Post-Operative Urinary Tract Infection Reduction: Discharge Bundle Implementation in Outpatient Urogynecology Patients

Abstract

Introduction/Background: Post-operative urinary tract infections (UTIs) are a common, costly and potentially serious postsurgical complication amongst urogynecology patients undergoing surgical pelvic procedures. A Maryland hospital’s urogynecology program had post-operative UTI incidence rates above the American College of Surgeons quality improvement program’s nationally desired metric (NSQIP), and previous interventions proved ineffective. Aims: The purpose of this project was to incorporate a standardized, evidence-based discharge care bundle, aimed at reducing UTI rates by at least 50% in post-surgical urogynecology patients. The intervention was a discharge care bundle which included non-prescription, pharmacologic supplements (cranberry & probiotic supplements) taken by patients for 30 days post-operatively. Methods: Patients who had surgical procedures during the months of October 2019 through December 2019, received education and after surgical care instructions encouraging intake of a standard 30 day supply of cranberry tablets and lactobacillus acidophilus chewable wafers, along with instructions for 32 ounces of daily water intake for 30 days post-operatively. Patient follow up at 2, 4 and 6 weeks, assessed for compliance and UTI symptom development. Baseline UTI data was then compared to post intervention data. Results: NSQIP UTI rates for the 3-months, post-bundle implementation, were favorable at 0%. Following bundle implementation, the NSQIP UTI rate for the urogynecology cohort remained below the expected rate of <4%, and dropped 6% from the clinic’s 3-month pre-implementation rate. There was only one documented UTI for all patients who opted to take the recommended supplements, compared to eight documented UTIs for patients who did not opt to take the recommended supplements. High compliance rates among those who followed the discharge bundle recommendations were also noted. Conclusions: A decrease in UTI rates was seen after implementation of an evidence based UTI discharge bundle within a selected urogynecology cohort. This intervention demonstrates the potential for effective use of supplements to avoid post-operative UTIs for patients undergoing urogynecology procedures.