RESUMO
The study objectives were to identify risk factors for surgical patients who develop postoperative urinary tract infections (UTIs) and to characterize urethral catheter practices at the study hospital. Patients from the 2006-2010 institutional National Surgical Quality Improvement Program database were evaluated. Patients with UTIs within 30 postoperative days (n = 116) were compared to patients without UTIs (n = 8685) using multivariable logistic regression. A nested case-control study evaluated the effects of catheter practices on postoperative UTI using conditional logistic regression. Independent predictors of UTI were sex, age, inpatient stay, functional status, renal failure, preoperative transfusion, and preoperative hospital stay. Compared with controls, patients with UTI more often maintained catheters for >2 postoperative days (66% vs 43%, P < .001) and had longer mean catheter duration (11.6 vs 5.1 days, P < .001). Study findings led to institutional recommendations to reduce catheter-associated UTIs. Quality improvement initiatives can increase awareness of performance enhancement opportunities and encourage collaborative, interdisciplinary improvement through shared objectives.
Assuntos
Infecção Hospitalar/etiologia , Melhoria de Qualidade/estatística & dados numéricos , Infecções Urinárias/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/etiologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores Sexuais , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/normas , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/normasRESUMO
Clostridium difficile (C diff) is an anaerobic bacterium that causes antibiotic-associated colitis, which can progress to a life-threatening illness for some patients. Clostridium difficile is highly transmissible in health care settings and has high morbidity and mortality rates. The increased prevalence of this bacterium and the consequences of infection necessitate an understanding of its transmission and use of stringent infection control practices. A two-year retrospective evaluation was performed to examine the effectiveness of a screening tool for patients requiring surgical intervention for C diff and to determine whether treatment was timely and effective. Early, aggressive surgical intervention appears to bel the single most effective treatment for fulminant C diff colitis.
