Reducing urinary tract infections in colon and rectal surgery.

BACKGROUND

Urinary tract infection is associated with increased morbidity, mortality, and healthcare costs. Colon and rectal surgery has been shown to be an independent risk factor for urinary tract infection. Decreased length of the indwelling urinary catheter may play a role in decreasing the rate of urinary tract infection.

OBJECTIVE

The aim of this study was to investigate the effect of standardized indwelling urinary catheter management on urinary tract infection.

DESIGN

This was a prospective cohort study.

SETTINGS

This study was conducted in an urban academic tertiary care center.

PATIENTS

All of the patients were undergoing colon or rectal resection from 2010 to 2012 at a single National Surgical Quality Improvement Program participating institution.

INTERVENTIONS

Intervention 1 (group 1) included implementation of a daily electronic order prompt requiring justification for an indwelling urinary catheter for >24 hours. Intervention 2 (group 2) included intervention 1 plus sterile intraoperative placement of a urinary catheter after the antiseptic preparation and draping of the patient.

MAIN OUTCOME MEASURES

The primary outcome measured was urinary tract infection rate.

RESULTS

A total of 811 patients were identified (control = 215; group 1 = 476; group 2 = 120). Patient demographics and comorbidities were similar among the groups. No differences existed in the proportion of proctectomy among the groups. Urinary tract infection rate decreased significantly with the implementation of each intervention (control, 6.9%; group 1, 2.7%; group 2, 0.8%; p = 0.004). The lone urinary tract infection in group 2 involved ureteral reconstruction and stent placement at the time of surgery.

LIMITATIONS

This study was limited by its small sample size and single institution design.

CONCLUSIONS

The implementation of 2 low-cost practice interventions was associated with a statistically significant decrease in urinary tract infection in patients undergoing colorectal surgery at an academic tertiary care center.