Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit

Healthcare workers' compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen

BACKGROUND

Catheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter.

METHODS

An observational study using a descriptive cross-sectional design was conducted at Sana'a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study.

RESULTS

The majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education.

CONCLUSION

Yemeni healthcare workers' overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Evolution of Pediatric Critical Care Nursing

Pediatric critical care nursing is a key pillar in patient care and outcomes for children who are ill and injured. Tremendous advances have occurred in pediatric critical care and nursing. This article provides an overview of the key advances in pediatric critical care nursing through the decades.

Participatory Methods to Improve and Develop Pediatric Nursing Practice: A Scoping Review

Children's nurses in African pediatric settings are often responsible for leading practice improvements. There is a shortage of contextually relevant guidance to inform the design of practice improvement projects in African care settings. Distinctive features of children's nursing practice in Africa include high levels of family caregiver involvement, and organizational and professional cultures which value participation. While established practice improvement methods offer many strengths, methods developed in other geographies should not be adopted uncritically. Our purpose in undertaking this review was to inform selection of methods for a multi-center practice improvement project in Africa. Our aim was to identify types of participatory methods used to improve and develop pediatric nursing practice. We used the PRISMA-ScR method to conduct a scoping review to identify published reports of participatory methods used to improve and develop pediatric nursing practice. We undertook structured searches of five bibliographic databases to identify articles. Only articles written in the English language were included and no limitation was applied to publication date. We identified 7,406 titles and abstracts. After screening, 76 articles met the inclusion criteria. A wide range of participatory methodologies were identified; just under half (n = 34) reported on methods that were not recognized or named methodologies but can be described as collaborative in nature. Plan-do-study-act cycles were reported in 22 articles. There was considerable heterogeneity in frameworks, practical tools and/or nursing models on which the participatory methods were based and there was no apparent relationship between these and the choice of participatory methods. The outcomes identified were also heterogenous in nature and were grouped according to whether they improved structure and/or processes and patient outcomes. Most of the included articles stem from high-income countries with little evidence from low-middle-income countries and none in African settings. Less than half of the included articles involved family caregivers in their practice improvement methodologies. This review highlights the need for greater application of formalized methods for practice improvement and improved rigor and consistency in reporting outcomes. There is also a need to formalize participatory practice improvement methodologies specifically suited to Africa's context of children's nursing.

In vitro Antibacterial Activities of Selected Medicinal Plants Used by Traditional Healers for Treating Urinary Tract Infection in Haramaya District, Eastern Ethiopia

Background

Despite the presence of antibacterial agents for urinary tract infection treatment, most of the uropathogenic bacteria reveal multi-drug resistance. Health and economic loss due to these represent a rising burden worldwide which necessitates serious action at regional, national and global levels. Thus, alternative approaches to overcome this problem by using bioactive compounds from traditional medicinal plants are required. This study was designed to evaluate the in-vitro antibacterial activity of Punica granatum fruit peels, Nigella sativa seeds, and Echinops kebericho used in the traditional treatment of urinary tract infections.

Methods

An experimental study was employed to evaluate the in vitro antibacterial activity of methanol and ethanol crude extract of Punica granatum fruit peels, Nigella sativa seeds, and Echinops kebericho roots of six dilutions (25, 50, 100, 125, 250, and 500) mg/mL. Disc diffusion and macro broth dilution methods were used to determine antimicrobial activity test and minimum inhibitory concentration respectively against E. coli, P. aeruginosa, K. pneumoniae, P. mirabilis, and S. aureus bacterias.

Results

Antibacterial activities of ethanol and methanol crude extract of Punica granatum fruit peels against E. coli ATCC25922, P. aeruginosa ATCC27853, S. aureus ATCC25923, K. pneumoniae UK5099 and P. mirabilis UK5999 had highest inhibition zones among tested plants. All tested bacteria were highly sensitive to Punica granatum extract. The second most active plant extract in inhibiting the growth of tested bacteria was Nigella sativa while Echinops kebericho showed the smallest efficacy against tested bacteria. The inhibition zone diameter produced by the methanol extract of each screened plant had higher inhibition zones than ethanol extract.

Conclusion

The crude extracts of Punica granatum fruit peels, Nigella sativa seeds, and Echinops kebericho roots have promising antibacterial activity against tested uropathogenic bacteria.

