Implementation of a clinical protocol to reduce urinary tract infections among women with urinary retention after pelvic reconstructive surgery.

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; (3) recommending 2L 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 healthcare resource utilization.

RESULTS: We included 31 patients prior to 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 (ED) visits. Multivariate regression showed that UTIs were 2.04 times more likely prior to than after the intervention.

CONCLUSION: Our quality improvement intervention was practical to implement and effective in reducing postoperative UTIs among patients with urinary catheters.