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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Reducing catheter-associated urinary tract infections with sterile, continuously closed drainage systems does not
Trevor D Fachko1, Catherine L Robey1, Glenn Cannon2
1Eastern Virginia Medical School, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, USA.
Insights
A new two-nurse protocol for urinary catheter insertion in the pediatric intensive care unit (PICU) significantly reduced costs by $38,521 annually without increasing catheter-associated urinary tract infection (CAUTI) rates. Nurses approved the cost-saving intervention.
Area of Science:
- Healthcare Economics
- Infection Control
- Pediatric Nursing
Background:
- Catheter-associated urinary tract infections (CAUTIs) are a significant source of morbidity and financial burden in pediatric intensive care units (PICUs).
- Implementing quality improvement initiatives to reduce CAUTIs can be costly, presenting a challenge for healthcare facilities.
Purpose of the Study:
- To evaluate the cost-effectiveness of a novel "two-part, two-person" urinary catheter insertion protocol in a pediatric quaternary care center PICU.
- To assess the impact of this protocol on CAUTI rates and nursing satisfaction.
- To determine the financial savings achieved by replacing pre-packaged, closed-system urinary catheter kits with individually packaged components.
Main Methods:
- A "two-part, two-person" insertion protocol was implemented, requiring two nurses to insert an indwelling catheter using individually packaged sterile components.
- The study included all patients with Foley catheters placed in the PICU from April 2021 to March 2022.
- Key endpoints measured were the cost per insertion, CAUTI rates (per 1000 Foley days), and nursing satisfaction.
Main Results:
- The new protocol projected a 12-month cost saving of $38,521.
- CAUTI rates during the study period (3.8 per 1000 Foley days) showed no significant increase compared to the prior 6 months (5.65 per 1000 Foley days).
- The protocol received an 87% approval rating from PICU nurses.
Conclusions:
- Eliminating costly pre-packaged urinary catheter kits in favor of individual components can reduce expenditures while maintaining quality standards.
- This protocol offers a sustainable and acceptable intervention for improving the value of care in PICUs.
- The "two-part, two-person" approach demonstrates a successful strategy for cost reduction and quality care in pediatric intensive settings.
Introduction:
Catheter-associated urinary tract infections (CAUTIs) cause significant morbidity and financial strain in the pediatric intensive care unit (PICU). There is a significant incentive to reduce the rate of CAUTIs through multimodal quality improvement initiatives; however, these initiatives are often costly to implement.
Objective:
This article examines the cost-savings associated with a novel "two-part, two-person" catheter insertion protocol implemented at a pediatric quaternary care center PICU which replaced costly pre-packaged, closed system urinary catheter kits with their individually packaged components, along with its impact on CAUTI rates and nursing satisfaction.
Study Design:
The "two-part, two-person" insertion protocol involved two nurses placing an appropriate size indwelling catheter using an individually packaged sterile insertion kit, urine meter bag, and Foley catheter. All patients with Foley catheters placed in the PICU between April 2021 and March 2022 were included in this study. Endpoints included the cost of each insertion, CAUTI rates per 1000 Foley days, and nursing satisfaction.
Results:
The "two-part, two-person" insertion protocol resulted in a projected 12-month cost savings of $38 521 while CAUTI rates over this period (3.8 per 1000 Foley days) did not significantly deviate from the 6 months prior to program initiation (5.65 per 1000 Foley days, p = 0.06). This protocol garnered an approval rating of 87 % by PICU nurses.
Conclusions:
Catheter expenditures can be reduced and quality standards can be maintained by eliminating costly pre-packaged, closed system urinary catheter kits in favor of their individual components. This protocol demonstrates an acceptable and sustainable intervention to improve value of care within the PICU.
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