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Clinical practice and evidence-based knowledge: reducing urinary tract infection in elderly hip fracture patients

Sørbye, Liv Wergeland; Martinsen, Mette Irene; Grue, Else Vengnes
Journal article, Peer reviewed
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URI
http://hdl.handle.net/11250/2407172
Date
2016
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Abstract
Objective: Urinary Tract Infections (UTIs) are a common

complication of hip fracture, but quality assurance processes might

help reduce their frequency. In this study, we measured the effect of

systematic quality prevention UTI with hip fracture.

Materials and Methods: Our analyses involved three samples:

A, n = 331, pre-intervention (2004-2006); B, n = 319 (2013-2014),

post-intervention one; and C, n = 349 (May 2015-March 2016), postintervention

two. Inclusion criteria were aged ≥65 years, hip fracture

and admission from home to acute care hospitals. From 2012, the

hospital participated in a national patient safety program to prevent

UTIs, emphasizing indications for indwelling urinary catheters (IUCs).

Education and practice for sterile catheter insertion and removal the

first morning after surgery. In 2015, a daily risk-assessment meeting

with the staff was implemented. One focus was following up on UTI

and the use of IUC.

Results: Samples A and B did not differ for UTI rates, but A and

C did (12.7% vs 7.2%; p = 0.02) and B and C (17.9 % vs 7.2 %; p <

0.01). Samples A and C had a significant correlation of length of stay

(LOS) and UTI compared to no UTI (A, p < 0.001 and C, p = 0.002)

while sample B, was close to significant (p = 0.057). The median LOS

decreased from 11 days in sample A to 6 days in samples B and C (p =

0.01) due to a governmental coordination reform. Logistic regression

revealed three significant predictors for UTI (p = 0.000): age > 81 year,

first intervention group (Sample B), LOS > 11 days.

Conclusion: Staff quality assurance training requires expertise,

time, and engagement to facilitate reduction in UTIs among hip

fracture patients. Quality improvement takes time, commitment and

continues follow up.
Publisher
Avens Publishing Group
Journal
Journal of urology and nephrology
Copyright
Open Access

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