ABSTRACT
Objective: To evaluate the effectiveness and safety of an evidence-based urine culture stewardship program in reducing hospital catheter-associated urinary tract infections (CAUTIs) and the rate of CAUTIs across a 3-hospital system. Patients and Methods: This is a prospective, 2-year quality improvement program conducted from October 1, 2018, to September 30, 2020. An evidence-based urine culture stewardship program was designed, which consisted of the following: criteria for allowing or restricting urine cultures from catheterized patients, a best practice advisory integrated into the ordering system of an electronic medical record, and a systematic provider education and feedback program to ensure compliance. The system-wide rates of CAUTIs (total CAUTIs/catheter days×1000), changes in intercepts, trends, mortality, length of stay, rates of device utilization, and rates of hospital-onset sepsis were compared for 3 years before and 2 years after the launch of the program. Results: Catheter-associated urinary tract infections progressively decreased after the initiation of the program (B=-0.21, P=.001). When the trends before and after the initiation of the program were compared, there were no statistically significant increases in the ratio of actual to predicted hospital length of stay, intensive care unit length of stay, system-wide mortality, and intensive care unit mortality. Although the rates of hospital-acquired sepsis remained consistent after the implementation of the stewardship program through the first quarter of 2020, the rates showed an increase in the second and third quarters of 2020. However, hospital-onset sepsis events associated with the diagnosis of a urinary tract infection did not increase after the intervention. Conclusion: Urine culture stewardship is a safe and effective way to reduce CAUTIs among patients in a large multihospital health care system. Patient safety indicators appeared unchanged after the implementation of the program, and ongoing follow-up will improve confidence in the long-term sustainability of this strategy.
ABSTRACT
Resuming elective surgery amid shortages of rapid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests and personal protective equipment, while protecting patient and staff safety, posed a challenge at the study institution. Many hospital systems implemented testing of all presurgical patients, using results from tests performed 3 or more days prior to surgery. Among asymptomatic persons, the percent positive rates of coronavirus disease 2019 (COVID-19) tests in the region did not appear to justify this practice. Instead of universal preoperative COVID-19 testing, the authors elected to mitigate risk by implementing a preoperative program including 14 days of recommended patient self-quarantine and social distancing. For those unable to complete this program and for those undergoing high-risk, aerosol-generating procedures, targeted rapid polymerase chain reaction testing within 2 days of surgery was performed. Data from the initial 4 months suggests that this approach was noninferior to universal preoperative testing with regard to postoperative COVID-19 detection and patient exposure-related COVID-19 cases among hospital staff.
