The pediatric catheter–associated urinary tract infection (CAUTI) prevention team was formed in August 2015 to address a patient safety need. CAUTI rates, specifically in the pediatric intensive care unit (PICU), were consistently above national benchmarks, resulting in unnecessary harm to patients.
To reduce indwelling urinary catheter (IUC) utilization in the PICU to less than 20% and to achieve 1 year with zero CAUTI.
The pediatric CAUTI prevention team is a multidisciplinary team made up of bedside staff, infection prevention, multiple physicians, midlevel providers, quality improvement, educators, and support staff. The team meets monthly and ad hoc to discuss metrics, bundle compliance, new products, and to make recommendations on IUC use and care. The team also reviews any CAUTI cases and determines action items for follow-up. The team has developed best practice guidelines that have been implemented throughout the hospital, including a bladder scan and straight catheterization algorithm, pediatric bladder capacity guidelines, and an appropriate Foley sizing guideline. Best practice for bathing, including standardized processes and timing, has been implemented.
Over a 2-year period, IUC utilization in the PICU decreased from an average of 30% to an average of 11%; a 63% decrease since 2014 (Fig. 1). In April 2017, we celebrated 1 year CAUTI free hospital-wide, with an overall 77% reduction since 2014. Notably, our PICU completed 498 days with zero CAUTI (Fig. 2), and reduced the number of patients per month with an IUC by 40%. Our institution also utilizes rounding to assess evidence-based practice prevention bundle compliance. Before action from the CAUTI team, bundle compliance in the PICU averaged 64%; now the PICU has an average compliance of 97%.
The team has established standards for IUC use and care which have had significant impact on CAUTI rates in our hospital, preventing our patients from harm.