1. UTIs at SPH Adrienne Melck, MD, MPH, FRCSC Division of General Surgery Meghan MacLeod, MSc Quality Improvement Specialist

2. NSQIP Nationally validated, risk adjusted, outcomes based quality improvement program Rigorous prospective collection of preoperative through 30 day postoperative outcome variables 1,680 cases across 8 specialties each year Intense Surgical Clinical Reviewer training, continuing education, and support Highly standardized and validated data definitions 135 total variables collected Data analyzed by NSQIP and hospital performance is reported back to drive quality improvement work

3. Geographic Distribution of ACS NSQIP Participating Sites Included in the Semiannual Report (n=289). A total of 440 sites are enrolled in all ACS NSQIP programs.

4. The Problem (NSQIP Data) SPH UTI incidence 2011: 4.4% NSQIP avg. UTI incidence 2011: 1.6% BC UTI incidence 2011: 2.8% OR = 1.84 10 th Decile! UTIs are a problem across the specialties

5. SPH Overall Multispecialty (All cases)

6. Overall Multispecialty (All cases) Raw Data

7. Our Goal 0% UTI incidence by December 2012!....or at least no longer “in the pink”

8. The Facts Up to 80% of UTIs are attributable to urinary catheterization Patients with indwelling Foleys >2 days postop are 2X more likely to develop a CAUTI >50% catheters in hospitalized patients may be unnecessary CAUTIs have a significant impact on morbidity, LOS and hospital costs Holy Moley, Remove that Foley!

9. UTI Working Group Surgery – Stephen Parker Ortho – Michele Bech Cardiac – Wendy Bowles, Marie McCoy O.R. – Jacek Murawski MSJ – Connie Degeau Clinical Care Analyst – Lisa Toback QI Specialists – Meghan MacLeod, Sophie Clyne IPAC – Dr. Victor Leung Anesthesia – Dr. Chan Urology – Dr. Mike Eng Gyne – Dr. Cundiff Chair – Dr. Melck

10. UTI WG – 1 st meeting Data and Literature Review –Nearly all of our UTI cases had a urinary catheter at some point –Of those, >50% developed a UTI within 6 days of surgery –Decision to make catheters our primary focus –ACS NSQIP Best Practice Guidelines

11. UTI WG – 2 nd meeting Information gathering –Observation from OR and wards: Poor sterile insertion technique (hand hygiene!!) Trainees inserting Foleys in OR Lack of adequate securing of catheters Drainage bags not being kept below bladder (especially during transfer) Routine Foleys for epidural analgesia Lack of daily meatal care Lack of hand hygiene prior to catheter manipulation Indwelling catheters to treat retention rather than in and outs CATHETERS LEFT IN TOO LONG!

12. UTI WG – 3 rd meeting Revision of Nursing Practice Standards –More emphasis on: hand hygiene proper sterile insertion technique using smallest catheter size possible Presentation at MSJ and SPH All Party rounds

13. How to do it all wrong http://youtu.be/7fRX2aKqlok

15. What are you curious about? Ask me!