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%.
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.
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.
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.
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.
Critical care nurse. 2020 Feb 01 [Epub]
Megan D Snyder, Margaret A Priestley, Michelle Weiss, Cindy L Hoegg, Natalie Plachter, Sarah Ardire, Allison Thompson
Megan D. Snyder is the Director of Nursing Professional Practice at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Margaret A. Priestley is an associate professor of clinical anesthesiology and critical care medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania., Michelle Weiss is a case management specialist at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Cindy L. Hoegg is the Senior Infection Preventionist in the Infection Prevention and Control Department at the Children's Hospital of Philadelphia., Natalie Plachter is a primary care nurse practitioner at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Sarah Ardire is a clinical nurse expert in the pediatric intensive care unit at the Children's Hospital of Philadelphia., Allison Thompson is the advanced practice provider manager for the critical care, sedation/radiology, and surgical subspecialty teams at the Children's Hospital of Philadelphia.