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Critically ill patients are particularly at risk for developing hospital-acquired infections. An understanding of the predisposing factors, the epidemiology of disease, and guidelines to treat and to prevent hospital-acquired infections is necessary to incorporate infection control into the daily care of the critically ill trauma patient. Although it remains a challenge, infection control programs have moved from providing surveillance data and guidelines recommendations to implementation and engagement programs aimed at a shared responsibility for hospital-acquired infections prevention. We describe a multidisciplinary approach to infection control in the critically ill trauma patient with a special focus on ventilator-associated pneumonia at a level 1 trauma and burn center.

Objective: To develop and validate an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs)., Design: Retrospective cohort study., Setting: 413-bed university-affiliated urban teaching hospital., Methods: An electronic surveillance tool was developed for CAUTI and urinary catheter utilization based on the objective components of the National Healthcare Safety Network (NHSN) definitions including fever, urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP)., Results: During January and February 2010, 204 positive urine cultures (≥10(3) colony-forming units/mL) were identified in 136 patients with indwelling urinary catheters during their hospitalization. The electronic surveillance tool detected 60 CAUTI cases and 7,098 catheter-days, yielding a CAUTI incidence rate of 8.5 per 1,000 catheter-days. Urinary catheter utilization ratios (Foley-days/patient-days) were: acute care units, 0.27 (3,637 of 13,229); intensive care units, 0.77 (3,461 of 4,469); and overall, 0.40 (7,098 of 17,698). In comparison, the IP identified 59 cases by manual review with a sensitivity of 51 of 59 (86.4%), specificity 136 of 145 (93.8%), and negative predictive value of 136 of 144 (94.4%). Fever was present in 54 of 59 (91.5%) of CAUTI cases identified manually, while subjective criteria were documented in only 6 of 59 (10.2%) infections. Agreement between the electronic surveillance and manual IP review was assessed as very good (κ, 0.80; 95% confidence interval, 0.71-0.89)., Conclusions: We report an attempt at automating surveillance for CAUTI. With a high negative predictive value, the electronic tool allows for more efficient CAUTI surveillance and facilitates housewide trending of rates and catheter utilization. This approach should be validated in different patient populations.