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

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.