Atlanta Children’s Hospital Achieves Zero CAUTIs in PICU with Innovative “No Diaper Zone” Strategy
A targeted initiative at Children’s Healthcare of Atlanta has eliminated catheter-associated urinary tract infections (CAUTIs) in its pediatric intensive care unit (PICU) for over a year, addressing persistent prevention challenges with strategies specifically designed for children.
CAUTIs remain one of the most common healthcare-associated infections among both adult and pediatric patients, leading to more extended hospital stays, higher costs, and increased patient risk. While national prevention guidelines exist, they are largely based on adult data, leaving a gap in pediatric-specific approaches.
A study published in Critical Care Nurse details how an interprofessional task force in the hospital’s 56-bed PICU rethought its prevention efforts, integrating new protocols alongside established best practices.
From Persistent Infections to Sustained Zero Rate
Before the initiative began in 2020, the PICU’s CAUTI rate was 3.13 per 1,000 catheter days, with an average of 92 days between events. One year after implementation, the rate dropped 22% to 2.44 per 1,000 catheter days, extending the average time between events to 129 days. By 2023, the team had achieved a rate of zero per 1,000 catheter days, maintaining 527 consecutive event-free days since July 2022.
The “No Diaper Zone”
One of the most impactful changes was the introduction of the No Diaper Zone.
“Our No Diaper Zone intervention tackled an aspect of CAUTI prevention not commonly discussed in existing guidelines,” said co-author Kathryn Cabral, BSN, RN, CCRN, critical care nurse and clinical patient safety coordinator at Children’s Healthcare of Atlanta. “With limited direct evidence available, we focused on addressing plausible pathways for urinary catheters to become contaminated with stool or urinary backflow.”
Through case reviews, the team identified a recurring pattern of liquid stool among CAUTI patients, suggesting possible contamination of catheters. As a solution, diapers were removed for all PICU patients with indwelling urinary catheters. Highly absorbent pads replaced diapers, and nurses checked for stool every two hours during vital signs and position changes, allowing prompt cleaning and reducing exposure risks.
Enhanced Urine Output Monitoring
For patients with urinary catheters in place for longer than 72 hours—a known risk factor for CAUTI—the PICU replaced traditional gravity-dependent collection bags with an advanced system from Accuryn. This setup utilizes gentle suction, features three one-way valves to prevent reflux, and incorporates integrated sensors for accurate hourly urine output, which is displayed digitally. Following a successful trial, the system expanded to the cardiac ICU and operating room.
Staff and Parent Education
Prevention efforts also focused on education.
- Staff received training during weekly bedside infection prevention rounds and new-hire orientation, with hands-on demonstrations of proper technique.
- Parents were informed about the rationale for the No Diaper Zone and their role in reducing contamination risk.
By combining evidence-based practices with pediatric-focused innovations, the PICU team demonstrated that zero CAUTIs is an achievable and sustainable goal.
The full study, “Entering a No Diaper Zone: Rethinking Prevention of Catheter-Associated Urinary Tract Infection,” is available in Critical Care Nurse, the American Association of Critical-Care Nurses’ bimonthly clinical practice journal.
Renée Hewitt is a seasoned writer, editor, and content strategist with a 25-year background in PR, marketing, and storytelling. As Editor-in-Chief of Daily Nurse, she curates impactful content that informs, inspires, and advocates for the nursing profession. Her work spans healthcare, wellness, lifestyle, and thought leadership—always with an eye for engaging narratives that connect with audiences.
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