Children’s Healthcare of Atlanta has launched a specialized initiative to confront catheter-associated urinary tract infections (CAUTIs) in its pediatric intensive care unit (PICU). Catheter-associated urinary tract infections continue to be a common cause of hospital-related infections among both adult and pediatric patients, causing increased hospital stays, higher expenditure, and amplified risk to patients. Standard prevention guidelines that exist predominantly are formulated on adult-based data, hence pediatric-focused initiatives have a blind spot. The implementation of innovative protocols, markedly intended for pediatric patients, has tremendously contributed to advancing the prevention measures in the fight against these infections. The successful implementation of these procedures has led to the eradication of CAUTIs in PICU for over twelve months.
A comprehensive report is published in the Critical Care Nurse journal unfolding how the hospital’s PICU interprofessional task force remarkably reduced its CAUTI rate from 3.13 per 1,000 catheter days to 0 per 1,000 catheter days in less than three years. Before we initiated this ambitious project back in 2020, an average of 92 days would elapse between CAUTI incidents, post the initiative’s implementation, this timeframe extended to 129 days. Ultimately, the PICU realized 527 consecutive CAUTI-free days starting from July 2022.
One extraordinary practice change fueling this significant achievement is the ‘No Diaper Zone,’ an intervention approach targeting the elimination of plausible infection pathways, such as urinary catheters contamination with stool or urinary backflow. Preceding to this practice, numerous case reviews revealed a persistent pattern of liquid stool in CAUTI infections patients pointing to probable catheter contamination. We completely did away with diapers for all patients with indwelling urinary catheters in the PICU. Highly absorbent pads replaced diapers and in conjunction with two-hourly stool checks during vital signs, and positions adjustments minimized exposure risks.
Patients with urinary catheters in place for over 72 hours were considered high risk for CAUTI, therefore, the traditional gravity-dependent collection bags in the PICU were substituted with an advanced Accuryn system. This system features gentle suction, three one-way valves to prevent reflux, and it integrates sensors that deliver accurate hourly urine output digitally. After effectively testing these methods, they are now being applied in the cardiac ICU and operating room.
We incorporated education as a significant part of the prevention strategy. By amalgamating evidence-based recommendations with new child-focused advances, we proved that the eradication of CAUTIs in PICU is a viable and manageable objective. The details of our CAUTI prevention approach are accessible in the entire study, ‘Entering a No Diaper Zone: Rethinking Prevention of Catheter-Associated Urinary Tract Infection,’ in the Critical Care Nurse journal.
Source: https://www.dailynurse.com/zero-cautis-success-no-diaper-zone/