Cauti case Scenarios Answer Key Case 1

CAUTI Case Scenarios

Answer Key

Case 1

Answer: True

This patient meets criteria for CAUTI on Feb 1 with fever, positive urine culture 100,000

CFU/ml of not more than 2 organisms. Foley had been in place > 2 days therefore= CAUTI.

Case 2

Answer: Yes, catheter-associated SUTI criterion 1a.

Patient has an indwelling urinary catheter in place for the entire day on the date of event and such catheter had been in place for >2 calendar days, on that date (day of device placement = Day 1).

Patient has at least one of the following signs or symptoms:

• 
  fever (>38.0°C)
  
• 
  suprapubic tenderness*
  
• 
  costovertebral angle pain or tenderness*
  

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.

Case 2 - Rationale

Date of event (3/5) occurred on or after day 3 of admission. This UTI is catheter-associated because the date of event was Foley day 4. Right or left lower back is the CVA and there was no other cause for the CVA pain. Patient has >105 CFU/ml of single bacteria in urine.

Case 3

Answer: No, it is a UTI that is POA.

Date that the first element of the SUTI 1a criterion occurred (during the infection window Period) was on Day 2 of hospitalization.

• 
  Date of event = Day 2. This is within the POA time period.
  

Case 4

Answer: No. UTI criterion not yet met. Because the only organism present at 100,000 CFU/ml was not a bacteria, this patient does not meet NHSN UTI criteria.

Case 4 - continued

Answer: Yes, Patient has a SUTI 1a and it is a CAUTI.

• 
  DOE= 4/7 –Date of urine culture.
  
• 
  No more than 2 organisms in urine, 1 of which was bacteria > 100,000 CFU/ml.
  
• 
  SUTI 1a criterion met; Infection Window Period = 4/4-4/10.
  
• 
  Foley had been in > 2days on DOE and removed that day = catheter-associated.
  

Case 4 – continued

Answer: Telemetry Unit.

Rationale: The date of event is the day of transfer from the telemetry unit.

Case 5

Answer: Yes, ABUTI with P. aeruginosa.

Yes. Patient without UTI criteria symptoms in the presence of blood culture matching urine culture (100,000 CFU/ml) = ABUTI.

• 
  Candida is not a pathogen for UTI therefore not documented in pathogen list.
  
• 
  Note that fever must be GREATER than 100.4°F to meet the fever requirements for NHSN definitions.
  

Case 6

Answer: No UTI

Urine reported >10,000 CFU/ml

May not reach minimum =100,000 CFU/ml

Physician diagnosis and treatment not part of NHSN UTI criteria.

* Must check with your lab to understand their reporting definitions.

Case 7

Answer: Yes, either 2 or 3 above.

Urine culture is positive for 2 organisms.

• 
  At least one is bacterium 100,000 CFU/ml.
  
• 
  Fever > 38.0°C during the Infection Window Period (4/15-4/21)
  
• 
  Date of event = 4/18.
  
• 
  Note: SUTI 1a can be used for patients < 1 year of age.
  

Q: Is this a CAUTI?

Answer: Yes. Catheter in place > 2 days on the date of event and still in place.

Case 8

Answer: B. For residents with an indwelling catheter (both criteria 1 and 2 must be present).

1. 
   At least 1 of the following sign or symptom subcriteria.
   
   1. 
      Fever, with no alternate site of infection.
      
   2. 
      Either acute change in mental status or acute functional decline, with no alternate diagnosis and leukocytosis.
      

Case 9

Answer: This is a symptomatic CAUTI.

CLABSI Case Scenarios

Answer Key

Miss Trinket Case Scenario

Side 37 Answer: B. HAI.

Remember to be Present on Admission - date of event* occurs on the day of admission or the day after admission.

The POA time period continues to include the day of admission, 2 days before and the day after admission.

Slide 39 Answer: A.

Slide 40: Rationale

BT Latier Case Scenario

Slide 45 Answer: B, CLABSI attributed to CCU.

