966 Managing Infection Risk in Flexible Cystoscopy: An Audit and Service evaluation

Aim The aim of this audit and service evaluation was to investigate the way in which the infection risk associated with diagnostic and therapeutic flexible cystoscopy was managed in one NHS trust, and to consider the impact that positive urinalysis rates prior to flexible cystoscopy had on service delivery. Method All appointments for both diagnostic and therapeutic flexible cystoscopy across the trust were audited prospectively for a two-month period. Results 276 appointments were booked across this time period, of which 237 were attended and documented. Of these appointments, flexible cystoscopies went ahead in 219 patients and were completed in 215 patients, terminated early in 4 patients. Urinalysis was performed and recorded in 227 appointments. 18 asymptomatic patients tested positive for nitrites, indicating bacteriuria. 3 patients were symptomatic for urinary tract infection, including 1 patient who also underwent urinalysis and tested positive for nitrites. None of the patients who were symptomatic for urinary tract infection underwent flexible cystoscopy. Of the 18 asymptomatic patients who tested positive for nitrites, 9 were cancelled due to infection risk. Infection was the most common reason that a flexible cystoscopy did not go ahead. 72 appointments had no safety netting for infection risk documented. Conclusions There was an excellent rate of performing and recording urinalysis in this trust. There is room for improvement for the documentation of infection related safety netting. The decision to cancel appointments on the basis of infection risk in asymptomatic patients was taken on a case-by-case basis, though no symptomatic patients underwent flexible cystoscopy.