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

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

doi:10.1097/XCS.0000000000001037

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

J Am Coll Surg. 2024 Feb 12. doi: 10.1097/XCS.0000000000001037. Online ahead of print.

Authors

Kyla A Clasie¹, Aniruddh V Deshpande^{2

3

4

5}, Andrew Ja Holland^{3

4

5}, Ashish V Jiwane⁶, Vanessa G Da Silva¹, Fiona A Filtness⁴, Margaret M Allen¹, Grahame Hh Smith^{3

4

5}

Affiliations

¹ The Sydney Children's Hospital Network Department of Surgery, Sydney, New South Wales.
² Newcastle University, Newcastle, New South Wales.
³ Children's Hospital at Westmead Department of Urology, Sydney, New South Wales.
⁴ Children's Hospital at Westmead Department of Surgery, Sydney, New South Wales.
⁵ University of Sydney, Sydney, New South Wales.
⁶ Sydney Children's Hospital Department of Surgery, Sydney, New South Wales.

PMID: 38345219
DOI: 10.1097/XCS.0000000000001037

Abstract

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 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.

Study design: 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.

Results: 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.

Conclusion: 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.