{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:22:22Z","timestamp":1792599742634,"version":"4.5.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2018,5,9]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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\u2009years following intervention. The primary outcome was the proportion of patients who developed postsurgical UTI within 30\u2009days 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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%\u201330.0%) while monthly UC insertion decreased more slowly before being sustained below baseline for 12\u2009months (range 8.4%\u201315.6%). Monthly catheter-days per patient-days decreased to 8.3% immediately following intervention with a sustained shift below the mean in the final 8\u2009months. 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2017-007458","type":"journal-article","created":{"date-parts":[[2018,5,29]],"date-time":"2018-05-29T12:20:15Z","timestamp":1527596415000},"page":"32-38","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Standardisation of perioperative urinary catheter use to reduce postsurgical urinary tract infection: an interrupted time series study"],"prefix":"10.1136","volume":"28","author":[{"given":"Mahsa","family":"Sadeghi","sequence":"first","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome A","family":"Leis","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude","family":"Laflamme","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrel","family":"Sparkes","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Ditrani","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Watamaniuk","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru","family":"Taggar","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatema","family":"Jinnah","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melisa","family":"Avaness","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Vearncombe","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery B","family":"Nathens","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,5,29]]},"reference":[{"key":"2025090413182713000_28.1.32.1","doi-asserted-by":"publisher","DOI":"10.1086\/650482"},{"key":"2025090413182713000_28.1.32.2","doi-asserted-by":"publisher","DOI":"10.1086\/657912"},{"key":"2025090413182713000_28.1.32.3","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-12-200906160-00013"},{"key":"2025090413182713000_28.1.32.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504906"},{"key":"2025090413182713000_28.1.32.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001774"},{"key":"2025090413182713000_28.1.32.6","doi-asserted-by":"publisher","DOI":"10.1086\/675718"},{"key":"2025090413182713000_28.1.32.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(00)00531-3"},{"key":"2025090413182713000_28.1.32.8","unstructured":"An Interprofessional guide on the use of orders, directives and delagation for regulated health professionals in Ontario. http:\/\/mdguide.regulatedhealthprofessions.on.ca\/orders\/what\/default.asp (accessed 10 Oct 2016)."},{"key":"2025090413182713000_28.1.32.9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1001\/jamainternmed.2015.6319","article-title":"Medical directive for urinary catheter removal by nurses on general medical wards","volume":"176","author":"Leis","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2025090413182713000_28.1.32.10","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.ajic.2015.05.046","article-title":"Indwelling urinary catheter surveillance using a task-oriented nurse acuity system","volume":"43","author":"Leis","year":"2015","journal-title":"Am J Infect Control"},{"key":"2025090413182713000_28.1.32.11","unstructured":"Provost LR , Murray SK . 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