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Published on: June 24, 2025
Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit
Megan D Snyder1, Margaret A Priestley2,3, Michelle Weiss4
1Megan D. Snyder is the Director of Nursing Professional Practice at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Targeted rounding effectively reduced catheter-associated urinary tract infections (CAUTIs) in a pediatric intensive care unit. This strategy improved bundle compliance and sustained a zero CAUTI rate for one year.
Area of Science:
- Healthcare-associated infections
- Quality Improvement in Pediatrics
- Infection Control Strategies
Background:
- Catheter-associated urinary tract infections (CAUTIs) are prevalent, increasing mortality, morbidity, length of stay, and costs.
- Prevention focuses on reducing unnecessary urinary catheter use and timely removal.
- Pre-intervention CAUTI bundle compliance was 84% with no unnecessary catheter use.
Purpose of the Study:
- To enhance CAUTI bundle compliance through targeted rounding.
- To specifically address dependent drainage loops and ensure appropriate urinary catheter use.
- To ultimately decrease the incidence of CAUTIs.
Main Methods:
- A multidisciplinary team implemented a 1-year quality improvement project in a pediatric intensive care unit.
- Daily targeted rounding was conducted for patients with indwelling urinary catheters.
- Rounds assessed catheterization appropriateness, aimed to boost bundle compliance, and mitigate CAUTI risk.
Main Results:
- Bundle compliance increased from 84% to 93% with targeted rounding.
- The overall CAUTI rate decreased from 2.7 to 0 infections per 1000 catheter-days.
- This significant reduction in CAUTIs was sustained for a full year.
Conclusions:
- Targeted rounding is a sustainable and effective method for reducing CAUTIs in pediatric patients with indwelling urinary catheters.
- The intervention's simplicity facilitates its application to diverse patient populations.
- This strategy offers a promising approach to infection control in healthcare settings.
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.
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