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Catheter-Associated Urinary Tract Infection Worksheet - NNJ … - suprapubic catheter replacement by nurses
Catheter-Associated Urinary Tract Infection (CAUTI) Worksheet
Date of Event of the infection is date first element of the criterion is met for the first time within the 7-day Infection Window Period and must occur on or after the 3rd calendar day of admission to an inpatient location where day of admission is Day 1.
NHSN #______________
|Patient: |MR# |AGE | M F |Adm: |Disch: | |
| |MC # | | | | | |
|Inserting Unit |Infection Unit |DOB |DATE Foley IN: |DATE Foley OUT: |Foley DAYS: | |
|Culture Date: Culture type: ? Foley ? Clean Catch ? Suprapubic ? Straight Catheter | |
|Pathogen: |Colony Count: |Date of Event: | |
|Positive Urine Culture: Colony count ≥ 100,000 (105cfu/ml) with 2 or less microorganisms (excluding yeast) of which at least one is a bacteria. |
|Symptomatic Urinary Tract Infection (SUTI) |
|All elements of the UTI criterion must occur during the 7-day Infection Window Period (see table below) |
|SUTI 1a: Patient ≥ one (1) year of age with a Positive Urine Culture must meet 1 and 2 below. |
|Patient has an indwelling urinary catheter in place for the entire day on the Date of the Event and such catheter had been in place for >2 calendar days, on that date |
|(day of device placement = Day 1). |
|Must have ONE |
|? Fever (>38°C or 100.4°F) ? suprapubic tenderness* ? costovertebral angle pain or tenderness* |
|OR |
|Patient had indwelling urinary catheter > 2 calendar days and catheter was removed on the day of, or the day before the Date of Event. |
|Must have ONE |
|2. ? Fever (>38°C or 100.4°F); ? urgency*; ? frequency*; ? dysuria*; ? suprapubic tenderness*; |
|? costovertebral angle pain or tenderness* |
|Note: Fever and hypothermia are nonspecific symptoms of infection and cannot be excluded from UTI determination because they are clinically deemed due to another |
|recognized cause. |
|SUTI 2: Patient ≤ one (1) year of age with a Positive Urine Culture must meet 1 and 2 below. |
|1. Patient had indwelling urinary catheter > 2 calendar days and catheter was in place on the Date of the Event or the |
|previous day the CAUTI criterion is met. |
|Must have ONE |
|? Fever (>38°C or 100.4°F) ? hypothermia* ( 2 calendar days and catheter was in place on the Date of Event or the day before. |
|? Patient with a Positive Urine Culture and has NO signs or symptoms of SUTI 1a or 2 (i.e., for any age patient, |
|no fever (>38°C or 100.4°F); urgency; frequency; dysuria; suprapubic tenderness; costovertebral angle pain or |
|tenderness OR for a patient ≤ 1 year of age, no fever (>38°C core); hypothermia (
When a suprapubic catheter is necessary? A suprapubic catheter (tube) drains urine from your bladder. It is inserted into your bladder through a small hole in your belly. You may need a catheter because you have urinary incontinence (leakage), urinary retention (not being able to urinate), surgery that made a catheter necessary, or another health problem.
