NHSN CAUTI: The Foley Was Removed, and the Patient Went Home. Can This Still Be an NHSN CAUTI?
Updated: Sep 2
The Question A patient's Foley catheter was removed before discharge. The patient later returned to the emergency department with fever and a positive urine culture. Can the event still meet NHSN CAUTI criteria and be attributed to the previous hospitalization?
The Case
Hospital Day 1: A patient is admitted to the hospital, and an indwelling urinary catheter is inserted.
Hospital Day 4: The catheter is removed, and the patient is discharged home.
The Next Calendar Day: The patient returns to the ED with a fever (> 38 °C). A urine culture is collected and grows >100,000 CFU/mL E. coli.
What Do You Think?
Does this meet NHSN criteria for a CAUTI attributed to the previous hospitalization?
Yes
No
Only if the catheter was still in place when the patient returned
More information is needed.
Reveal the Answer
Answer: Yes.
This meets NHSN criteria for a CAUTI attributed to the previous hospitalization.
Walking Through the Definition
Does the urine culture meet the laboratory criterion?
Yes. The urine culture grew greater than 100,000 CFU/mL of Escherichia coli. NHSN SUTI criteria require at least one qualifying bacterial species identified at a level of at least 100,000 CFU/mL, with no more than two species reported in the culture.
Does the patient have a qualifying symptom?
Yes. The patient had a temperature greater than 38°C. Fever is an eligible symptom for an adult patient who had an indwelling urinary catheter in place on the date of the event or the day before.
Was the indwelling urinary catheter in place long enough?
Yes. The catheter was inserted on hospital day 1 and remained in place through hospital day 4. Therefore, it had been in place for more than two consecutive calendar days, with the day of insertion counted as day 1.
Can it still be a CAUTI after the catheter was removed?
Yes. The catheter does not have to be present when the qualifying elements occur. NHSN permits an event to be catheter-associated when the catheter was removed on the calendar day before the day of the event.
In this case:
Catheter removed and patient discharged: hospital day 4
Fever and qualifying urine culture: the next calendar day
The patient therefore remains within the catheter-associated window.
Is the infection healthcare-associated?
Yes. The date of event is the day the fever and qualifying urine culture occurred. Because that date falls after hospital day 3, the infection is healthcare-associated rather than present on admission.
Where is the CAUTI attributed?
The event is attributed to the inpatient location from which the patient was discharged because the date of event occurred on the calendar day following discharge.
The Catch
The patient's catheter had already been removed, and the patient had already been discharged. But neither fact automatically excludes the event.
For NHSN purposes, a UTI may still be catheter-associated when the indwelling urinary catheter was in place for more than two consecutive calendar days and, if removed, was done on the same calendar day or the calendar day before the date of event.
The return to the emergency department also does not make this community-onset. Because the date of event occurred on the calendar day after discharge, the CAUTI is attributed to the discharging inpatient location.
The key is to follow the calendar-day rules and not simply ask whether the catheter was still present or whether the patient was still physically inside the hospital.
Final Determination
This event meets NHSN criteria for a SUTI 1a CAUTI attributed to the prior hospitalization.
The patient had an indwelling urinary catheter in place for more than two consecutive calendar days.
The catheter was removed on hospital day 4, and the qualifying fever and urine culture occurred on the following calendar day - within the allowable catheter-association window.
Because the date of event occurred the day after discharge, the CAUTI is attributed to the inpatient location from which the patient was discharged.
