Prevention of Healthcare-Associated Infections (HAIs) in a Surgical Urology Ward: Observational Study-Analysis of the Problem and Strategies for Implementation - Beyond the Abstract

Infections related to healthcare (IRAS) are a potentially severe complication to patients receiving health care and leads to higher health costs and has negative consequences concerning morbidity and mortality. When infection does appear, antibiotic treatment must be prescribed as early as possible. The highest success rates are associated with the design of individual patient profiles. 

The article presents the results of our working group with the aim of reducing the incidence of IRAS in a Urology ward and, optimize the treatment of healthcare-associated infections (HAIs).

The study consists of an observational database designed to analyze the incidence and characteristics of HAIs in patients hospitalized in Urology. To start, we evaluated the situation in 2012 and 2013. Based on the results obtained, a critical evaluation was carried out, and specific measures are established to reduce HAIs. The measures implemented include:

  • Periodical revision of the evolution and characteristics of IRAS
  • Assessing risk factors according to patient profiles
  • Implementation of protocols for empirical antibiotic treatment according to the local  microbiological results
  • Training for all healthcare professionals and patients in order to prevent infections, such as correct hands washing, avoid the use of rings and watches, early removal of vascular and urinary catheters
  • Finally, we evaluated the impact and results of the implemented measures

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The incidence of IRAS in patients admitted to Urology decreased from 6.6 to 7.3% from 2012-2014 to 5.4 to 5.8% in 2016-2018. 

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Evaluating patients with risk factors for infections, we reported that the incidence of HAIs decreased in patients with immunosuppression from 12.8%-18% in 2012-2013 to 8.1%-10.2% in 2017-2018, those with a previous urinary tract infection from 13.6% to 4.8%, those who underwent a radical cystectomy (65% to 36.6%), with a urinary catheter prior admission (12.6% to 10.8%), and patients with a nephrostomy tube (16% to 10.9%). 

The effect of the protocol and the better training in healthcare professional was also demonstrated with a reduction in the percentage of patients with suspicion of HAIs with no culture from 6% to less than 0% in 20167 and  2018. Moreover, the implementation of protocols for empirical treatment has reduced the incidence of patients with inadequate empirical antimicrobial therapy from 20% to 8.1% with no increase in the isolation of multidrug-resistant microorganisms. 

The incidence of extended-spectrum beta-lactamase producing bacteria ESBL declined from 25% in 2012 to 10.9% in 2017-2018. However, special attention is required from ESBL-producing bacteria non-E.coli mainly reported in patients with a urinary catheter in the upper urinary tract.

Our project is ongoing and includes some future measures such as: 

  • Data evaluation twice per year (Security Project)
  • Maintain personnel training - hand hygiene and isolation measures
  • Protocol of antibiotic empirical treatment (yearly revision)
  • Optimize the prescription of antibiotics in inpatient and outpatient (diagnosis and treatment procedures)

In conclusion, the incidence of HAIs must be monitored, and measures for prevention are useful to decrease the rate of infections and optimize their management. An active aptitude to control HAIs is required, and the program must include medical staff, nurses and also patients and relatives.


Written by: José Medina-Polo, Ph.D., FEBU, Department of Urology and Infectious Diseases, University Hospital, Madrid, Spain

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