Postoperative infections and bladder distension following hip fracture surgery Findings from implementing patient safety innovations

Abstract: Adverse events such as hospital-acquired infections and bladder distension are largely preventable if evidence-based recommendations are adhered to. The overall aim of this thesis was to promote healthcare workers’, involved in the care of patients with hip fracture, ownership of postoperative infections, especially urinary catheter associated urinary tract infections (UC-UTIs), and bladder distension prevention. Methods: Process evaluations of two theory driven interventions, the Safe Hands, Study I and the Safe Bladder, Study II-IV, spanning over 5 years. In studies I and IV, a qualitative approach was used to describe fidelity and mechanism of impact. In Study II and III, quantitative data analysis was performed to describe the interventions effectiveness on patient outcomes. The implementation strategies were integrated knowledge translation, facilitation and were underpinned by theories of organizational culture, leadership and dialogue. Findings: The theories and strategies used were important mechanism of impact and affected not only participants response to the intervention but also the co-creation of new innovations that might promote ownership of UC-UTI and bladder distension prevention. The interventions were associated with a decreased incidence of both UC-UTIs and bladder distension. Study II, UC UTI decreased from 18.5% (n=75/406) to 4.2% (n=27/647) (P<0.0001). When adjusting for confounders, patients in phase 4 were 74% less likely to contract an UC-UTI, OR 0.26 (95% CI 0.15-0.45). Bladder distension decreased from 40.6 % (n=165/406) to 9.1% (n=57/626), P<0.0001). When adjusting for confounders the yearly reduction in odds of bladder distension was 39%, OR 0.61 (95% CI 0.57-0.64). Conclusion: Theory driven interventions and strategies that involves facilitation, co-creation and educations can promote the uptake of preventive measures and showed to be associated with a reduced incidence of two of the most common and preventable adverse events