Impact of surgical care improvement project inf-9 on postoperative urinary tract infections: do exemptions interfere with quality patient care?
BACKGROUND
The Surgical Care Improvement Project (SCIP) Inf-9 guideline promotes removal of indwelling urinary catheters (IUCs) within 48 hours of surgery.


OBJECTIVE
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.


METHODS
Southeastern academic medical center.


METHODS
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.


METHODS
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.
Division of General and Gastrointestinal Surgery.
Rachel M
RM
Owen
Sebastian D
SD
Perez
William A
WA
Bornstein
John F
JF
Sweeney
D001437:Bacteriuria / Q000209:etiology / Q000517:prevention & control; D016022:Case-Control Studies; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000592:standards*; D015984:Causality; D002423:Cause of Death; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D020878:Device Removal / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States; D062885:Urinary Catheters / Q000009:adverse effects / Q000592:standards*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*