Utilization of a Pre-operative Checklist Reduces Risk of Penile Prosthesis Infection
PURPOSE:: Infection of a penile prosthesis (PP) is a devastating complication that necessitates removal of all device components. Many aspects of pre- and intra-operative infection prophylaxis practices have been examined but the specific relevant factors remain unknown. We determined whether use of a mandatory checklist of peri-operative practices believed to reduce prosthesis infection risk would impact patient safety. MATERIALS AND METHODS:: We retrospectively reviewed men with erectile dysfunction (ED) who underwent PP insertion. Only patients who had not previously undergone PP surgery were included. Following an outbreak of infections, a mandatory checklist comprised of best infection prophylaxis practices was developed and required for all subsequent implant surgeries. Patient cohorts were divided into 3 groups: baseline period, outbreak period, and intervention period. Statistical analysis was performed using Chi-Square, Fisher's exact test, and ANOVA. RESULTS:: During the baseline period 2/68 (2.9%) inflatable penile prosthesis (IPP) devices became infected. During the outbreak break 6/11 (54.5%) of devices became infected, representing an incidence risk ratio 18.55 times that of the baseline period. Following the implementation of the pre-operative checklist, the incidence risk ratio fell to 0.0 in the intervention period with 0/52 (0%) becoming infected. CONCLUSIONS:: Following an outbreak of an unusually high number of PP infections, implementation of a required checklist brought the rate down to zero. Although the specific factors that led to the infection outbreak and subsequent cessation of infections are unknown, we have shown that utilization of a checklist was associated with a dramatic impact on patient safety.