Reducing Catheter-associated Urinary Tract Infections via Cost-saving Diagnostic Stewardship

Luu, Allison; Domínguez, Fernándo; Yeshoua, Brandon; Vo, Christopher; Nallapa, Swathi; Chung, David; Wald-Dickler, Noah; Butler-Wu, Susan M.; Khaleel, Huda; Chang, Kai-Ting; Canamar, Catherine P; Holtom, Paul; Spellberg, Brad

doi:10.1093/cid/ciaa1512

Cited by 13 publications

(11 citation statements)

References 7 publications

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“…In addition, a hospital-wide screensaver encouraged providers to stop sending urine cultures as part of routine nosocomial fever workups. These combined interventions reduced monthly urine cultures to half across most intensive care units and wards, with a corresponding decrease in CAUTI [57].…”

Section: Cognitive Aids Rules and Policiesmentioning

confidence: 99%

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Advani

Vaughn

2021

Curr Infect Dis Rep

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Purpose ofReview-The goal of this article is to highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interventions to improve urine culture practices in the acute care setting. Recent Findings-Quality improvement initiatives aimed at reducing inappropriate treatment of asymptomatic bacteriuria often focus on optimizing urine test utilization (i.e., urine culture stewardship). Urine culture stewardship interventions in acute care hospitals span the spectrum of quality improvement initiatives, ranging from strong systems-based interventions like suppression of urine culture results to weaker interventions that focus on clinician education alone. While most urine culture stewardship interventions have met with some success, overall results are mixed, and implementation strategies to improve sustainability are not well understood.Summary-Successful diagnostic stewardship interventions are based on an assessment of underlying key drivers and focus on multifaceted and complementary approaches. Individual intervention components have varying impacts on effectiveness, provider autonomy, and sustainability. The best urine culture stewardship strategies ultimately include both technical and socio-adaptive components with long-term, iterative feedback required for sustainability.

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Section: Cognitive Aids Rules and Policiesmentioning

confidence: 99%

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Advani

Vaughn

2021

Curr Infect Dis Rep

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“…Diagnostic stewardship strategies could be effective in the treatment and prevention of NHSN CAUTI. 27,29,30 When interventions are implemented to prevent CAUTI, improved outcomes expected are reduced CAUTI, reduced indwelling urethral catheter use, reduced collection and antibiotic use for positive urine cultures, reduced antibiotic-associated complications, and reduced costs associated with these outcomes.…”

Section: Additional Approachesmentioning

confidence: 99%

“…Diagnostic stewardship strategies could be effective in the treatment and prevention of NHSN CAUTI. 27,29,30…”

Section: Section 1: Rationale and Statements Of Concernmentioning

confidence: 99%

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

Patel,

Advani,

Kofman

et al. 2023

Infect. Control Hosp. Epidemiol.

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and purposeThe intent of this document is to highlight practical recommendations in a concise format designed to assist physicians, nurses, and infection preventionists at acute-care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates the Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals published in 2014. It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission.

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“…While implementation of CPOE and CDS tools appear to result in a modest reduction in unnecessary urine culture requests, studies have shown that DS pre-analytic strategies were most effective when coupled with antibiotic stewardship-led educational support and clinician/infectious disease physician direction in devising appropriate EMR order prompts [20]. Effective interventions include a lecture series with case-based vignettes, institutional developed pocket cards with easy-to-reference diagnostic algorithms for UTI, and evidence-based guidelines with preferred treatment regimen and duration of therapy [22,25,35,[43][44][45][46][47]. One example of the effectiveness of educational objectives involved a multi-interventional approach.…”

Section: Pre-analytical Urinary Stewardship Interventionsmentioning

confidence: 99%

“…A lecture to the department of surgery and department of medicine on appropriate urine culture diagnostics was held, followed by individualized educational monthly sessions with nursing leadership from each care unit, informationtechnology (IT) computer screensaver reminders, and random chart review by infection control staff with monthly provider-specific feedback. This was combined with hospital administration support and ultimately resulted in a near 50% reduction in urine culture orders (post-interventional 280 compared to 509 urine cultures monthly) without any observed change in patient mortality [44]. Similarly, Trautner et al implemented a streamlined diagnostic algorithm for ASB and CAUTI combined with case-based audit and feedback at a Veterans Affairs (VA) health system.…”

Section: Pre-analytical Urinary Stewardship Interventionsmentioning

confidence: 99%

Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections

Morado

Wong

2022

Antibiotics

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A urinary tract infection is amongst the most common bacterial infections in the community and hospital setting and accounts for an estimated 1.6 to 2.14 billion in national healthcare expenditure. Despite its financial impact, the diagnosis is challenging with urine cultures and antibiotics often inappropriately ordered for non-specific symptoms or asymptomatic bacteriuria. In an attempt to limit unnecessary laboratory testing and antibiotic overutilization, several diagnostic stewardship initiatives have been described in the literature. We conducted a systematic review with a focus on the application of molecular and microbiological diagnostics, clinical decision support, and implementation of diagnostic stewardship initiatives for urinary tract infections. The most successful strategies utilized a bundled, multidisciplinary, and multimodal approach involving nursing and physician education and feedback, indication requirements for urine culture orders, reflex urine culture programs, cascade reporting, and urinary antibiograms. Implementation of antibiotic stewardship initiatives across the various phases of laboratory testing (i.e., pre-analytic, analytic, post-analytic) can effectively decrease the rate of inappropriate ordering of urine cultures and antibiotic prescribing in patients with clinically ambiguous symptoms that are unlikely to be a urinary tract infection.

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Reducing Catheter-associated Urinary Tract Infections via Cost-saving Diagnostic Stewardship

Cited by 13 publications

References 7 publications

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections

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