Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Pediatr Crit Care Med. 2020 Sep;21(9):e819-e826. doi: 10.1097/PCC.0000000000002469.
To eliminate catheter-associated urinary tract infections in a pediatric cardiac ICU.
Quality improvement methodology.
Twenty-five bed cardiac ICU in a quaternary freestanding children's hospital.
All patients with an indwelling urinary catheter admitted to the cardiac ICU.
Catheter-associated urinary tract infection was defined according to National Healthcare Safety Network criteria. Failure modes and effects analysis and Pareto charts were used to determine etiology of process failures. We implemented a team-based multi-interventional approach in 2012 using the Model for Improvement, which included as follows: 1) establish indications for inserting and/or maintaining bladder catheterization, 2) standardization of maintenance care for the indwelling urinary catheters, 3) protocol for management of the leaking urinary catheters, 4) incorporation of urinary catheter days and prompts for removal in daily rounds, and 5) review of all cases of prolonged indwelling urinary catheter use (> 3 d). Process control charts were used to evaluate change.
From 2011 to 2018, we showed an early and sustained improvement in catheter-associated urinary tract infection prevention standards compliance from 44% to 96% (52% improvement). These interventions showed a reduction and then elimination of catheter-associated urinary tract infections from January 2012 to the present day, despite fluctuations in total indwelling urinary catheter days.
Utilization of quality improvement methodology allowed us to identify components of care that contributed to catheter-associated urinary tract infections. After addressing these issues, we noted a substantial reduction and then elimination of catheter-associated urinary tract infections in our pediatric cardiac ICU. Widely disseminating these interventions across multiple pediatric hospitals to determine the ability to achieve similar results are important next steps.
消除小儿心脏重症监护病房（PICU）中的导管相关尿路感染。
质量改进方法。
一家四级儿童医院的 25 张床位的心脏重症监护病房。
所有留置导尿管的小儿心脏 ICU 患者。
根据国家医疗保健安全网络（National Healthcare Safety Network）的标准，将导管相关尿路感染定义为。采用失效模式和效果分析以及帕累托图来确定流程故障的原因。我们在 2012 年使用改进模型（Model for Improvement）实施了基于团队的多干预方法，其中包括以下内容：1）确定插入和/或维持膀胱导尿的适应证，2）标准化留置导尿管的维护护理，3）处理漏尿导尿管的方案，4）将导尿管天数和拔除提示纳入日常查房，5）审查所有留置导尿管时间延长（>3d）的病例。使用过程控制图来评估变化。
从 2011 年到 2018 年，我们显示出导管相关尿路感染预防标准的依从性从 44%提高到 96%（提高了 52%）。尽管留置导尿管天数波动，但这些干预措施显示出导管相关尿路感染的减少，随后消除。
利用质量改进方法，我们能够确定导致导管相关尿路感染的护理环节。在解决这些问题后，我们注意到我们的小儿心脏重症监护病房中的导管相关尿路感染明显减少，随后消除。在多个儿科医院广泛推广这些干预措施，以确定实现类似结果的能力，是下一步的重要步骤。
