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Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network
Charles B Foster1, Kathy Ackerman2,3, Vera Hupertz2
1Cleveland Clinic Children's, Cleveland Clinic, Cleveland, Ohio; fosterc3@ccf.org.
Insights
Catheter-associated urinary tract infections (CAUTIs) decreased 61.6% in children after implementing insertion and maintenance bundles. These evidence-based practices improved patient safety without increasing urinary catheter use.
Area of Science:
- Healthcare-associated infections
- Pediatric patient safety
- Infection prevention and control
Background:
- Catheter-associated urinary tract infections (CAUTIs) are a significant concern in healthcare settings.
- Existing CAUTI prevention bundles (insertion and maintenance) lack extensive validation in pediatric populations.
- This study addresses the CAUTI prevention efforts within a large network of children's hospitals.
Purpose of the Study:
- To evaluate the effectiveness of catheter insertion bundles (IBs) and maintenance bundles (MBs) in preventing CAUTIs in pediatric patients.
- To assess the impact of these bundles on CAUTI rates and urinary catheter utilization across a network of children's hospitals.
- To determine the reliability of adherence to IBs and MBs in a real-world, multi-institutional pediatric setting.
Main Methods:
- A network of children's hospitals participated in a CAUTI prevention initiative from 2011 to 2017.
- Hospitals implemented pediatric-specific CAUTI insertion bundles (IBs) and maintenance bundles (MBs) starting in May 2014.
- Data on CAUTIs, patient-days, and urinary catheter-line days were collected; CAUTI rates and bundle reliability were monitored using run or control charts.
Main Results:
- A 61.6% reduction in CAUTI rates was observed network-wide, decreasing from 2.55 to 0.98 infections per 1000 catheter-line days.
- Urinary catheter use rates remained stable, indicating that the reduction in CAUTIs was not due to decreased catheter utilization.
- Network reliability in adhering to IBs reached 95.4%, and to MBs reached 86.9%.
Conclusions:
- The implementation of insertion bundles (IBs) and maintenance bundles (MBs) significantly reduced CAUTI rates in hospitalized children.
- These findings demonstrate the efficacy of evidence-based bundles in preventing CAUTIs in pediatric populations.
- The study highlights the successful application of standardized infection prevention strategies across a large network of children's hospitals.
Background:
Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals.
Methods:
Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component.
Results:
After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively.
Conclusions:
IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.
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