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Reduced post‐operative urinary tract infection using the National Surgical Quality Improvement Program
Author(s) -
Scanlon Kate,
Shakeshaft Anthony J.,
Cox Michael R.
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15293
Subject(s) - medicine , incidence (geometry) , odds ratio , confidence interval , quality management , urinary system , catheter , surgery , emergency medicine , management system , physics , management , optics , economics
Background The incidence of post‐operative urinary tract infection (UTI) is frequently unknown or underestimated. Failure to recognize a clinical problem results in no action occurring to improve outcomes. The aims of this study were firstly to define the incidence of post‐operative UTI in general surgery patients using the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP). Secondly to design and implement an intervention to reduce the incidence of post‐operative UTI and assess the extent of improvement. Methods ACS‐NSQIP data were collected and analysed from June 2015 to June 2016 and reported in the Semi Annual Report (SAR). A quality improvement programme was designed and implemented to manage the high incidence of UTI. The outcomes were assessed by the subsequent ACS‐NSQIP SAR. Results The SAR in 2016 reported that Nepean Hospital as a significant outlier with an incidence of post‐operative UTI of 3.62% (odds ratio 2.21, confidence limits 1.51–3.44, P < 0.001). A hospital‐wide policy for catheter insertion in surgical patients was developed including: education, workshops, accreditation for aseptic technique for catheter insertion, reduced rates of insertion, reduced duration of use and improved catheter care. There was a significant improvement in the incidence of UTI (1.21%) reported by the 2018 SAR (odds ratio 1.01, confidence limits 0.64–1.60, P = 0.68). Conclusions ACS‐NSQIP identified a 2.2‐fold increased risk of post‐operative UTI. There was no increased risk of UTI after the programme to reduce UTI was introduced.