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Standardisation of perioperative urinary catheter use to reduce postsurgical urinary tract infection: an interrupted time series study
  1. Mahsa Sadeghi1,
  2. Jerome A Leis1,2,
  3. Claude Laflamme1,
  4. Darrel Sparkes1,
  5. Wendy Ditrani1,
  6. Aaron Watamaniuk1,
  7. Ru Taggar1,
  8. Fatema Jinnah1,
  9. Melisa Avaness1,
  10. Mary Vearncombe1,
  11. Avery B Nathens1,3
  1. 1 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2 Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Jerome A Leis, Sunnybrook Health Sciences Centre, Toronto, ON M43N3M5, Canada; Jerome.Leis{at}


Background Prevention of healthcare-associated urinary tract infection (UTI) has been the focus of a national effort, yet appropriate indications for insertion and removal of urinary catheters (UC) among surgical patients remain poorly defined.

Methods We developed and implemented a standardised approach to perioperative UC use to reduce postsurgical UTI including standard criteria for catheter insertion, training of staff to insert UC using sterile technique and standardised removal in the operating room and surgical unit using a nurse-initiated medical directive. We performed an interrupted time series analysis up to 2 years following intervention. The primary outcome was the proportion of patients who developed postsurgical UTI within 30 days as measured by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Process measures included monthly UC insertions, removals in the operating room and UC days per patient-days on surgical units.

Results At baseline, 22.5% of patients were catheterised for surgery, none were removed in the operating room and catheter-days per patient-days were 17.4% on surgical units. Following implementation of intervention, monthly catheter removal in the operating room immediately increased (range 12.2%–30.0%) while monthly UC insertion decreased more slowly before being sustained below baseline for 12 months (range 8.4%–15.6%). Monthly catheter-days per patient-days decreased to 8.3% immediately following intervention with a sustained shift below the mean in the final 8 months. Postsurgical UTI decreased from 2.5% (95% CI 2.0-3.1%) to 1.4% (95% CI 1.1-1.9; p=0.002) during the intervention period.

Conclusions Standardised perioperative UC practices resulted in measurable improvement in postsurgical UTI. These appropriateness criteria for perioperative UC use among a broad range of surgical services could inform best practices for hospitals participating in ACS NSQIP.

  • surgery
  • quality improvement
  • infection control

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  • Contributors All authors contributed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Sunnybrook Health Sciences Centre Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.