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Determinants of urinary catheter removal practices in the pediatric intensive care unit: A survey

Karen Trudel1, Samara Zavalkoff2, Nicholas Winters3

  • 1London School of Tropical Medicine, University of London, London, UK.

American Journal of Infection Control
|March 10, 2018
PubMed

Insights

Factors like recent extubation and fever prompt urinary catheter removal in pediatric intensive care units (PICUs). However, shock and fluid overload are associated with continued catheter use. Further research is needed to reduce catheter-associated urinary tract infections (CAUTIs).

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease epidemiology
  • Healthcare quality improvement

Background:

  • Prolonged indwelling urinary catheter use is a significant risk factor for hospital-acquired urinary tract infections (UTIs).
  • Limited research exists on the specific factors influencing urinary catheter removal and maintenance in pediatric intensive care unit (PICU) populations.
  • This study addresses the knowledge gap by investigating determinants of urinary catheter removal in critically ill children.

Purpose of the Study:

  • To identify and describe the key factors that influence the decision to remove indwelling urinary catheters in pediatric intensive care unit (PICU) patients.
  • To understand the clinical variables associated with both catheter removal and prolonged catheter maintenance in this vulnerable patient group.

Main Methods:

  • A cross-sectional survey was conducted among 171 physicians and nurses in two tertiary PICUs in Montreal, Canada.
  • Survey questions were developed using focus groups and a comprehensive literature review, incorporating three clinical scenarios.
  • Data analysis involved descriptive statistics and multivariate multinomial regression to identify significant determinants.

Main Results:

  • A total of 131 (77%) healthcare professionals responded to the survey.
  • Factors significantly associated with urinary catheter removal included recent extubation, superficial sedation, fever, and a history of UTI (P < .01).
  • Conversely, the presence of shock (P < .01) and fluid overload (P < .05) were linked to maintaining urinary catheter use. Physicians demonstrated a higher likelihood of removing catheters compared to nurses across all scenarios.

Conclusions:

  • A consistent set of clinical variables reliably predicts the removal of indwelling urinary catheters in PICU settings.
  • Further research is warranted to evaluate the impact of integrating these identified determinants into infection control strategies.
  • The ultimate goal is to reduce both urinary catheter utilization and the incidence of catheter-associated UTIs in critically ill children.
Abstract

Keywords:
Catheter-associated urinary tract infectionchildcritical carehospital-acquired infectioninfection controlsurvey

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