Developing an educational resource for parents on pediatric catheter-associated urinary tract infection (CAUTI) prevention

Abstract

Background: Pediatric catheter-associated urinary tract infection (CAUTI) prevention guidelines encourage family engagement; however, there is a dearth of research on parent-facing CAUTI prevention resources. We aimed to meet the learning needs of parents about CAUTI prevention in the hospital by developing and refining an educational pamphlet with parents.

Methods: Phase 1: We compiled existing evidence from CAUTI prevention guidelines and conducted a focus group with parents to form learning objectives. Phase 2: We developed prototype design elements, tested initial designs with a survey, and conducted qualitative participatory design sessions with parents to iteratively refine the pamphlet until design saturation was reached.

Results: We identified the following key themes and preferences: (1) Clear boundaries for engagement (e.g., parents would not be emptying the catheter); (2) Positive, actionable framing (e.g., what should proper catheter positioning look like?); (3) What to expect (e.g., is the catheter painful for my child?); (4) Parents considered both their and their child's comprehension of the content when providing feedback.

Conclusions: Overall, we demonstrated the utility of remote participatory design methods in developing and refining a CAUTI prevention resource based on parents' preferences. Future research should consider adapting these methods and implementing formal evaluation for comprehension for eventual integration into clinical practice.

Keywords: Catheter-associated urinary tract infections; Healthcare-associated infections; Infection prevention; Patient and family engagement; Patient safety; Pediatric.

Figure 1

Rendering of the Cover Image of the Final Pamphlet

Figure 2. Annotated Rendering of the Inner Spread of the Final Pamphlet

A- This page is an introduction to the basic structure and functioning of a urinary catheter, along with a visual representation of what the urinary catheter looks like both inside and outside the body; A1 & A2 – Labels placed to show parts of the catheter with clarification that the healthcare staff will empty the bag; B – What to Expect section added to describe the subjective experience of the child and provide additional boundaries for what parents can interact with; C– Prompt to communicate with healthcare team if parents have more specific questions about their child’s urinary catheter.

Figure 3. Annotated Rendering of the Main Spread of the Final Pamphlet

D – Section introducing the risk of CAUTI with use of a urinary catheter; D1 – Image depicting bladder infection with redness, pain lines, and arrow; E – Introduction to the subsequent sections of the pamphlet, with 3 actionable components in which parents can be involved; F – Notification for parents to check in with healthcare team about the necessity of the catheter because risk of CAUTI increases with additional catheter days; G – Hand hygiene section 1 (of 3) – describes the significance of handwashing and highlights commonly missed areas of the hand to emphasize thorough hand hygiene procedures; H – Hand hygiene section 2 – describes general directions to wash and dry hands; I – Hand hygiene section 3 – describes optimal procedure for using hand sanitizer effectively; J – Hand hygiene call-out – prompt for parents to advocate for their child by encouraging anyone in contact with their child to wash their hands; K – Summary of what proper catheter positioning should look like, with visual indicators and descriptive sentences that include steps on how to maintain proper positioning.

Figure 4. Annotated Rendering of the Back Cover of the Final Pamphlet

L – Back cover: Causes of concern and reasons to notify your healthcare team; M – Depiction of physical symptoms that may indicate signs of infection; N – Skin irritation depicted to demonstrate the catheter tubing pulling on the skin, or irritation caused by the tape; O – Changes in the catheter bag depicted with two scenarios that parents can observe; P – Call to action for parents to communicate with the healthcare team to identify what ‘normal’ values to look for in their child’s specific scenario.