Implementation of a Clinical Protocol to Reduce Urinary Tract Infections Among Women With Urinary Retention After Pelvic Reconstructive Surgery: A Prospective Quality Improvement Study |
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| Affiliation: | 1. Fakultas Kedokteran, Universitas Airlangga, Surabaya, Indonesia/Indonésie;1. Division of Obstetrics and Gynecology, “Antoine Béclère” Hospital, Paris Saclay University Hospitals, APHP, Paris, France;2. Division of Virology, “Paul Brousse” Hospital, Paris Saclay University Hospitals, APHP, Paris, France;3. Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George''s University Hospitals NHS Foundation Trust, London, United Kingdom;4. Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Belgium;5. Division of Neonatology, Department of Translational Medical Sciences, “Federico II” University, Naples, Italy;6. Division of Virology, Department of Translational Medical Sciences, “Federico II” University, Naples, Italy;7. Division of Microbiology, “Louis Mourier” Hospital, Paris Saclay University Hospitals, APHP, Paris, France;8. Division of Obstetrics and Gynecology, “Louis Mourier” Hospital, Paris Saclay University Hospitals, APHP, Paris, France;9. Division of Pediatrics and Neonatal Critical Care, “A.Béclère” Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France;10. Division of Microbiology, “Antoine Béclère” Hospital, Paris Saclay University Hospitals, APHP, Paris, France;11. Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy |
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| Abstract: | ObjectiveWe implemented and assessed a clinical practice quality improvement protocol aimed at decreasing postoperative urinary tract infections (UTIs) among patients with transurethral catheters.MethodsThis was a quality improvement study with pre- and post-intervention comparisons. Patients requiring postoperative transurethral catheters underwent 3 interventions: (1) shortening the time from surgery to repeat voiding trials to 3–5 days for pelvic reconstructive surgeries and to 1–3 days for mid-urethral slings, (2) avoiding routine urine cultures at the time of voiding trials, and (3) recommending 2 L of water intake daily until 3 days after the voiding trial. The primary outcome was the percentage of patients receiving antibiotics for UTIs within 6 weeks. Secondary outcomes included rates of failing office voiding trials, UTI symptoms/cultures, adherence to hydration, and health care resource utilization.ResultsWe included 31 patients before and 40 patients after the intervention. The 2 cohorts had similar demographic and clinical characteristics. Among patients requiring catheterization, rates of antibiotic treatment for UTIs decreased from 65% to 40% after the intervention (P = 0.04). UTI symptoms and urine cultures sent for analysis decreased significantly (P = 0.04 and P = 0.005, respectively). There was high adherence (84%) to increased hydration. Rates of failing office voiding trials remained similar. The number of phone calls decreased by 43% (P = 0.003), and there was no increase in office or emergency department visits. Multivariate regression showed that UTIs were 2.04 times more likely before than after the intervention.ConclusionOur quality improvement intervention was practical to implement and effective in reducing postoperative UTIs among patients with urinary catheters. |
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| Keywords: | clinical practice intervention postoperative urinary catheters quality improvement protocol urinary tract infection |
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