Entering a No Diaper Zone: Rethinking Prevention of Catheter-Associated Urinary Tract Infection

Area of Science:

• Infection Control
• Critical Care Medicine
• Pediatric Nursing

Background:

• Catheter-associated urinary tract infections (CAUTI) are a significant cause of hospital-acquired infections, particularly in pediatric intensive care units (PICUs).
• Indwelling urinary catheters are essential for monitoring fluid balance but pose an infection risk, exacerbated by factors like stool contamination.
• Staffing challenges and high nurse turnover in a PICU led to inconsistent CAUTI prevention practices.

Purpose of the Study:

• To develop and implement a comprehensive strategy to prevent catheter-associated urinary tract infections in a pediatric intensive care unit.
• To address the increased risk of CAUTI associated with diaper use and indwelling urinary catheters.

Main Methods:

• An interprofessional team utilized plan-do-study-act cycles to design and implement CAUTI prevention interventions.
• Key interventions included an exploratory no-diapering protocol, an advanced indwelling urinary catheter drainage system, and consistent staff reeducation.
• Compliance and infection rates were monitored using electronic surveys, bedside rounds, bundle audits, and statistical process control charts.

Main Results:

• The rate of catheter-associated urinary tract infection decreased from 3.13 to 0 per 1000 catheter days.
• The unit achieved 527 consecutive catheter-associated urinary tract infection-free days, spanning approximately 1.5 years.
• The implemented interventions demonstrated a significant reduction in CAUTI rates.

Conclusions:

• A combination of eliminating diapers, utilizing an advanced urinary catheter drainage system, and structured staff reeducation effectively reduced CAUTI in a PICU.
• This multifaceted approach shows promise for reducing infection rates and improving patient outcomes in both pediatric and adult critical care settings.
• The study highlights the importance of targeted interventions and consistent practices in preventing hospital-acquired infections.