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Owen RM, Perez SD, Bornstein WA, Sweeney JF. Impact of Surgical Care Improvement Project Inf-9 on Postoperative Urinary Tract Infections: Do Exemptions Interfere With Quality Patient Care? Arch Surg. 2012;147(10):946–953. doi:10.1001/archsurg.2012.1485
Author Affiliations: Division of General and Gastrointestinal Surgery (Drs Owen and Sweeney), Department of Surgery Patient Safety and Data Management Program (Drs Owen and Sweeney and Mr Perez), and Department of Medicine, Emory Healthcare Office of Quality and Risk (Dr Bornstein), Emory University School of Medicine, Atlanta, Georgia.
Background The Surgical Care Improvement Project (SCIP) Inf-9 guideline promotes removal of indwelling urinary catheters (IUCs) within 48 hours of surgery.
Objectives 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.
Setting Southeastern academic medical center.
Patients 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.
Main Outcome Measure Postoperative UTI.
Results 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).
Conclusions 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.
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