Infection Control & Hospital Epidemiology (2019), 40, 228–231 doi:10.1017/ice.2018.325
Concise Communication
Use of diagnostic stewardship practices to improve urine culturing among SHEA Research Network hospitals
Kaede V. Sullivan MD, MSc1, Daniel J. Morgan MD, MS2,3 and Surbhi Leekha MD, MPH2 1Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland and 3Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
Abstract
This survey investigated interventions used by acute-care hospitals to reduce the detection of asymptomatic bacteriuria. Half of the respondents reported using reflex urine cultures but with varied urinalysis criteria and perceived outcomes. Other diagnostic stewardship interventions for urine culture ordering and specimen quality were less common.
(Received 31 August 2018; accepted 24 November 2018; electronically published 7 December 2018)
Asymptomatic bacteriuria often leads to inappropriate anti- microbial use.1 If culturing is associated with nonspecific symp- toms such as fever, a catheter-associated urinary tract infection (CAUTI) may be reported.2 Diagnostic stewardship strategies that reduce laboratory detection of asymptomatic bacteriuria may help to mitigate these negative outcomes. We conducted a survey to investigate the interventions used by acute-care hospitals to reduce unnecessary laboratory detection of asymptomatic bacteriuria.
Methods Survey development and administration
We conducted a survey on adult urine culturing practices among acute-care hospitals in the Society for Healthcare Epidemiology Research Network (SRN). A 16-item survey was created using Magnet Mail Surveys software. The survey recorded demographic characteristics of the respondent institutions; institutional prac- tices pertaining to urine culture ordering, urine collection, and transport; and in institutions that offer reflex urine cultures, the urine sources accepted for reflex testing, restriction of reflex urine cultures to specific patient populations, and strategic use of the electronic medical record (EMR) to guide orders toward reflex urine cultures. Reflex urine culture was described as follows: “Reflex urine culturing involves screening urine samples with a urinalysis (‘UA’) first. Urine is processed for culture only if pre- defined criteria are met.” Respondents were advised to consult with their laboratory for questions related to urine culture pro- cessing. The survey was e-mailed to SRN members on 3 occa- sions, and responses were accepted between March 22 and April
Author for correspondence: Kaede V. Sullivan, Temple University Hospital, 3401 Broad St, Room A2 F329, Philadelphia, PA 19140. E-mail:
kaede.ota@tuhs.temple.edu Cite this article: Sullivan KV, et al. (2019). Use of diagnostic stewardship practices to
improve urine culturing among SHEA Research Network hospitals. Infection Control & Hospital Epidemiology 2019, 40, 228–231. doi: 10.1017/ice.2018.325
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
30, 2018. Survey results were analyzed using JMP Pro 13 software (SAS Institute, Cary, NC).
Results Survey demographics
The survey was e-mailed to the 132 members of the SRN; e-mails to 10 members bounced back or the member opted out. The response rate was 43% (52 of 122). Among respondents, 39 of 52 (75%) were based in the United States or Canada and 27 of 52 (52%) described themselves as an academic medical center. An additional 16 of 52 respondents (31%) affirmed an affiliation with a medical school.
Urine culture ordering
Questionnaire responses are summarized in the Supplementary Material online. Of respondents, 23 of 52 (44%) reported that their hospital had published indications for ordering a urine culture. Of these, 4 of 23 (17%) reported that an indication had to be entered into their EMR when ordering a urine culture.
Reflex urine culturing
Among respondents, 26 of 51 (51%; 66% in the United States and Canada and 8% of international respondents) reported that their laboratory offers reflex urine cultures. Of these 26 respondents, 14 (54%) reported that their EMR was configured to guide the ordering clinician preferentially toward reflex urine cultures. Stra- tegies included placing the reflex urine culture option at the top of a list of options with routine urine culture located further down the list and/or having the reflex urine culture option “pre-checked.” Table 1 summarizes the respondents using reflex urine culture.
Among them, 25 of 26 respondents (96%) reported being able to order urine culture without a urinalysis, but 5 of 26 (19%) indi- cated restriction of “urine culture only” orders to certain
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