Children’s Healthcare of Atlanta significantly reduced catheter-associated urinary tract infections (CAUTIs) to zero in its pediatric intensive care unit (PICU), maintaining this record for more than 500 days by implementing an innovative strategy. CAUTI prevention guidelines are predominantly built on studies conducted on an adult population, leading to certain gaps in pediatric-specific strategies, as stated on an Aug 5 news release on the website of the American Association of Critical Care Nurses.
Recognizing this gap, a task force at the Atlanta healthcare center began assessing CAUTI instances, subsequently identifying a correlation between liquid stool incidents and CAUTI development. The team surmised that stool contamination of the catheter was contributing to the infection, leading to the proposal to remove diapers from PICU patients with indwelling urinary catheters. What came to be labeled as the ‘No Diaper Zone’ strategy soon became routine practice. Patients were positioned on highly absorbent pads, with nurses implementing regular screenings for stool presence at two-hour intervals during vital sign checks and position alterations.
Additionally, urinary output monitoring saw further enhancements through the replacement of standard gravity-dependent urine collection bags with advanced systems that employed gentle suction and three one-way valves for continuous urine flow maintenance. These advanced systems, besides preventing stagnation of urine, also delivered accurate hourly urine output data on an easily interpretable digital display. Due to the effectiveness of this urine monitoring system, it saw implementation across all ICU subdivisions, including the cardiac ICU and operating room sectors.
Prior to the implementation of this combined strategy, the PICU’s CAUTI rate was 3.13 per 1,000 catheter days in 2020. However, in the first post-intervention year, there was a marked decrease in the CAUTI rate by 22%. By 2023, the PICU touched a zero per 1,000 catheter days infection rate, leading to 527 event-free days in infection prevention since July 2022. As infection prevention professionals, it is crucial to consider and adapt such innovative strategies to ensure optimal patient care.