Reducing urinary tract infections in colon and rectal surgery

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.