A recent quality improvement study led by collaborators at UPMC Children’s Hospital of Pittsburgh and Eastern Virginia Medical School evaluated a cost-conscious approach to reducing catheter-associated urinary tract infections (CAUTIs) in the pediatric intensive care unit (PICU). The article, “Reducing Catheter-Associated Urinary Tract Infections with Sterile, Continuously Closed Drainage Systems Does Not Have to Be Costly,” was published online ahead of print in the Journal of Pediatric Urology.
Contributing to the study from UPMC Children’s Division of Pediatric Urology were division chief, Glenn M. Cannon, MD, Leslie Konyk, MSN, RN; Shaina Thomas, MSN, RN; Christina Jockel, BSN, RN; and Lindsay Montoya, BSN, RN. Janelle Fox, MD — formerly a fellow and faculty member at UPMC Children’s — was senior author on the study.
Context and Implementation Strategy
Catheter-associated urinary tract infections remain a significant source of morbidity and cost in pediatric critical care. While many institutions have implemented bundled interventions to reduce CAUTI rates, such efforts are often resource-intensive and may rely on expensive pre-packaged catheterization kits.
In response, the PICU at UPMC Children’s implemented a “two-part, two-person” sterile insertion protocol using individually packaged catheter components instead of commercial closed-system kits. The protocol required two nurses to collaboratively place the catheter using a sterile insertion kit, urine meter bag, and Foley catheter assembled on-site.
Key Findings
Across a 12-month implementation period (April 2021–March 2022), the protocol generated a projected annual cost savings of $38,521. CAUTI rates declined from 5.65 to 3.8 per 1,000 Foley days during the intervention window, though this reduction did not reach statistical significance. Importantly, the new protocol was well received by PICU nursing staff, with an 87% approval rating.
Clinical Takeaways
This study highlights that cost reduction in the PICU can be achieved without sacrificing infection control standards. By switching to individually packaged components and engaging nursing staff through a structured protocol, the team maintained stable CAUTI rates while improving financial efficiency. The positive reception among nurses supports this model as a potentially sustainable, and value-based approach to care that may be adaptable to other critical care settings
Study Reference
Fachko TD, Robey CL, Cannon GM, Konyk L, Thomas S, Jockel C, Montoya L, Fox JA. Reducing catheter-associated urinary tract infections with sterile, continuously closed drainage systems does not have to be costly. J Pediatr Urol. 2025 Jan 6: S1477-5131(24)00688. Online ahead of print.
