Presentation Authors: Vincent Roth*, Pedro Espino-Grosso, Carl Henriksen, Benjamin Canales, Gainesville, FL
Introduction: In 2011, our facility transitioned from sterile to high-level disinfection (HLD) reprocessing of flexible cystoscopes following an AUA white paper that endorsed both as acceptable practices. Our objective was to examine the effect of this change by evaluating cost and symptomatic UTI rates before and after implementation.
Methods: We retrospectively reviewed 30-day outcomes following 1,888 simple cystoscopy encounters that occurred from 2007-2010 (sterile conditions; n = 905) and 2012-2015 (HLD conditions; n = 983) at the Malcom Randall VA. We excluded patients who had recent urologic instrumentation, active or recent UTI, performed intermittent catheterization, or had complicated cystoscopy (dilation, biopsy, etc). Procedural indications, patient demographics and comorbidities, prophylactic antibiotic use, post-procedural complications, and reprocessing costs were collected and compared between groups. Statistical significance between groups was assessed using Fisherâ€™s exact test.
Results: Both cohorts were predominantly Caucasian (82.5%) with mean age 68Â±10.5 years. Most common indications were cancer surveillance (50%) and hematuria (34%). Common comorbidities included a history of cancer (62%), type 2 diabetes mellitus (36%), and tobacco use (24.5%). Across both cohorts, overall rate of urological complications was 1.43%. Reported UTI events occurred in 9/905 (0.99%) of sterile and 5/983 (0.51%) HLD group (p = 0.29). Unplanned clinic/ED visits occurred in 6/905 (0.66%) of sterile and 7/983 (0.71%) HLD groups. Prophylactic antibiotics, most commonly fluoroquinolones (91%), were prescribed in over 99% of both cohorts. HLD was significantly cheaper ($82.32) per procedure than sterile conditions with the majority of cost disparity stemming from reprocessing. Total annual savings by switching to HLD was ~$101,000 for our facility.
Conclusions: In our older, highly morbid veteran population receiving centralized care and prophylactic antibiotics, we found no difference in UTI rate between sterile and HLD techniques. HLD comes with a sizable cost savings, easier scope access/storage, and easier procedure preparation. The UTI rate of 0.79% is the lowest post-procedural UTI rate ever reported in the literature, perhaps due to pervasive prophylactic antibiotic use.
Source of Funding: AUA Summer Medical Student Fellowship (Urology Care Foundation, Florida Urological Society)