Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice

Rosa Park, Justin Gyorfi, Kalyan Dewan, Girish Soorapp Kirimanjeswara, Joseph Y. Clark, Matthew G. Kaag, Kathleen Lehman, Jay Raman

Research output: Contribution to journalArticle

Abstract

Purpose: To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. Methods: A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. Results: Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. Conclusions: What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

Original languageEnglish (US)
Pages (from-to)1563-1568
Number of pages6
JournalInternational Urology and Nephrology
Volume50
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Institutional Practice
Local Anti-Infective Agents
Patient Safety
Prostate
Biopsy
Needle Biopsy
Povidone-Iodine
Chlorhexidine
Sepsis
Quinolones
Cross Infection
Infection
Urinary Tract Infections
Immunosuppression
Alcohols
Anti-Bacterial Agents
Safety

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Urology

Cite this

@article{b28fffad931245ad8facf5792d89e4b7,
title = "Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice",
abstract = "Purpose: To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. Methods: A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4{\%} chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. Results: Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90{\%} of patients were Caucasian, 13{\%} had diabetes, 3{\%} were on immunosuppression, 32{\%} had at least one prior biopsy, 14{\%} received antibiotics, and 7{\%} were hospitalized in the past 6 months. 22 patients (2.2{\%}) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3{\%}, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. Conclusions: What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.",
author = "Rosa Park and Justin Gyorfi and Kalyan Dewan and Kirimanjeswara, {Girish Soorapp} and Clark, {Joseph Y.} and Kaag, {Matthew G.} and Kathleen Lehman and Jay Raman",
year = "2018",
month = "9",
day = "1",
doi = "10.1007/s11255-018-1937-3",
language = "English (US)",
volume = "50",
pages = "1563--1568",
journal = "International Urology and Nephrology",
issn = "0301-1623",
publisher = "Springer Netherlands",
number = "9",

}

TY - JOUR

T1 - Topical rectal antiseptic at time of prostate biopsy

T2 - how a resident patient safety project has evolved into institutional practice

AU - Park, Rosa

AU - Gyorfi, Justin

AU - Dewan, Kalyan

AU - Kirimanjeswara, Girish Soorapp

AU - Clark, Joseph Y.

AU - Kaag, Matthew G.

AU - Lehman, Kathleen

AU - Raman, Jay

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Purpose: To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. Methods: A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. Results: Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. Conclusions: What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

AB - Purpose: To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. Methods: A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. Results: Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. Conclusions: What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

UR - http://www.scopus.com/inward/record.url?scp=85049953990&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049953990&partnerID=8YFLogxK

U2 - 10.1007/s11255-018-1937-3

DO - 10.1007/s11255-018-1937-3

M3 - Article

C2 - 30019310

AN - SCOPUS:85049953990

VL - 50

SP - 1563

EP - 1568

JO - International Urology and Nephrology

JF - International Urology and Nephrology

SN - 0301-1623

IS - 9

ER -