Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-07T16:37:27.171Z Has data issue: false hasContentIssue false

Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units

Published online by Cambridge University Press:  08 July 2021

Layla A. Al-Bizri
Affiliation:
Division of Internal Medicine, Henry Ford Health System, Detroit, Michigan
Amit T. Vahia
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Khulood Rizvi
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Ana C. Bardossy
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Paula K. Robinson
Affiliation:
Department of Infection Prevention and Control, Henry Ford Health System, Detroit, Michigan
Ryan T. Shelters
Affiliation:
Department of Infection Prevention and Control, Henry Ford Health System, Detroit, Michigan
Susan Klotz
Affiliation:
Department of Nursing, Henry Ford Health System, Detroit, Michigan
Patricia M. Starr
Affiliation:
Department of Infection Prevention and Control, Henry Ford Health System, Detroit, Michigan
Katherine Q. Reyes
Affiliation:
Division of Internal Medicine, Henry Ford Health System, Detroit, Michigan Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Geehan Suleyman
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan Department of Infection Prevention and Control, Henry Ford Health System, Detroit, Michigan
George J. Alangaden*
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan Department of Infection Prevention and Control, Henry Ford Health System, Detroit, Michigan
*
Author for correspondence: George J. Alangaden, E-mail: galanga1@hfhs.org.

Abstract

Objective:

Urine cultures have poor specificity for catheter-associated urinary tract infections (CAUTIs). We evaluated the effect of a urine-culture stewardship program on urine culture utilization and CAUTI in adult intensive care units (ICUs).

Design:

A quasi-interventional study was performed from 2015 to 2017.

Setting and patients:

The study cohort comprised 21,367 patients admitted to the ICU at a teaching hospital.

Intervention:

The urine culture stewardship program included monthly 1-hour discussions with ICU house staff emphasizing avoidance of “pan-culture” for sepsis workup and obtaining urine culture only if a urinary source of sepsis is suspected. The urine culture utilization rate metric (UCUR; ie, no. urine cultueres/catheter days ×100) was utilized to measure the effect. Monthly UCUR, catheter utilization ratio (CUR), and CAUTI rate were reported on an interactive quality dashboard. To ensure safety, catheterized ICU patients (2015–2016) were evaluated for 30-day readmission for UTI. Time-series data and relationships were analyzed using Spearman correlation coefficients and regression analysis.

Results:

Urine culture utilization decreased from 3,081 in 2015 to 2,158 in 2016 to 1,218 in 2017. CAUTIs decreased from 78 in 2015 to 60 in 2016 and 28 in 2017. Regression analysis over time showed significant decreases in UCUR (r, 0.917; P < .0001) and CAUTI rate (r, 0.657; P < .0001). The co-correlation between UCUR and CAUTI rate was (r, 0.625; P < .0001) compared to CUR and CAUTI rate (r, 0.523; P = .004). None of these patients was readmitted with a CAUTI.

Conclusions:

Urine culture stewardship program was effective and safe in reducing UC overutilization and was correlated with a decrease in CAUTIs. Addition of urine-culture stewardship to standard best practices could reduce CAUTI in ICUs.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Preliminary data from this study was presented as an abstract at Society for Healthcare Epidemiology of America (SHEA) Spring Conference 2017 on March 29, 2017, in St Louis, Missouri.

References

Weber, DJ, Kang, J, Brown, VM, Sickbert-Bennett, EE, Rutala, WA. Preventing catheter-associated urinary tract infections: hospital location of catheter insertion. Infect Control Hosp Epidemiol 2012;33:10571058.CrossRefGoogle ScholarPubMed
Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101114.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Todi, SK, Álvarez-Moreno, C, et al. Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Infection 2012;40:517526.CrossRefGoogle Scholar
Lo, E, Nicolle, LE, Coffin, SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:464479.CrossRefGoogle ScholarPubMed
Niven, DJ, Laupland, KB, Tabah, A, et al. Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators survey. Crit Care 2013;17.Google ScholarPubMed
Tambyah, PA, Maki, DG. The relationship between pyuria and infection in patients with indwelling urinary catheters. Arch Intern Med 2000;160:673677.CrossRefGoogle ScholarPubMed
O’Grady, NP, Barie, PS, Bartlett, JG, et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 2008;36:13301349.CrossRefGoogle ScholarPubMed
Bardossy, AC, Williams, T, Jones, K, et al. Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: the tale of two teaching hospitals. Infect Control Hosp Epidemiol 2018;39:14941496.CrossRefGoogle ScholarPubMed
Allen-Bridson, K, Pollock, D, Gould, CV. Promoting prevention through meaningful measures: improving the Centers for Disease Control and Preventions National Healthcare Safety Network urinary tract infection surveillance definitions. Am J Infect Control 2015;43:10961098.CrossRefGoogle Scholar
National Healthcare Safety Network (NHSN) Patient Safety Component Manual. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Published 2019. Accessed on August 11, 2019.Google Scholar
Knoll, BM, Wright, D, Ellingson, L, et al. Reduction of inappropriate urinary catheter use at a Veterans’ Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis 2011;52:12831290.CrossRefGoogle Scholar
Saint, S, Kowalski, CP, Banaszak-Holl, J, Forman, J, Damschroder, L, Krein, SL. The importance of leadership in preventing healthcare-associated infection: results of a multisite qualitative study. Infect Control Hosp Epidemiol 2010;31:901907.CrossRefGoogle ScholarPubMed
Singh, S, Kumar, RK, Sundaram, KR, Kanjilal, B, Nair, P. Improving outcomes and reducing costs by modular training in infection control in a resource-limited setting. Int J Qual Health Care 2012;24:641648.CrossRefGoogle Scholar
Saint, S, Olmsted, RN, Fakih, MG, et al. Translating healthcare-associated urinary tract infection prevention research into practice via the bladder bundle. Joint Comm J Qual Patient Saf 2009;35:449455.Google Scholar
Chenoweth, C, Saint, S. Preventing catheter-associated urinary tract infections in the intensive care unit. Crit Care Clin 2013;29:1932.CrossRefGoogle ScholarPubMed
Palumbo, AJ, Loveless, PA, Moll, ME, Ostroff, S. Evaluation of healthcare-associated infection surveillance in Pennsylvania hospitals. Infect Control Hosp Epidemiol 2012;33:105–11.CrossRefGoogle ScholarPubMed
Meddings, J, Rogers, MAM, Macy, M, Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51:550560.CrossRefGoogle ScholarPubMed
Shirley, D, Scholtz, H, Osterby, K, Musuuza, J, Fox, B, Safdar, N. Optimizing inpatient urine culture ordering practices using the electronic medical record: a pilot study. Infect Control Hosp Epidemiol 2017;38:486488.CrossRefGoogle ScholarPubMed
Mullin, KM, Kovacs, CS, Fatica, C, et al. A multifaceted approach to reduction of catheter-associated urinary tract infections in the intensive care unit with an emphasis on “stewardship of culturing.” Infect Control Hosp Epidemiol 2017;38:186188.CrossRefGoogle ScholarPubMed
Catheter-associated urinary tract infection (CAUTI). Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/training/strive.html#anchor_CAUTI. Published 2019. Accessed June 16, 2021.Google Scholar
Supplementary material: File

Al-Bizri et al. supplementary material

Al-Bizri et al. supplementary material

Download Al-Bizri et al. supplementary material(File)
File 412.5 KB