BERKELEY, CA (UroToday.com) - Pediatric catheter-associated urinary tract infections (CAUTI) have been and remain a challenge for many health care institutions, both pediatric and adult alike. Until this publication, pediatric institutions have only had interventions that had been trialed in adult populations. Our evidence-based intervention bundle focused on minimizing inappropriate catheter use and improving adherence to aseptic technique when inserting or manipulating a urinary catheter, interventions common in the adult population. Our study provides evidence that intervention bundles borrowed from the adult literature are feasible and effective in the pediatric population at preventing CAUTI and provides epidemiologic data identifying risk factors.
Our data confirm what we suspected in that most patients with CAUTIs are female and are very sick while in the hospital, often having an ICU stay and at least one complex chronic condition. The surprising element of the study came when we realized that our catheter utilization ratio remained stable and did not decrease over the course of the two-year study period. Additionally, about 90% of patients who developed a CAUTI had a recognized indication for catheter placement. Therefore, we strongly feel that the impetus behind our > 50% drop in CAUTI post-bundle implementation resulted from nurses and other staff adhering to aseptic technique, from placement to removal of the urinary catheter.
Since study data collection ended in June 2012, our CAUTI rate has continued to decline, however, we are not yet at zero. Through our work, we learned that maintaining the reservoir bag below the level of the bladder, eliminating dependent loops in the tubing, and requiring the urinary catheter insertion involve 2 persons (one to coach and one to perform the procedure) are important processes to continue monitoring and improving upon as we move towards eliminating CAUTI at our institution.
Written by:
Katherine Finn Davis, PhD, RN as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
University of Pennsylvania School of Nursing, Philadelphia PA USA; Department of Nursing, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
Reducing catheter-associated urinary tract infections: A quality-improvement initiative - Abstract