Introduction

This quality standard covers the care of infants, children and young people under 16 years with a first or recurrent upper or lower urinary tract infection and without known underlying uropathy. For more information see the topic overview.

Why this quality standard is needed

Urinary tract infection is a common bacterial infection in infants, children and young people. A urinary tract infection is defined by a combination of clinical features and the presence of bacteria in the urine. Around 1 in 10 girls and 1 in 30 boys will have had a urinary tract infection by the age of 16 years.

Making the diagnosis can be difficult because the presenting symptoms or signs (fever, irritability and vomiting) are non-specific and are commonly seen in many childhood viral illnesses, particularly in younger children. A severe infection can make a child extremely unwell and sometimes have serious consequences; even minor infections can be distressing. Repeated episodes of acute urinary tract infection are distressing to infants, children and young people, and their parents or carers.

Although most infants, children and young people recover promptly from a urinary tract infection and have no long-term complications, there is a small subgroup at risk of significant morbidity.

Prompt and accurate diagnosis of urinary tract infection is essential, and it is important to recognise and treat recurrent infection.

How this quality standard supports delivery of outcome frameworks

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcomes framework published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2013 to 2014

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

ii Children and young people

Improvement areas

Reducing deaths in babies and young children

1.6 i Infant mortality*

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

i GP services

ii GP Out of hours services

4b Patient experience of hospital care

Improvement areas

Improving children and young people's experience of healthcare

4.8 An indicator is under development

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF).

Table 2 Public health outcomes framework for England, 2013 to 2016

Domain

Objectives and indicator

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicator

4.1 Infant mortality*

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework

Coordinated services

The quality standard for urinary tract infection in infants, children and young people under 16 specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole urinary tract infection care pathway for this population. A person-centred, integrated approach to provision of services is fundamental to delivering high-quality care to infants, children and young people with a urinary tract infection.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality service for infants, children and young people with a urinary tract infection are listed in related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare practitioners involved in assessing, caring for and treating infants, children and young people with a urinary tract infection should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.