327 Catheter Related Urinary Tract Infections in a Pediatric Intensive Care Unit: Incidence Rates and Impact of a Quality Improvement Intervention to Decrease Foley Use

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Charles Monney, MS, CIC , Memorial Hermann Hospital, Houston, TX
Galit Holzmann-Pazgal, MD , University of Texas Medical School, Houston, TX
Nathaniel Strobel, MD , University of Texas Medical School, Houston, TX
Felix Tsai, MD , University of Texas Medical School, Houston, TX
Kathy Masters , Memorial Hermann Hospital, Houston, TX
Background: Urinary tract infections are the most common hospital acquired infection, with 80% associated with an indwelling foley catheter (FC).  Incidence data on catheter related UTI (CRUTI) in pediatric intensive care unit (PICU) patients demonstrates median rates of 3-5 per 1000 catheter days.  Established published guidelines for prevention of CRUTI recommend routine evaluation of catheter necessity and limiting use and duration.  Data on decreasing FC use in pediatric patients are lacking.
Objective:  Determine the incidence of CRUTI in a PICU and determine efficacy of a quality improvement initiative to decrease FC use and the impact of this intervention on CRUTI incidence.
Methods: Children’s Memorial Hermann Hospital (CMHH) is a 240 bed tertiary care pediatric hospital with a 20 bed PICU.  CRUTI surveillance was initiated in 11/2007.  CRUTI was defined using National Healthcare Safety Network definitions.  Rates were calculated per 1000 foley days.  In 2/2009, criteria for FC necessity were developed by infection control (IC) in conjunction with pediatric surgeons and intensivists following review of evidence based published guidelines.  Foley necessity criteria limited foley use to first 48 hours post cardiovascular (CV) surgery, urinary retention, renal failure,  syndrome of inappropriate antidiuretic hormone secretion or diabetes insipidus, patients requiring extra corporeal membrane oxygenation and trauma patients during first 24 hours of admission.  In 3/2009, IC began rounding with PICU and surgical attending physicians several times per week to review whether patients with FC met necessity criteria.  Removal of FC not meeting criteria was discussed.  Statistical analysis was performed using 2 sample t-test (Mini-Tab), p<.05 significant.
Results:  43 CRUTI occurred over the 22 month surveillance period.  Overall mean rate was 7.9 per 1000 foley days (43/5,446).  Foley device utilization rates (foley days per patient days) decreased from .49 (3988/8185) pre-implementation of FC necessity criteria (11/07-2/09) to .39 (1458/3723) post-implementation (3/09-9/09), p=.002.  32 CRUTI (mean=8.02 per 1000 foley days) occurred from 11/07-2/09 and 11 CRUTI (mean=7.54 per 1000 foley days) occurred from 3/09-9/09, p=.50.  The mean time to infection from foley insertion was 15.1 days from 11/07-2/09 and 17.8 days from 3/09-9/09, p=.74.  CV surgery patients accounted for 50% (16/32) of CAUTI pre-intervention and 18% (2/11) post, p=.07.
Conclusions: CRUTI occur frequently in PICU patients.  Establishing clear indications for FC use in this population along with routine assessment of ongoing FC necessity did significantly reduce foley utilization, however CRUTI rate did not significantly decrease.  Continuing evaluation of FC necessity and development of additional interventions to reduce CRUTI in this population is warranted.