Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection

Area of Science:

• Pediatric Critical Care Medicine
• Infectious Disease Prevention
• Quality Improvement in Healthcare

Background:

• Inappropriate urinary catheter (UC) use in critically ill children increases morbidity, including catheter-associated urinary tract infections (CAUTIs).
• Checklists are proven to reduce medical errors, but their effect on device utilization in pediatric critical care is understudied.
• This study investigates the impact of a daily rounding checklist on UC utilization and CAUTI rates.

Purpose of the Study:

• To evaluate trends in urinary catheter utilization after implementing a daily rounding checklist.
• To assess the impact of the checklist on catheter-associated urinary tract infection rates.
• To determine the effectiveness of a quality improvement checklist in pediatric critical care.

Main Methods:

• Retrospective review of a checklist database (2006-2016) in a 36-bed pediatric intensive care unit.
• Interventions included a "Daily QI Checklist" (2006), education on device necessity, and a CAUTI prevention bundle (2013).
• Urinary catheter utilization and duration were analyzed using time series models; CAUTI rates were assessed using Poisson regression.

Main Results:

• Urinary catheter utilization decreased significantly from 30% to 18% of patient-days (P < 0.0001).
• Catheter duration remained unchanged (median 2.0 days, P = 0.18).
• Catheter-associated urinary tract infection rates declined by 89%, from 9.49 to 1.04 per 1,000 catheter-days (P = 0.0047).

Conclusions:

• Checklist implementation correlated with a sustained 40% reduction in urinary catheter utilization.
• This reduction may stem from improved patient selection and timely catheter removal.
• An 89% decrease in CAUTI rates was observed, underscoring the checklist's role in promoting best practices.