MP31-19: Reducing catheter associated-urinary tract infections with sterile, continuously closed drainage systems does not have to be costly

Janelle Fox*, Suffolk, VA, Christina Jockel, Leslie Konyk, Shaina Thomas, Omar Ayyash, Rajeev Chaudhry, Glenn Cannon, Francis Schneck, Daniel Pelzman, Lindsay Montoya, Pittsburgh, PA

Introduction: Urinary tract infections (UTIs) are the fifth most common hospital-acquired infection.  Each foley day increases the risk of UTI by 3-7%, hence the National Healthcare Safety Network (NHSN) has provided hospitals with a means of tracking catheter associated-urinary tract infections (CA-UTIs) and toolkits to help reduce their frequency.  One means by which CA-UTIs are reduced is through use of sterile, continuously closed drainage systems. To do so, many hospitals have switched to use of pre-packaged and sealed systems which are more costly.  An alternative was proposed in the UPMC Children’s Hospital of Pittsburgh (CHP) Pediatric Intensive Care Unit (PICU) whereby two nurses perform every foley placement to ensure sterile technique. They use a separate foley catheter, sterile insertion kit and urine meter bag which are then treated as a functionally closed system.

Methods: During the 7-month period of April – October 2021, the CHP PICU instituted the two-part, two-person foley insertion protocol and tracked both CA-UTI rates and cost savings compared with the 7-month period using a pre-packaged catheter kit.  Closed-system catheter kits cost CHP $198.18 per unit.   Two-part, two-person foley insertions cost CHP $68.33 per insertion, with each repeat attempt adding $5.33.

Results: A total of 215 patients had indwelling urinary catheters during the study period.  Of these, 124 were placed in the PICU and 91 by other services (OR, IR, outside hospitals, Urology).  Of the 124 PICU catheterizations, first attempts were successful in 101 patients with 17 second attempts, 5 third attempts and 1 fourth attempt.  Costs of using the closed-system catheter kit based on these numbers of attempts would be $30,519.  Costs of using a two-part, two-person protocol which remained closed after insertion were $8821.82, translating into a cost savings of $21,679.18 over 7 months or $37,164.30 over 1 year. Among 15 nurses who provided feedback on the new two-person, two-part protocol, 13 of the 15 (87%) preferred this method.  There was no statistically significant increase in CA-UTIs after the new protocol was adopted, with CA-UTI rates remaining at 0 throughout the study period.

Conclusions: Switching from pre-packaged closed system catheter kits to a two-part, two-person protocol for foley insertions translates into significant annual cost savings for pediatric acute care facilities, without an increase in CA-UTIs.

Source of Funding: None