Prevention of healthcare-associated infections (HAIs) in a surgical urology ward: observational study—analysis of the problem and strategies for implementation

  • José Medina-PoloEmail author
  • Javier Gil-Moradillo
  • Juan Justo-Quintas
  • Daniel Antonio González-Padilla
  • Esther García-Rojo
  • Alejandro González-Díaz
  • Pablo Abad-López
  • Mario Hernández-Arroyo
  • Rocío Santos-Pérez de la Blanca
  • Helena Peña-Vallejo
  • Julio Téigell-Tobar
  • Francisco López-Medrano
  • Ángel Tejido-Sánchez
Topic Paper



Our purpose is to present the results of our working group, with a view to reduce the incidence and improve the management of healthcare-associated infections (HAIs) in a urology ward.


The study consists on an observational database designed with the view to analyse the incidence and characteristics of HAIs in Urology. Based on the results obtained, a critical evaluation was carried out and specific measures put in place to reduce HAIs. Finally, the impact and results of the implemented measures were periodically evaluated.


The incidence of HAIs in urology decreased from 6.6 to 7.3% in 2012–2014 to 5.4–5.8% in 2016–2018. In patients with immunosuppression the incidence of HAIs decreased from 12.8 to 18% in 2012–2013 to 8.1–10.2% in 2017–2018, in those with a previous urinary infection fell from 13.6 to 4.8%, in those with a urinary catheter prior to admission from 12.6 to 10.8%, and in patients with a nephrostomy tube from 16 to 10.9%. The effect of the protocol also demonstrated a reduction in the percentage of patients with suspicion of HAIs for whom no culture was taken, from 6% in 2012 to zero in 2017 and 2018. Moreover, the implementation of protocols for empirical treatment has reduced the incidence of patients experiencing inadequate empirical antimicrobial therapy from 20 to 8.1%.


It is essential to monitor the incidence of HAIs, and preventive measures play a useful role in reducing the rate of infection and in optimising their management.


Antibiotic resistance Healthcare-associated infection (HAI) Surgical site infection (SSI) Urinary tract infection (UTI) Urology Department 



We acknowledge the effort and collaboration to all personnel of the department of Urology for preventing infections. Moreover, special thanks for all the residents of our department who have actively collected and reviewed the data.

Author contributions

JM-P: project development, data collection or management, data analysis, and manuscript writing/editing. JG-M: data collection or management, data analysis, and manuscript writing/editing. JJ-Q: data collection or management, data analysis, and manuscript writing/editing. DAG-P: data collection or management, data analysis, and manuscript writing/editing. EG-R: data collection or management, data analysis, and manuscript writing/editing. AG-D: data collection or management, data analysis, and manuscript writing/editing. PA-L: data collection or management, and manuscript writing/editing. MH-A: data collection or management, and manuscript writing/editing. RS-PB: data collection or management manuscript writing/editing. HP-V: data collection or management and manuscript writing/editing. JT-T: data collection or management and manuscript writing/editing. FLM: data analysis and manuscript writing/editing. ÁT-S: project development, data analysis, and manuscript writing/editing.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The prospective observational study did not affect the daily clinical practice. Therefore, additional informed consent was not required the patients included in the registry.


