title: Reducing catheter-associated urinary tract infections: a quality-improvement initiative.
abstract: BACKGROUND
  Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs.
  
  
  METHODS
  An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children's hospital over a 3-year period (June 2009 to June 2012).
  
  
  RESULTS
  Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: -1.28 to -0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement.
  
  
  CONCLUSIONS
  CAUTI is a common pediatric health care-associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children.
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia Pennsylvania; Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Katherine Finn
authors.initials: KF
authors.lastname: Davis
authors.affiliation: Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Colebaugh
authors.affiliation: Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Eithun
authors.affiliation: Division of Infectious Diseases.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Klieger
authors.affiliation: Department of Infection Prevention and Control and.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Meredith
authors.affiliation: Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Natalie
authors.initials: N
authors.lastname: Plachter
authors.affiliation: Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Division of Infectious Diseases, Department of Infection Prevention and Control and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Julia Shaklee
authors.initials: JS
authors.lastname: Sammons
authors.affiliation: Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Allison
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Division of Infectious Diseases, Department of Infection Prevention and Control and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania coffin@email.chop.edu.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D058996:Quality Improvement / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*
keywords: catheter-associated urinary tract infection; child; epidemiology; health care–associated infection; quality improvement