient has a urine culture with no more than two species of organisms,
at least one of which is a bacteria of ≥105 CFU/ml (see Comment
section below)
3. Patient has a positive blood culture with at least one matching bacteria
to the urine culture, or meets LCBI criterion 2 (without fever) and
matching common commensal(s) in the urine. All elements of the
ABUTI criterion must occur during the Infection Window Period (See
Definition Chapter 2 Identifying HAIs in NHSN).

Comment

*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 or the day before.
“Mixed flora” is not available in the pathogen list within NSHN. Therefore it
cannot be reported as a pathogen to meet the NHSN UTI criteria. Additionally,
“mixed flora” represent at least two species of organisms. Therefore an
additional organism recovered from the same culture, would represent >2
species of microorganisms. Such a specimen also cannot be used to meet the
UTI criteria.

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Criterion

Urinary System Infection (USI) (formerly OUTI) (kidney, ureter, bladder,
urethra, or tissue surrounding the retroperitoneal or perinephric space)
Other infections of the urinary system must meet at least one of the following
criteria:
1. Patient has microorganisms isolated from culture of fluid (excluding
urine) or tissue from affected site
2. Patient has an abscess or other evidence of infection on gross
anatomical exam, during invasive procedure, or on histopathologic
exam
3. Patient has at least one of the following signs or symptoms:



fever (>38.0°C)
localized pain or tenderness*
And at least one of the following:




purulent drainage from affected site
organisms cultured from blood and imaging test evidence of
infection (e.g., ultrasound, CT scan, magnetic resonance imaging
[MRI], or radiolabel scan [gallium, technetium])

4. Patient <1 year of age has at least one of the following signs or
symptoms:
•
•
•
•
•
•

fever (>38.0°C)
hypothermia (<36.0°C)
apnea*
bradycardia*
lethargy*
vomiting*
And at least one of the following:




purulent drainage from affected site
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
Notes:

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

Comments 



Fever and hypothermia are non-specific symptoms of infection and cannot
be excluded from UTI determination because they are clinically deemed due
to another recognized cause.
All elements of the USI criterion must occur during the Infection Window
Period (See Definition Chapter 2 Identifying HAIs in NHSN).
Report infections following circumcision in newborns as SST-CIRC.
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.
For NHSN reporting purposes, Urinary System Infection (USI) cannot be
catheter associated, therefore, USI will only present as specific event type if
urinary catheter status is marked “Neither”.

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Figure 3: Identifying SUTI and ABUTI Flowchart

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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. USIs are never included in CAUTI data and are reported
separately on the HAI Custom Event 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).The method of collecting device-day denominator data may differ depending
on the location of patients being monitored. The following methods may be used:
Denominator Data
Collection Method
Manual, Daily (i.e.,
collected at the same
time every day of the
month)

Manual, sampled
once/week (i.e.,
collected at the same
time on the same
designated day, once
per week)

Details
Denominator data are collected at the same time, every day, per
location.
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.
For locations other than specialty care areas/oncology (SCA/ONC)
and NICUs (e.g., ICUs, step-down units, wards), the denominator
sampling method can be used.
To reduce staff time spent collecting surveillance data, once weekly
sampling of denominator data to generate estimated urinary catheter
days may be used as an alternative to daily collection in nononcology ICUs and wards. The number of patients in the location
(patient-days) and the number of patients with an indwelling urinary
catheter (urinary catheter-days) is collected on a designated day each
week (e.g., every Tuesday), at the same time during the month.

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Denominator Data
Collection Method

Details
Evaluations of this method have repeatedly shown that use of
Saturday or Sunday generate the least accurate estimates of
denominator data, and, therefore, these days should not be selected as
the designated day.5-7 If the day designated for the collection of
sampled data is missed, collect the data on the next available day
instead.
The following must be collected and entered into NHSN:
1. The monthly total for patient-days, based on collection daily
2. The sampled total for patient-days
3. The sampled total urinary catheter-days
When these data are entered, the NHSN application will calculate an
estimate of urinary catheter-days.
Notes:
• To ensure the accuracy of estimated denominator data
obtained by sampling, only ICU and ward location types with
an average of 75 or more urinary catheter-days per month are
eligible to use this method. A review of each location’s
urinary catheter denominator data for the past 12 months in
NHSN will help determine which locations are eligible.
• The accuracy of estimated denominator data generated by
sampling can be heavily influenced by incorrect or missing
data. Careful implementation of data collection following the
guidance in this protocol is essential to avoid erroneous
fluctuations in rates or Standardized Infection Ratios (SIRs).

Electronic

For any location, when denominator data are available from
electronic sources (e.g., urinary catheter days from electronic
charting), these sources may be used as long as the counts are not
substantially different (+/- 5%) from manually-collected, once a day
counts, pre-validated for a minimum of three months.
The validation of electronic counts should be performed for each
location separately.

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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.8, 9
Notes:
• The SIR will be calculated only if the number of predicted CAUTIs (numExp) is ≥1
to help enforce a minimum precision criterion.
• In the NHSN application, “predicted” is referred to as “expected”.

