Owen Rachel M, Perez Sebastian D, Bornstein William A, Sweeney John F
Division of General and Gastrointestinal Surgery.
Arch Surg. 2012 Oct;147(10):946-53. doi: 10.1001/archsurg.2012.1485.
The Surgical Care Improvement Project (SCIP) Inf-9 guideline promotes removal of indwelling urinary catheters (IUCs) within 48 hours of surgery.
To determine whether a correlation exists between SCIP Inf-9 compliance and postoperative urinary tract infection (UTI) rates and whether an association exists between UTI rates and SCIP Inf-9 exemption status. DESIGN Retrospective case control study.
Southeastern academic medical center.
American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and SCIP Inf-9 compliance data were collected prospectively on randomly selected general and vascular surgery inpatients. Monthly UTI rates and SCIP Inf-9 compliance scores were tested for correlation. Complete NSQIP data for all the inpatients with postoperative UTIs were compared with a group of 100 random controls to determine whether an association exists between UTI rates and SCIP Inf-9 exemption status.
Postoperative UTI.
In 2459 patients reviewed, SCIP Inf-9 compliance increased over time, but this was not correlated with improved monthly UTI rates. Sixty-one of the 69 UTIs (88.4%) were compliant with SCIP Inf-9; however, 49 (71.0%) of these were considered exempt from the guideline and, therefore, the IUC was not removed within 48 hours of surgery. Retrospective review of 100 random controls showed a similar compliance rate (84.0%, P = .43) but a lower rate of exemption (23.5%, P < .001). The odds of developing a postoperative UTI were 8 times higher in patients deemed exempt from SCIP Inf-9 (odds ratio [OR], 7.99; 95% CI, 3.85-16.61). After controlling for differences between the 2 groups, the adjusted ORs slightly increased (OR, 8.34; 95% CI, 3.70-18.76).
Most UTIs occurred in patients deemed exempt from SCIP Inf-9. Although compliance rates remain high, practices are not actually improving. Surgical Care Improvement Project Inf-9 guidelines should be modified with fewer exemptions to facilitate earlier removal of IUCs.
外科护理改进项目（SCIP）Inf-9指南提倡在手术48小时内拔除留置导尿管（IUC）。
确定SCIP Inf-9合规情况与术后尿路感染（UTI）发生率之间是否存在相关性，以及UTI发生率与SCIP Inf-9豁免状态之间是否存在关联。设计：回顾性病例对照研究。
东南部学术医疗中心。
前瞻性收集美国外科医师学会国家外科质量改进计划（NSQIP）和SCIP Inf-9合规数据，对象为随机选取的普通外科和血管外科住院患者。对每月UTI发生率和SCIP Inf-9合规评分进行相关性检测。将所有术后发生UTI的住院患者的完整NSQIP数据与一组100名随机对照患者进行比较，以确定UTI发生率与SCIP Inf-9豁免状态之间是否存在关联。
术后UTI。
在纳入研究的2459例患者中，SCIP Inf-9合规情况随时间推移有所改善，但这与每月UTI发生率的改善并无相关性。69例UTI中有61例（88.4%）符合SCIP Inf-9；然而，其中49例（71.0%）被认为可豁免该指南，因此IUC未在手术48小时内拔除。对100名随机对照患者进行回顾性分析显示，其合规率相似（84.0%，P = 0.43），但豁免率较低（23.5%，P < 0.001）。被认定可豁免SCIP Inf-9的患者发生术后UTI的几率高出8倍（优势比[OR]，7.99；95%可信区间[CI]，3.85 - 16.61）。在控制两组间差异后，调整后的OR值略有增加（OR，8.34；95% CI，3.70 - 18.76）。
大多数UTI发生在被认定可豁免SCIP Inf-9的患者中。尽管合规率仍然很高，但实际做法并未得到改善。应修改外科护理改进项目Inf-9指南，减少豁免情况，以便更早拔除IUC。