  1. 1.
    Trinchieri A, Paparella S, Cappoli S et al (2009) Prospective assessment of the efficacy of the EAU guidelines for the prevention of nosocomial acquired infections after genitourinary surgery in a district hospital. Arch Ital Urol Androl 81:46–50Google Scholar
  2. 2.
    Doyle B, Mawji Z, Horgan M et al (2001) Decreasing nosocomial urinary tract infection in a large academic community hospital. Lippincotts Case Manag Manag Process Patient Care 6:127–136CrossRefGoogle Scholar
  3. 3.
    Spoorenberg V, Hulscher MEJL, Akkermans RP et al (2014) Appropriate antibiotic use for patients with urinary tract infections reduces length of hospital stay. Clin Infect Dis 58:164–169. CrossRefGoogle Scholar
  4. 4.
    Haley RW, Culver DH, White JW et al (1985) The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 121:182–205CrossRefGoogle Scholar
  5. 5.
    Gross PA (2006) Hypotension and mortality in septic shock: the “golden hour”. Crit Care Med 34:1819–1820. CrossRefGoogle Scholar
  6. 6.
    Hamasuna R, Takahashi S, Yamamoto S et al (2011) Guideline for the prevention of health care-associated infection in urological practice in Japan. Int J Urol 18:495–502. CrossRefGoogle Scholar
  7. 7.
    Global Alliance for Infections in Surgery Working Group (2017) A global declaration on appropriate use of antimicrobial agents across the surgical pathway. Surg Infect 18:846–853. CrossRefGoogle Scholar
  8. 8.
    Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332. CrossRefGoogle Scholar
  9. 9.
    Johansen TEB (2004) Nosocomially acquired urinary tract infections in Urology Departments. Why an international prevalence study is needed in urology. Int J Antimicrob Agents 23(Suppl 1):S30–S34. CrossRefGoogle Scholar
  10. 10.
    Lo E, Nicolle LE, Coffin SE et al (2014) Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35:464–479. CrossRefGoogle Scholar
  11. 11.
    Anderson DJ, Podgorny K, Berríos-Torres SI et al (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(Suppl 2):S66–S88CrossRefGoogle Scholar
  12. 12.
    Hedrick TL, Sawyer RG (2005) Health-care-associated infections and prevention. Surg Clin North Am 85(1137–1152):ix. Google Scholar
  13. 13.
    Medina-Polo J, Sopeña-Sutil R, Benítez-Sala R et al (2017) Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a urology ward. Investig Clin Urol 58:61–69. CrossRefGoogle Scholar
  14. 14.
    Medina-Polo J, Jiménez-Alcaide E, García-González L et al (2014) Healthcare-associated infections in a department of Urology: incidence and patterns of antibiotic resistance. Scand J Urol 48:203–209. CrossRefGoogle Scholar
  15. 15.
    Grabe M, Botto H, Cek M et al (2012) Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol 30:39–50. CrossRefGoogle Scholar
  16. 16.
    Cai T, Verze P, Brugnolli A et al (2016) Adherence to European Association of Urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship. Eur Urol 69:276–283. CrossRefGoogle Scholar
  17. 17.
    DasGupta R, Sullivan R, French G, O’Brien T (2009) Evidence-based prescription of antibiotics in urology: a 5-year review of microbiology. BJU Int 104:760–764. CrossRefGoogle Scholar
  18. 18.
    Wagenlehner FME, Cek M, Naber KG et al (2012) Epidemiology, treatment and prevention of healthcare-associated urinary tract infections. World J Urol 30:59–67. CrossRefGoogle Scholar
  19. 19.
    Wagenlehner FME, Naber KG (2004) Emergence of antibiotic resistance and prudent use of antibiotic therapy in nosocomially acquired urinary tract infections. Int J Antimicrob Agents 23(Suppl 1):S24–S29. CrossRefGoogle Scholar
  20. 20.
    Tenke P, Kovacs B, Bjerklund Johansen TE et al (2008) European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 31(Suppl 1):S68–S78. CrossRefGoogle Scholar
  21. 21.
    Gastmeier P (2001) Nosocomial urinary tract infections: many unresolved questions. Clin Microbiol Infect 7:521–522CrossRefGoogle Scholar
  22. 22.
    Jain P, Parada JP, David A, Smith LG (1995) Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 155:1425–1429CrossRefGoogle Scholar
  23. 23.
    Shokeir AA, Al Ansari AA (2006) Iatrogenic infections in urological practice: concepts of pathogenesis, prevention and management. Scand J Urol Nephrol 40:89–97. CrossRefGoogle Scholar
  24. 24.
    Lara-Isla A, Medina-Polo J, Alonso-Isa M et al (2017) Urinary infections in patients with catheters in the upper urinary tract: Microbiological Study. Urol Int 98:442–448. CrossRefGoogle Scholar
  25. 25.
    Gili-Ortiz E, González-Guerrero R, Béjar-Prado L et al (2015) Surgical site infections in patients who undergo radical cystectomy: excess mortality, stay prolongation and hospital cost overruns. Actas Urol Esp 39:210–216. CrossRefGoogle Scholar
  26. 26.
    Kyoda Y, Takahashi S, Takeyama K et al (2010) Decrease in incidence of surgical site infections in contemporary series of patients with radical cystectomy. J Infect Chemother 16:118–122. CrossRefGoogle Scholar
  27. 27.
    Tenke P, Köves B, Johansen TEB (2014) An update on prevention and treatment of catheter-associated urinary tract infections. Curr Opin Infect Dis 27:102–107. CrossRefGoogle Scholar
  28. 28.
    Tandoğdu Z, Bartoletti R, Cai T et al (2016) Antimicrobial resistance in urosepsis: outcomes from the multinational, multicenter global prevalence of infections in urology (GPIU) study 2003–2013. World J Urol 34:1193–1200. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Urology and School of MedicineUniversidad Complutense Madrid, Hospital Universitario 12 de OctubreMadridSpain
  2. 2.Department of Infectious Diseases, School of MedicineUniversidad Complutense de Madrid and Health Research Institute i + 12, Hospital Universitario 12 de OctubreMadridSpain

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