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 ICUs in
your facility.
Note: Only those locations for which baseline data have been published will be included in
the SIR calculations. For acute care hospitals, the baseline time period is 2009; for long term
acute care hospitals and inpatient rehabilitation facilities (IRFs) and IRF units, the baseline
time period is 2013.8,9
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 output options of numerator and denominator data, such as line listings,
frequency tables, and bar and pie charts are available in the NHSN application. SIRs and
CAUTI rates and run charts are also available. Guides on using NHSN analysis features are
available at: http://www.cdc.gov/nhsn/PS-Analysis-resources/reference-guides.html.

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REFERENCES
Magill, SS., Hellinger, W., et al. “Prevalence of Healthcare-associated Infections in
Acute Care Facilities”. Infection Control Hospital Epidemiology. 33: (2012):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 Healthcare-associated Infections and
Deaths in U.S. Hospitals”. Public Health Reports 122: (2007):160-166.
4
Gould, CV., Umscheid, CA., Agarwal, RK., Kuntz, G., Pegues, DA. “Guideline for
Prevention of Catheter-associated Urinary Tract Infections”. Infection Control Hospital
Epidemiology. 31: (2010): 319-26.
5
Klevens, RM., et al. “Sampling for Collection of Central Line Day Denominators in
Surveillance for Healthcare-associated Bloodstream Infections”. Infection Control Hospital
Epidemiology. 27: (2006):338-42.
6
Thompson, ND., et al.” Evaluating the Accuracy of Sampling to Estimate Central Line–
Days: Simplification of NHSN Surveillance Methods”. Infection Control Hospital
Epidemiology. 34(3): (2013): 221-228.
7
See, I., et al. ID Week 2012 (Abstract #1284): Evaluation of Sampling Denominator
Data to Estimate Urinary Catheter- and Ventilator-Days for the NHSN. San Diego,
California. October 19, 2012.
8
Dudeck, MA., Horan, TC., Peterson, KD. National Healthcare Safety Network (NHSN)
Report, Data Summary for 2009, “Device-associated Module”, American Journal of Infection
Control 39: (2011): 349-67.
9
Dudeck, MA., et al. National Healthcare Safety Network (NHSN) Report, Data
Summary for 2013, Device-associated Module. Pending publication.
1

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1 Instructions for Completion of Urinary Tract Infection
(UTI) Form (CDC 57.114)

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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

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.
Conditionally required. Enter the patient’s Medicare number for
all events reported as part of a CMS Quality Reporting Program.
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 for the first time, during the Infection
Window Period. 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, Record the
date when the NHSN procedure started. .

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NHSN procedure code

ICD-9-CM procedure
code

MDRO Infection
Surveillance

Location

Conditionally required. If Post-procedure UTI = Y, enter the
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-9-CM
codes identified in Table 1 of the Surgical Site Infection Event
Chapter (Chapter 10 of NHSN Manual: Patient Safety
Component Protocol) are allowed.
NOTE: ICD-10-CM/PCS codes will replace ICD-9-CM codes
on October 1, 2015 however NHSN will not have the ability to
receive these codes until the January 2016 release.
The NHSN guidance for entry of surgical denominator data for
the last quarter of 2015 data is to enter the NHSN Procedure
Code (e.g. COLO or HYST) but do not enter any ICD-10CM/PCS codes associated with the procedure.
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,
Klebsiella pneumoniae, Klebsiella oxytoca, or Enterobacter),
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/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).

January 2015 (Modified April 2015)

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Device-associated Module
CAUTI

Date admitted to
facility

Required. Enter date patient admitted to an inpatient location
using this format: MM/DD/YYYY.
NOTES:




Risk factor:
Urinary catheter status
on the date of event

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.
When reporting a UTI which occurs on the day of or day after
discharge use the previous date of admission as admission
date.

Required. Check one of the following:



“In place” if urinary catheter that had been in place for >2
days was in place on the date of event
“Removed” if a urinary catheter that had been in place for >
2 calendar days was removed the day before the date of
event “Neither” if:
 Patient has/had an indwelling urinary catheter but it
has/had not been in place >2 calendar days on the
date of event
OR
 Patient did not have a urinary catheter in place on
the day of event or the day before the date of event

NOTES:

Location of device
insertion
Date of device
insertion
Event details:
Specific event: UTI




Date of insertion = Day 1.
Urinary System Infection (USI) cannot be catheter
associated, therefore, USI will only present as specific
event type if urinary catheter status was marked
“Neither”.

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.

January 2015 (Modified April 2015)

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Device-associated Module
CAUTI

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

Antimicrobial agent
and susceptibility
results

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 protocol chapter).
Required. Check Y if patient died during the hospitalization,
otherwise check N.
Conditionally required. If patient died, check Y if such evidence
is available (e.g., death/discharge note, autopsy report, etc.).
Optional. Date patient discharged from facility.
Required. Enter Y if pathogen identified, N if otherwise. If Y,
specify organism name on reverse.
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 least as #3
(usually this order will be indicated on the laboratory report). If
secondary BSI pathogens are entered, they should be entered
only after site-specific pathogens are entered. 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.).
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

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.
For each box listing several drugs of the same class, at least one
drug susceptibility must be recorded.
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.

January 2015 (Modified April 2015)

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