Abstract
Objective
We implemented and assessed a clinical practice quality improvement protocol aimed
at decreasing postoperative urinary tract infections (UTIs) among patients with transurethral
catheters.
Methods
This 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.
Results
We 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.
Conclusion
Our quality improvement intervention was practical to implement and effective in reducing
postoperative UTIs among patients with urinary catheters.
Résumé
Objectif
Nous avons mis en œuvre puis évalué un protocole d’amélioration de la qualité de la
pratique clinique visant à réduire les infections urinaires postopératoires chez les
patientes sondées par voie transurétrale.
Méthodologie
Il s’agit d’une étude sur l’amélioration de la qualité comportant des comparaisons
avant et après l’intervention. Les patientes ayant eu besoin d’une sonde urinaire
postopératoire ont été soumises à trois mesures d’intervention: 1) raccourcir le délai
entre la chirurgie et le sevrage de sonde à 3 à 5 jours pour les chirurgies de reconstruction
pelvienne et à 1 à 3 jours pour les bandelettes mi-urétrales; 2) éviter les urocultures
de routine au moment du sevrage; 3) recommander la consommation de 2 litres d’eau
par jour jusqu’à 3 jours après la tentative de sevrage. Le critère de jugement principal
était le pourcentage de patientes ayant reçu des antibiotiques pour des infections
urinaires dans les 6 semaines. Les critères de jugement secondaires étaient les taux
d’échec du sevrage de sonde en cabinet, les urocultures et symptômes d’infection urinaire,
l’observance de l’hydratation et l’utilisation des ressources du système de santé.
Résultats
Nous avons inclus 31 patientes avant l’intervention et 40 patientes après l’intervention.
Les 2 cohortes présentaient des caractéristiques démographiques et cliniques similaires.
Chez les patientes sondées, le taux d’antibiothérapie pour traiter une infection urinaire
a diminué de 65% –40% après l’intervention (P = 0,04). Les symptômes d’infection urinaire et les résultats positifs des urocultures
envoyées aux fins d’analyse ont diminué de façon significative (P = 0,04 et P = 0,005, respectivement). Le taux d’observance de l’hydratation était élevé (84%).
Le taux d’échec du sevrage de sonde en cabinet est resté semblable. Le nombre d’appels
téléphoniques a diminué de 43% (P = 0,003) et il n’y a eu aucune augmentation des consultations en cabinet ou des visites
à l’urgence. Une régression multivariée a montré que les infections urinaires étaient
2.04 fois plus probables avant l’intervention qu’après l’intervention.
Conclusion
Notre intervention d’amélioration de la qualité était pratique et simple à mettre
en œuvre et elle s’est avérée efficace en ce qui concerne la réduction des infections
urinaires postopératoires chez les patientes ayant une sonde urinaire.
Keywords
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Article info
Publication history
Published online: December 21, 2022
Accepted:
November 30,
2022
Received:
September 12,
2022
Footnotes
Disclosures: The authors declare they have nothing to disclose.
Each author has indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
