Reduction of Urinary Tract Infection in Pediatric Surgical Patients Using NSQIP-P and Quality Improvement Methodology.

Autor:	Clasie KA; From the Department of Surgery, Sydney Children's Hospital Network, Sydney, New South Wales, Australia (Clasie)., Deshpande AV; School of Medicine and Public Health, Newcastle University, Newcastle, New South Wales, Australia (Deshpande).; Departments of Urology (Deshpande, Holland, Smith), Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Surgery (Deshpande, Holland, Filtness, Smith), Children's Hospital at Westmead, Sydney, New South Wales, Australia.; The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics and Child Health, Sydney Medical School, Faculty of Health, The University of Sydney, Sydney, New South Wales, Australia (Deshpande, Holland, Smith)., Holland AJ; Departments of Urology (Deshpande, Holland, Smith), Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Surgery (Deshpande, Holland, Filtness, Smith), Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Department of Paediatric Surgery (Holland).; The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics and Child Health, Sydney Medical School, Faculty of Health, The University of Sydney, Sydney, New South Wales, Australia (Deshpande, Holland, Smith)., Jiwane AV; Department of Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia (Jiwane, Da Silva, Allen)., Da Silva VG; Department of Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia (Jiwane, Da Silva, Allen)., Filtness FA; Surgery (Deshpande, Holland, Filtness, Smith), Children's Hospital at Westmead, Sydney, New South Wales, Australia., Allen MM; Department of Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia (Jiwane, Da Silva, Allen)., Smith GH; Departments of Urology (Deshpande, Holland, Smith), Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Surgery (Deshpande, Holland, Filtness, Smith), Children's Hospital at Westmead, Sydney, New South Wales, Australia.; The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics and Child Health, Sydney Medical School, Faculty of Health, The University of Sydney, Sydney, New South Wales, Australia (Deshpande, Holland, Smith).
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2024 Jun 01; Vol. 238 (6), pp. 1057-1066. Date of Electronic Publication: 2024 Feb 12.
DOI:	10.1097/XCS.0000000000001037
Abstrakt:	Background: 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 NSQIP-Pediatric (NSQIP-P) to monitor postoperative 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 patients with UTI also had a urinary catheterization performed intraoperatively. A quality improvement project was conducted between mid-2018 and 2021 to minimize catheter-associated UTIs (CAUTIs) at SCHN. Study Design: NSQIP-P samples include pediatric (younger than 18 years) surgical patients from an 8-day cycle operative log. NSQIP-P data are statistically analyzed by the American College of Surgeons and provide biannual internationally benchmarked reports. The project used clinical redesign methodology with a 6-phase process for quality improvement projects. Results: The objectives of the project were to reduce urinary catheter duration of use, educate parents or 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 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. Conclusions: 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 3-year timeframe. Although this project has reduced UTI rates at SCHN, there remain opportunities for further improvement. (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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