Reducing catheter-associated urinary tract infections with sterile, continuously closed drainage systems does not have to be costly

Abstract

Introduction

Catheter-associated urinary tract infections (CAUTIs) cause significant morbidity and financial strain in the pediatric intensive care unit (PICU). There is a significant incentive to reduce the rate of CAUTIs through multimodal quality improvement initiatives; however, these initiatives are often costly to implement.

Objective

This article examines the cost-savings associated with a novel “two-part, two-person” catheter insertion protocol implemented at a pediatric quaternary care center PICU which replaced costly pre-packaged, closed system urinary catheter kits with their individually packaged components, along with its impact on CAUTI rates and nursing satisfaction.

Study design

The “two-part, two-person” insertion protocol involved two nurses placing an appropriate size indwelling catheter using an individually packaged sterile insertion kit, urine meter bag, and Foley catheter. All patients with Foley catheters placed in the PICU between April 2021 and March 2022 were included in this study. Endpoints included the cost of each insertion, CAUTI rates per 1000 Foley days, and nursing satisfaction.

Results

The “two-part, two-person” insertion protocol resulted in a projected 12-month cost savings of $38 521 while CAUTI rates over this period (3.8 per 1000 Foley days) did not significantly deviate from the 6 months prior to program initiation (5.65 per 1000 Foley days, p = 0.06). This protocol garnered an approval rating of 87 % by PICU nurses.

Conclusions

Catheter expenditures can be reduced and quality standards can be maintained by eliminating costly pre-packaged, closed system urinary catheter kits in favor of their individual components. This protocol demonstrates an acceptable and sustainable intervention to improve value of care within the PICU.

Summary Table. Comparative cost savings between closed system catheter insertion protocol and “two-part, two-person” insertion protocols the 12-month study period.

Closed system	Number of patients	Cost per patient	Total
First attempt	171	$198.18	$33,888.78
2 attempts	28	$396.36	$11,098.08
3 attempts	10	$594.54	$5945.40
4 attempts	3	$792.72	$2378.16
Total 12-month cost of closed systems			$53,310.42
Open insertion system	Number of patients	Cost per patient	Total
First attempt	171	$68.33	$11,684.43
2 attempts	28	$73.66∗	$2062.48
3 attempts	10	$78.99∗	$789.90
4 attempts	3	$84.32∗	$252.96
Total 12-month cost for two-part, two-person insertion		$14,789.77

∗

Due to ability to keep urine meter bag, as only one urine meter bag was used in multiple open insertion attempts.