TY  - JOUR
T1  - Impact of surgical care improvement project inf-9 on postoperative urinary tract infections: Do exemptions interfere with quality patient care?
AU  - Owen RM, Perez SD, Bornstein WA, Sweeney JF
Y1  - 2012/10/01
N1  - 10.1001/archsurg.2012.1485
JO  - Archives of Surgery
SP  - 946
EP  - 953
VL  - 147
IS  - 10
N2  - 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.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2012.1485
UR  - http://dx.doi.org/10.1001/archsurg.2012.1485
ER  -