Reduced post-operative urinary tract infection using the National Surgical Quality Improvement Program.

Abstract

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. 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. 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). 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.