title: Presence of a Physician Safety Champion Is Associated with a Reduction in Urinary Catheter Utilization in the Pediatric Intensive Care Unit.
abstract: BACKGROUND
  Safety champions are effective in a variety of safety initiatives; however, there are no reports of their role in hospital-acquired infections prevention.
  
  
  OBJECTIVE
  We aimed to describe the association of the presence of a physician safety champion with our urinary catheter device utilization ratios (DUR) in the Pediatric Intensive Care Unit (PICU).
  
  
  METHODS
  Our PICU has incidence rates of catheter-associated urinary tract infections (CAUTI) and urinary catheter DUR above the 90th percentile. Using a quasi-experimental design, we compared our DUR when the PICU team was exposed and unexposed (champion's maternity leaves) to a physician safety champion. Hospital acquired infection (HAI) surveillance of all PICU admissions between April 1st 2009 and June 29th 2013 was done prospectively. To ensure stable acuity of the patient population over time, we used the central venous catheter (CVC) DUR as a control.
  
  
  RESULTS
  The urinary catheter DUR was 0.44 (95% confidence interval [CI] 0.42-0.45) during the unexposed period versus 0.39 (95%CI 0.38-0.40) during the exposed period, for an absolute difference of 0.05 (95%CI 0.03-0.06; p<0.0001). The overall CVC DUR increased from 0.57 (95%CI 0.55-0.58) during the unexposed period to 0.63 (95%CI 0.61-0.64) during the exposed period, an absolute increase of 0.06 (95%CI 0.04-0.08; p<0.0001). Comparing the exposed and unexposed periods, adjusting for time trend, we observed a 17% decrease in the urinary catheter DUR when the safety champion was present (odds ratio [OR] 0.83; 95%CI 0.77-0.90). The rate of catheter-associated urinary tract infections did not change.
  
  
  CONCLUSIONS
  The presence of a unit-based safety champion can have a positive impact on urinary catheter DUR in a PICU.
authors.affiliation: Division of Critical Care, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Samara
authors.initials: S
authors.lastname: Zavalkoff
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Korah
authors.affiliation: Infection Control, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.|Division of Infectious Diseases, Department of Pediatrics, McGill University, Montreal, QC, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Quach
mesh_terms: D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D002648:Child; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D062665:Epidemiological Monitoring; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals; D006801:Humans; D015278:Intensive Care Units, Pediatric; D061214:Patient Safety / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D062885:Urinary Catheters / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control