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Preventing Urinary Tract Infections in Urogynecology Surgery by Implementing a Surgical Bundle

Presenting Author(s)

Shauna Regan, MD (she/her/hers)

Resident
University of Alberta
Edmonton, Alberta, Canada

Co-Author(s)

VG

Virginia Goetz, MD

Resident
University of ALberta
Edmonton, Alberta, Canada
JE

Judith Eversley, MD

Resident
University of Alberta
Edmonton, Alberta, Canada
MS

May Sanaee, MD FRCSC MHScEd (she/her/hers)

Clinical Associate Professor
University of Alberta
EDMONTON, Alberta, Canada

Objectives: Urogynecologic procedures for pelvic organ prolapse and urinary incontinence carry a higher risk of urinary tract infection (UT) than other gynecologic procedures. Within six weeks of surgery 9% of patients develop a UTI. At the Royal Alexandra Hospital, high rates of UTI and antibiotic us, consistent with other centers, have been found, so a novel peri-operative surgical bundle was introduced, this study aims to assess the impact of a perioperative surgical bundle on UTIs for major urogynecology surgeries.

Methods: This is a pre-post study following surgical bundle implementation. The pre-study data was obtained through retrospective chart review of all major and minor urogynecology procedures from January 1, 2019, to April 31, 2021. Following March 1, 2021, all major urogynecology procedures received a 5-part surgical bundle incorporating improved catheter care, appropriate prophylaxis with cranberry capsules or antibiotics, and enhanced patient education. Preliminary data shown here is collected from run charts. Currently pending REB approval for further data collection. Data was stored in a RedCap database with Research Ethics Board (REB) Approval.

Results: 518 charts before intervention were assessed: 315 were major and 203 were minor surgeries. Before surgical bundle implementation, major urogynecology procedures had more culture proven postoperative UTIs than minor procedures (14.37% and 6.36%, p=0.003), with comparable unplanned antibiotics prescriptions rates without positive urine culture (14.57% and 14.56%, p=0.284). At the time of this abstract submission, data from the quality improvement study indicates that of 335 post-intervention patients, 50 (14.9%) patients had a culture proven UTI (p=1.000), but only 18 people (5.4%) had antibiotics without a positive urine culture (p=0.028).

Conclusions: Preliminary data suggests that postoperative UTIs have remained stable despite bundle implementation. However, there may be a decrease in unplanned post-operative antibiotic prescribing. Completion of data collection and analysis will help to further elucidate this.