• Deborah Nagle, Thomas Curran, Lorenzo Anez-Bustillo, and Vitaliy Poylin.
• Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
• Dis. Colon Rectum. 2014 Jan 1;57(1):91-7.

BackgroundUrinary tract infection is associated with increased morbidity, mortality, and healthcare costs. Colon and rectal surgery has been shown to be an independent risk factor for urinary tract infection. Decreased length of the indwelling urinary catheter may play a role in decreasing the rate of urinary tract infection.ObjectiveThe aim of this study was to investigate the effect of standardized indwelling urinary catheter management on urinary tract infection.DesignThis was a prospective cohort study.SettingsThis study was conducted in an urban academic tertiary care center.PatientsAll of the patients were undergoing colon or rectal resection from 2010 to 2012 at a single National Surgical Quality Improvement Program participating institution.InterventionsIntervention 1 (group 1) included implementation of a daily electronic order prompt requiring justification for an indwelling urinary catheter for >24 hours. Intervention 2 (group 2) included intervention 1 plus sterile intraoperative placement of a urinary catheter after the antiseptic preparation and draping of the patient.Main Outcome MeasuresThe primary outcome measured was urinary tract infection rate.ResultsA total of 811 patients were identified (control = 215; group 1 = 476; group 2 = 120). Patient demographics and comorbidities were similar among the groups. No differences existed in the proportion of proctectomy among the groups. Urinary tract infection rate decreased significantly with the implementation of each intervention (control, 6.9%; group 1, 2.7%; group 2, 0.8%; p = 0.004). The lone urinary tract infection in group 2 involved ureteral reconstruction and stent placement at the time of surgery.LimitationsThis study was limited by its small sample size and single institution design.ConclusionsThe implementation of 2 low-cost practice interventions was associated with a statistically significant decrease in urinary tract infection in patients undergoing colorectal surgery at an academic tertiary care center.

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