Slide 46: Rationale

Haymitch Case Scenario

Slide 49 Answer: True

Slide 50 Answer: B, this is BSI HAI.

Slide 51 Answer: A. CL related.

Slide 52: Rationale

Mrs. Apple Case Scenario

Slide 57 Answer: A. Yes, this patient has an LCBI criterion 1.

Slide 58 Answer: A. Yes

Slide 59: Rationale

Mr. Webb Case Scenario

Slide 62 Answer: C, No, this patient’s BSI is secondary to a GIT infection.

Requires 2 matching blood cultures with common commensals.

Cath tips are not used.
Pt does not meet any GIT criteria.

Slide 63: revised scenario, notice temperature change and number of positive blood cultures.

Slide 64 Answer: A, this is a LCBI because S. epidermidis is a CNS, making them matching organisms, collected on the same day.

Slide 65 Answer: 6/30 – the first date of the fever during the infection window period.

Slide 66: Rationale

Slide 67 Answer: 1, Medical ICU.

Ms. Veruca Salt Case Scenario

Slide 70 Answer: B this is a non-surgical IAB with a secondary BSI.

Slide 71-74: Rationale

Mr. Duval Case Scenario

Slide 76 Answer: A, Yes, the patient has a CLABSI with E. faecium.

Slide 78 Answer: B, Yes, the patient has an LCBI with P. aeruginosa.

Slide 79 Answer: 1, this is still a CLABSI… Even if the site is infected, the BSI is always the infection that is reported, because it is the most important.

Baby Girl Golden Case Scenario

Slide 82 Answer: D. No, patient has a UTI with secondary BSI.

Slide 83-84: Rational

Home Health Case Scenario

Slide 86 Answer: C. Clinical sepsis.

Slide 87: Rationale

Outbreak Investigation Exercise
Answer Key

Determine Incidence Rate (slides 39-40)

Answer:

# new patients in ICU with MRSA in June = 2

# patients in ICU in June = 120

Formula is:

# new cases in population in given period x 10^n*

# in same population during given period

2 x 100 = 1.7

120

How we state our findings is important: This result is stated as “the incidence rate of MRSA in the ICU in June is 1.7 cases per 100 patients”

What is attack rate for MRSA in June? We use 100 as the constant, so it’s the same as we calculated above—1.7 cases per 100 patients or 1.7%. Note that attack rate is most commonly used for foodborne outbreaks.

Attack rate is really a proportion of persons at risk who become infected over an entire period of exposure. There is no specification of time. Always a percent.

Prevalence Rate (slides 41-43)

Answers:

# new patients in ICU with MRSA in June = 2

# patients with MRSA in May still in ICU in June = 3

# patients in ICU in June = 120

ASK: What is the formula?

# new and existing cases of MRSA x 100

# ICU pts in June

New and existing cases = 3 from May +2 in June = 5 (our numerator)

Population in ICU in June= 120 (our denominator)

We multiply by 100 to give us a whole number.

Answer is 5/120 x 100=4.2

Besides being able to use the formula, you must be able to explain the result you obtain. This is stated as a “the prevalence rate of MRSA in the ICU in June is 4.2 cases per 100 patients”

Notice the difference between the MRSA prevalence and incidence rates in June:

Prevalence rate is 4.2 cases per 100 patients – this rate includes both new and existing cases

Incidence rate is 1.7 cases per 100 patients and includes only newly diagnosed patients

Incidence-Density Rate (Slides 44-45)

Answer:

Formula is:

# Infections X 1000 = rate

# Patient (or resident) - days in total population

5/843 x 1000 = 5.843 0r 5.9

Stated as: There were 5.9 UTIs per 1,000 resident-days in May. Remember that we cannot express an incidence density rate as a percentage.

Device-Associated Infection Rate (DAR) (Slides 46-47)

# CLABSI in MICU X 1000 = 1/630 x 1000 = 1.6

# catheter-days in MICU

State rate as: there were 1.6 CLABSIs per 1,000 catheter-days in the MICU in April