title: Eight-year sustainability of a successful intervention to prevent urinary tract infection: A mixed-methods study.
abstract: Data on long-term effects of interventions in infection control are scarce. We aimed to evaluate the 8-year sustainability of a successful intervention to reduce urinary tract infections (UTIs) through restriction of urinary catheter (UC) use in an orthopedic surgical population.
  
  
  
  Prospective UTI surveillance from November 2009-January 2010 was conducted to compare the results against the 2-year sustainability assessment performed in 2004. Semistructured staff interviews focused on UC indication, training, insertion techniques, and recall of the former intervention.
  
  
  
  A total of 336 consecutive patients were included (median age, 63 years; range, 16-95 years; 55% women). A UC was placed in 17.6% of patients (operating room [OR], 10.1%; postanesthesia care unit [PACU], 3.6%; surgical wards [SW], 3.9%) compared with 20.0% in 2004 (OR, 15.7%; PACU, 1.0%; SW, 3.7%). The incidence rate of UTI was 2.4 per 1,000 patient-days in 2010 versus 2.6 per 1,000 patient-days in 2004; adjusted incidence rate ratio 0.76; 95% confidence interval, 0.21-2.76; P = .67. The qualitative inquiry demonstrated poor recall of the intervention and knowledge of guidelines except in the OR, where we identified a champion leader.
  
  
  
  The intervention effect was sustained with regard to overall UTI rate and UC placement in the OR, but less in the PACU and SW.
  
  
  
  Continuous leadership of a single opinion leader in a pivotal position can contribute critically to sustainability.
authors.affiliation: Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland. Electronic address: hugo.sax@usz.ch.
authors.forename: Hugo
authors.initials: H
authors.lastname: Sax
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland.
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Kuster
authors.affiliation: Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Yassaman Alipour
authors.initials: YA
authors.lastname: Tehrany
authors.affiliation: Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Ruoxi
authors.initials: R
authors.lastname: Ren
authors.affiliation: Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland; Clinic of Orthopedic Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
authors.affiliation: Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Americo
authors.initials: A
authors.lastname: Agostinho
authors.affiliation: Department of Anesthesiology, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Stephan
authors.affiliation: Department of Anesthesiology, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Maud
authors.initials: M
authors.lastname: Wachsmuth
authors.affiliation: Department of Anesthesiology, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Walder
authors.affiliation: Clinic of Orthopedic Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.affiliation: Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D055499:Catheter-Related Infections / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000517:prevention & control*; D055815:Young Adult
keywords: Infection control; Quality improvement intervention; Urinary catheterization