1093

Abstract

Introduction: Catheter associated urinary tract infections (CAUTI) are the second most common cause of healthcare associated infections (HAI), with a daily risk ranging from 3 to 7%. In May 2012, surveillance in our Pediatric Intensive Care Unit (PICU) identified CAUTI rates and urinary catheter utilization (UCU) above 75th percentile for those in National Healthcare Safety Network (NHSN). The purpose of this quality improvement (QI) project was to reduce CAUTI and UCU. Methods: In July 2012, a multidisciplinary QI team introduced two evidence-based interventions in a staged fashion: 1) daily UC needs assessment and 2) hourly documentation of an indication of UC by a bedside nurse in electronic medical record by selecting an option from a drop down menu. Standard NHSN reporting definitions were used to define CAUTI, UCU ratio (UC days/patient days) and CAUTI rates per 1000 UC days. Rates of CAUTI pre (July 2011 to June 2012) and post (July 2012 to June 2013) intervention were compared using the generalized estimating equation Poisson regression analysis. Duration of UC per patient (n=26) and compliance with documentation of indication for UC (88 UC days) were audited post intervention for a 2-month period. Results: Six CAUTIs occurred during the study period (5/842 UC days pre and 1/439 UC days post intervention). Implementation of the interventions reduced CAUTI rates from a mean of 5.94 (CI:2.8-12.6) to 2.28 (CI:0.4-14)(p=0.26). UCU ratio reduced significantly (p<0.0001) from 0.31 (CI:0.25-0.37) to 0.15 (CI:0.13-0.16). Eighty five percent patients had UC for ≤4 days. Compliance with documentation of indication for UC was 100%. 'Measurement of accurate urine output' was selected as an indication for 95% of UC days, suggesting need for more education on documentation. Conclusions: HAIs are a continual challenge to quality care. Evidence is growing that HAI's are avoidable through the use of best practices. Implementation of bundled interventions significantly reduced UCU. CAUTI rates reduced below reported 2011 NHSN mean (3.1) but did not meet statistical significance likely due to the small number of CAUTIs per 1000 UC days. Longer time frame is likely needed to prove statistical reduction in CAUTI rates.