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 Periodand 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)
Allelements 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.
  1. 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
  1.  Fever (>38°C or 100.4°F)  suprapubic tenderness*  costovertebral angle pain or tenderness*

OR
1.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
  1.  Fever (>38°C or 100.4°F)  hypothermia* (<36.0°C)  vomiting*  lethargy*  apnea*  suprapubic tenderness*  bradycardia*

Asymptomatic Bacteremic Urinary Tract Infection (ABUTI)
All elements of the UTI criterion must occur during the 7-day Infection Window Period (see Table below).
Patient had an indwelling urinary catheter in place for > 2 calendar days and catheter was in place on the Date of Event or the day before.
 Patient with a Positive Urine Culture andhas 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 (<36°C core); apnea; bradycardia;
dysuria;lethargy; or vomiting.
 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 in the urine culture.
Infection Window Period / 3 Days before
First positive diagnostic test
OR
First documented localized sign and/or symptom in the absence of a diagnostic test
3 Days after

*With no other recognized causeREV April 2015

NOTE: Repeat Infection Timeframe (RIT)= 14 day time frame, in which no new infections of the same type are reported. Date of Event is day 1 of the 14-day RIT.