Accuracy of catheter-associated urinary tract infections reported to the National Healthcare Safety Network, January 2010 through July 2018

Background Surveillance of health care-associated, catheter-associated urinary tract infections (CAUTI) are the corner stone of infection prevention activity. The Centers for Disease Control and Prevention's National Healthcare Safety Network provides standard definitions for CAUTI surveillance, which have been updated periodically to increase objectivity, credibility, and reliability of urinary tract infection definitions. Several state health departments have validated CAUTI data that provided insights into accuracy of CAUTI reporting and adherence to CAUTI definition. Methods Data accuracy measures included pooled mean sensitivity, specificity, positive predictive value, and negative predictive value. Total CAUTI error rate was computed as proportion of mismatches among total records. The impact of 2015 CAUTI definition changes were tested by comparing pooled accuracy estimates of validations prior to 2015 with post-2015. Results At least 19 state health departments conducted CAUTI validations and indicated pooled mean sensitivity of 88.3%, specificity of 98.8%, positive predictive value of 93.6%, and negative predictive value of 97.6% of CAUTI reporting to the National Healthcare Safety Network. Among CAUTIs misclassified (121), 66% were underreported and 34% were overreported. CAUTI classification error rate declined significantly from 4.3% (pre-2015) to 2.4% (post-2015). Reasons for CAUTI misclassifications included: misapplication of CAUTI definition, misapplication of general health care–associated infection definitions, and clinical judgement over surveillance definition. Conclusions CAUTI underreporting is a major concern; validations provide transparency, education, and relationship building to improve reporting accuracy.