Hospital acquired urinary tract infections (UTIs) have a detrimental effect on patients, families and hospital resources. The Sydney Children's Hospital Network (SCHN) participates in the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) to monitor post operative complications. NSQIP-P data revealed that the median UTI rate at SCHN was 1.75% in 2019, 3.5 times higher than the NSQIP-P target rate of 0.5%. Over three quarters of the NSQIP-P identified UTI cases also had a urinary catheterization performed intra-operatively. A quality improvement project was conducted between mid-2018 to 2021 to minimise catheter associated UTIs (CAUTIs) at SCHN.
NSQIP-P samples pediatric (<18 years) surgical cases from an 8-day cycle operative log. NSQIP-P data is statistically analysed by the American College of Surgeons and provides biannual internationally benchmarked reports. The project utilized Clinical Redesign Methodology with a six-phase process for quality improvement projects. The project utilized Clinical Redesign Methodology with a six-phase process for quality improvement projects.
The objectives of the project were to reduce urinary catheter duration of use, educate parents/carers and improve catheter care and insertion technique by health staff. The duration of a urinary catheter in situ reduced from a median of 4.5 days to 3 days from 2017 to 2021. The median NSQIP-P UTI rate at SCHN was reduced by 47.4% from 1.75% in 2019 to 0.9% in 2022.
A multifactorial approach in quality improvement has been shown to be an effective strategy to reduce UTI rates at SCHN and patient outcomes were improved within a three-year time frame. Whilst this project has reduced UTI rates at SCHN, there remain opportunities for further improvement.
Journal of the American College of Surgeons. 2024 Feb 12 [Epub ahead of print]
Kyla A Clasie, Aniruddh V Deshpande, Andrew Ja Holland, Ashish V Jiwane, Vanessa G Da Silva, Fiona A Filtness, Margaret M Allen, Grahame Hh Smith
The Sydney Children's Hospital Network Department of Surgery, Sydney, New South Wales., Newcastle University, Newcastle, New South Wales., Children's Hospital at Westmead Department of Urology, Sydney, New South Wales., Sydney Children's Hospital Department of Surgery, Sydney, New South Wales., Children's Hospital at Westmead Department of Surgery, Sydney, New South Wales.