Major ArticleEight-year sustainability of a successful intervention to prevent urinary tract infection: A mixed-methods study

•An intervention effect to reduce urinary tract infections in orthopedic surgery lasted for 8 years.•The intervention and knowledge of guidelines were recalled poorly.•A champion leader in the operating room was of value for the sustainability of the effect.

BackgroundData on long-term effects of interventions in infection control are scarce. We aimed to evaluate the 8-year sustainability of a successful intervention to reduce urinary tract infections (UTIs) through restriction of urinary catheter (UC) use in an orthopedic surgical population.MethodsProspective UTI surveillance from November 2009-January 2010 was conducted to compare the results against the 2-year sustainability assessment performed in 2004. Semistructured staff interviews focused on UC indication, training, insertion techniques, and recall of the former intervention.ResultsA total of 336 consecutive patients were included (median age, 63 years; range, 16-95 years; 55% women). A UC was placed in 17.6% of patients (operating room [OR], 10.1%; postanesthesia care unit [PACU], 3.6%; surgical wards [SW], 3.9%) compared with 20.0% in 2004 (OR, 15.7%; PACU, 1.0%; SW, 3.7%). The incidence rate of UTI was 2.4 per 1,000 patient-days in 2010 versus 2.6 per 1,000 patient-days in 2004; adjusted incidence rate ratio 0.76; 95% confidence interval, 0.21-2.76; P = .67. The qualitative inquiry demonstrated poor recall of the intervention and knowledge of guidelines except in the OR, where we identified a champion leader.DiscussionThe intervention effect was sustained with regard to overall UTI rate and UC placement in the OR, but less in the PACU and SW.ConclusionsContinuous leadership of a single opinion leader in a pivotal position can contribute critically to sustainability.

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