Reducing External Ventricular Drain (EVD) Associated Ventriculitis: An improvement project in a Level 1 Trauma Center

BACKGROUND

External ventricular drain (EVD)-associated infections have a negative impact on healthcare cost and patient outcomes. Practice variation in EVD management may place patients at increased risk for EVD-associated infection. This project aimed to evaluate the impact of implementing an interprofessional evidence-based EVD bundle of care on reduction of EVD-related ventriculitis rates.

METHODS

An interprofessional team developed an evidence based EVD care bundle and order set to eliminate practice inconsistencies. Standardization of EVD equipment and optimization of the electronic health record occurred. Education and competency validation were completed with neurosurgical providers and nurses. Interprofessional rounds occur weekly for observation, recognition, and in-the-moment education.

RESULTS

A pre/post intervention design was used to show that the rate of EVD-associated ventriculitis decreased from 8.8 per reported EVD days in 2019 to 0 per reported EVD days in 2021 after implementation of the EVD care bundle.

CONCLUSION

Through an interprofessional team approach, reduction in EVD-associated infection rates is feasible with implementation of an evidence based EVD care bundle.

Prediction Model for Urinary Tract Infection in Pediatric Urological Surgery Patients

Background

Urinary tract infection (UTI) is a common complication in pediatric urological surgery patients and is associated with long-term sequelae, including subsequent recurrent infections and renal scarring. In this study, we aimed to explore the risk factors for UTI in pediatric urological surgery patients and construct a predictive model for UTI.

Materials and Methods

A total of 2,235 pediatric patients who underwent urological surgery at a tertiary hospital between February 2019 and January 2020 were included. A multivariate logistic regression model was applied to identify the predictive factors, and a predictive model was constructed using a receiver operating characteristic curve. A multifactorial predictive model was used to categorize the risk of UTI based on the weight of the evidence.

Results

A total of 341 patients with UTI were identified, which corresponded to a prevalence of 15.26% in pediatric urological surgery patients. Multivariate analysis identified six significant risk factors for UTI, including age <12.0 months, upper urinary tract disease, not using an indwelling drainage tube, hospital stay ≥10 days, administration of two or more types of antibiotics, and stent implantation. A combination of the aforementioned factors produced an area under the curve value of 88.37% for preventing UTI in pediatric urological surgery patients. A multifactorial predictive model was created based on the combination of these factors.

Conclusions

The constructed multifactorial model could predict UTI risk in pediatric urological surgery patients with a relatively high predictive value.

Improving Nurses’ Knowledge about Prevention of Catheter Acquired Urinary Tract Infections in Intensive Care Units

BACKGROUND: Lack of knowledge about causes and strategies to prevent catheter-acquired urinary tract infections (CAUTIs) requires an intervention that focuses on providing all evidence-based information to decrease the incidence of CAUTIs in admitted intensive care units (ICU) patients. Improving the nurses’ knowledge will eventually help in the reduction of CAUTIs. AIM: We aimed to investigate the improving nurses’ knowledge about prevention of catheter acquired urinary tract infections in intensive care units. METHODS: The present study is a h ealth system-operational research, pre-test–post-test design with a control arm study. The study was conducted in two ICU units in one of the University hospitals, Cairo, Egypt, involving a total sample of 42 nurses. Self-administered questionnaires were used to assess nurses’ knowledge about CAUTIs. The intervention was implemented through on job educational training sessions to nursing staff. Cochran Q was used to test the effect of the intervention on a satisfactory level of knowledge. RESULTS: Knowledge score improved from 61.4 ± 14.1 in pre-test to 90.5 in the early post-test (EP) test done after 1 week to 91.3 in late post-test ( LP) done after 1 month among nurses of the intervention ICU (p < 0.001). The percentage of nurses reporting a satisfactory level of knowledge significantly increased from 13.3% in the pre-test to 90% and 93.3% in follow-up (EP and LP, respectively) in the intervention ICU (p < 0.05) CONCLUSION: The implemented training and education strategy used were effectively improved ICU nurses’ knowledge concerning CAUTI.

Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care

BACKGROUND

Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models.

OBJECTIVES

We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs.

RESEARCH DESIGN

Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes.

MEASURES

The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay.

RESULTS

The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P<0.001). There were no differences in lengths of stay.

CONCLUSIONS

Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.