Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network

Abstract

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals.METHODS: Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. RESULTS:After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively.CONCLUSIONS: IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.

Effectiveness of Evidence-Based Guidelines on Catheter Associated Urinary Tract Infection Rate among Pediatric Intensive Care Children

“…These interventions revealed a decrease and then eradication of CAUTI. As well as (25) who concluded that, after the implementation of the pediatric CAUTI insertion and maintenance bundles care, CAUTI rates reduced among hospitalized children with indwelling urinary catheters after intervention.…”

“…Adverse effects associated with indwelling urinary catheters include increases in length of hospital stay (LOS), health care costs, morbidity and mortality in hospitalized pediatric patients. (25,26) The National Healthcare Safety Network revealed that pooled mean CAUTI rates were similar in children and adults, the national pooled mean for pediatric intensive care units (PICUs) was 2.5 infections per 1000 catheter-days.…”

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

“…3,4 The burden of CAUTI in pediatric patients is not well defined; however, bundles adapted from work in adults have been applied to the pediatric population with favorable results. 5 Urinary catheters remain one of the most common medical devices experienced by adults in emergency departments and hospitals worldwide. Often, these devices are placed and maintained in use without an appropriate clinical indication to justify the risk compared to the benefit.…”

Don’t just do it—Conducting and publishing improvement science in infection prevention and antibiotic stewardship

“…Solutions for Patient Safety, an engagement network of >145 North American children's hospitals, has used this concept of 'All Teach, All Learn' to reduce harm to hospitalized children, including HAIs like catheter-associated bloodstream infections (CLABSIs), surgical site infections (SSIs), and catheter-associated urinary tract infections (CAUTIs). [9][10][11] Shared learning includes both successes and failures. A key tenet of improvement science is that failing is inevitable and acceptable and can lead to insights that contribute to success.…”

“…10,48,64,65 For example, the Solutions for Patient Safety collaborative has reduced CLABSIs (13.7%), CAUTIs (56.6%) and SSIs (16.6%) since 2012. 11,66 Another multicenter collaborative of 5 adult hospitals in Brazil reduced CLABSI, CAUTIs and VAPs. 51 Regular communication and collaboration among collaborative members has been cited as a key factor for their success.…”