Successful Strategies to Reduce Catheter Associated Urinary Tract Infections (CAUTIs) in a Pediatric Hospital

Purpose:
Urinary tract infections represent 36% of the total hospital-acquired infections (HAIs). Nationwide Children's Hospital (NCH) is taking proactive measures to prevent and reduce the number of HAIs on its campus. The 2011 goal is ≤10 CAUTIs and a rate of ≤1.0 infections per 1000 catheter days.

Significance:
Indwelling catheters predispose patients to infection. Complications resulting from a CAUTI can extend a patient's hospital stay 0.4-2 days and increase the expense $3,803 per occurence. Complications include:Secondary bacteremia/sepsis, Acute pylonephritis, Acquisition of MDROs, Urethral strictures

Strategy and Implementation:
NCH's CAUTI Reduction Committee formed January 2010. The following evidence based initiatives were implemented: Daily Goals: Rounding physicians discuss the need for the catheter and indicate its necessity or removal on the form. Insertion Bundle: Tool used to document best practice when inserting a catheter. Catheter Care Reminder Card: Indicates best practice points when caring for a patient with a urinary catheter. Root Cause Analysis (RCA): When a healthcare associated CAUTI has been identified, unit staff huddle to discuss risk factors and prevention methods specific to the infection and an action plan is determined. Policy Review: Reviewed and provided input on revisions to hospital policies relating to the care and insertions of catheters. With Administrative support, the multidisciplinary representatives on CAUTI Reduction Committee spearheaded promising change. Education and updates on CAUTI reduction were presented at various committees/peer groups throughout 2010-2011.

Evaluation:
4th Quarter 2010, NCH achieved 81 days without a CAUTI. 8 of 17 CAUTIs occurred on the Gen/Med unit in 2010. The unit has had 1 in 2011. 9 of 17 CAUTIs could be attributed to insertion in the OR or ED but only 1 since August of 2010. Catheter utilization decreased from .069 in 2010 to 0.05 in 2011.

Implications for Practice:
ED increased hand hygiene compliance prior to insertion. OR implemented a mandatory field for insertion bundle completion and only RNs can insert a catheter. Perineal pre-cleaning step added to insertion policy so skin antiseptic is effective. Daily discussion of catheter need reduced catheter days.