Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit

Abstract

Background Catheter-associated urinary tract infections are common health care–associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%. Objective To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections. Methods A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds. Results Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year. Conclusion Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.

Healthcare workers’ compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen

“…The majority of the Yemeni HCWs (> 85%) followed good practices in terms of keeping the tubing and collecting bag free from kinking and below the level of the patient’ bladder. Studies reported that these items were complied with at all times, which is congruent with our study [ 14 , 33 , 39 ].…”

Prediction Model for Urinary Tract Infection in Pediatric Urological Surgery Patients

“…Microscopic analysis of the bacterial biofilms revealed a honeycomb structure, which was difficult for antibiotics to infiltrate, and could result in multidrug resistance through repeated antibiotic use ( 19 ). The use of an indwelling drainage tube, which could reduce the risk for UTI, could be explained by the following: the underlying effect of an indwelling drainage tube was balanced by other characteristics; the bundle compliance to eliminate the dependent loop in the drainage tube through targeted rounds ensured that the appropriate use of the catheter could reduce the risk for UTI ( 20 ); the appropriate indication for the insertion of the drainage tube, standardization of care for the indwelling drainage tube, appropriate management of leaking urinary catheters, urinary catheter days and removal were combined in daily rounds, and the prolonged use of an indwelling drainage tube should be carefully monitored to improve the progression of UTI ( 21 ).…”

Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care

“…We did find evidence that APP staffing was associated with decreased risk of experiencing a hospital acquired infections. A possible mechanism for this finding is that APPs were able to spend time implementing evidence-based practices known to reduce these infections, such as line insertion and maintenance bundles, line rounding and daily rounding quality improvement checklists 31–33. In addition, in nursing literature, improvements in staffing have been associated with lower rates of hospital acquired infections 34.…”

“…A possible mechanism for this finding is that APPs were able to spend time implementing evidence-based practices known to reduce these infections, such as line insertion and maintenance bundles, line rounding and daily rounding quality improvement checklists. [31][32][33] In addition, in nursing literature, improvements in staffing have been associated with lower rates of hospital acquired infections. 34 When APPs are used in units with physician shortages, they improve unit staffing in ways that may contribute to overall improvements in patient safety outcomes.…”