Children’s Healthcare of Atlanta cut its catheter-associated urinary tract infections in the pediatric intensive care unit to zero — and maintained a rate of zero for more than 500 days — with a new strategy.
Here is what to know:
1. National guidelines for prevention CAUTIs are largely based on the adult population, with limited pediatric-specific strategies, according to an Aug. 5 news release published on the American Association of Critical Care Nurses website.
2. During huddles on CAUTI cases, a task force at the hospital identified a pattern of liquid stool occurrences in patients with CAUTI. They theorized that the stool was contaminating the catheter and contributing to the infection. The proposed fix: Remove diapers from PICU patients with indwelling urinary catheters.
3. This practice became known as the No Diaper Zone. Patients would be placed on highly absorbent pads, and nurses look for the presence of stool every two hours during vital sign checks and position changes. Staff also improved urine output monitoring by replacing traditional gravity-dependent urine collection bags with advanced systems that used gentle suction and three one-way valves to maintain continuous urine flow. The system also provided accurate hourly urine output data on a digital display.
4. The urine monitoring system was so effective it was implemented across the ICU, cardiac ICU and operating room.
5. Prior to the change, the baseline CAUTI rate in the PICU was 3.13 per 1,000 catheter days in 2020. Within the first post-intervention year, the CAUTI rate decreased by 22% and by 2023, the PICU achieved a rate of 0 per 1,000 catheter days. It has since maintained a streak of 527 event-free days since July 2022.
