The implementation of a multifaceted prevention strategy can significantly reduce the incidence of urinary tract infections after surgery according to a controlled, prospective, before-after intervention trial with 1328 adult patients. A locally developed guideline for the prevention of urinary tract infections was implemented for orthopedic surgery patients while abdominal surgery patients served as control subjects. The incidence of urinary tract infections decreased from 10.4 to 3.9 episodes per 100 patients in the intervention group, and adherence to guidelines was 82.2%. Antibiotic therapy after surgery dropped in the intervention group due to a reduced need for treatment of urinary tract infections. Follow-up after two years revealed a sustained impact of the strategy, and a low use of antibiotics consistent with stable adherence to guidelines.