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Developing a Urine Culture Stewardship Program for Hospitalized Patients

Survey Current Practices and Outcomes

 

Survey current practices and outcomes to determine the potential benefit of urine culture stewardship for your facility.

Current Practices

Understanding baseline staff practices and knowledge, and available process and outcome measures is important prior to planning and implementing a urine culture stewardship program.

Does your organization perform surveillance for CAUTIs?

  • Consistent tracking and reporting of catheter-associated urinary tract infection (CAUTI) surveillance data can provide the opportunity to understand the epidemiology of CAUTIs at your facility and target areas where prevention might be most impactful.
  • Surveillance definitions can be found on the National Healthcare Safety Network (NHSN)
  • Does your organization perform surveillance for CAUTIs? If so, are the CAUTI events reviewed periodically?
  • What are your facility baseline CAUTI rates and standardized infection ratio (SIR)? Are certain units disproportionately affected?

When urine cultures are ordered is the indication for the culture documented?

  • Documenting an indication for urine cultures can help determine whether cultures are ordered for appropriate reasons.
  • Does your organization have a policy regarding the documentation of urine culture indication?
  • Are indications appropriate?

What is the urine culture rate per 1,000 patient days?

  • Obtaining a baseline measure of urine culture rates will help gauge reductions achieved by the initiative. Does your organization track urine culture rates?

Has your organization taken any actions to reduce the use of antibiotics for the inappropriate treatment of asymptomatic bacteriuria?

  • Antibiotic stewardship teams may have implemented initiatives to reduce use of antibiotics. Have any of these initiatives targeted preventing inappropriate treatment for asymptomatic bacteriuria (ASB)?

Has your organization undertaken any performance improvement initiatives related to reducing CAUTI?

  • Several evidence-based practices have been shown to reduce CAUTI including reducing the use of urinary catheters. For example, many facilities have developed interventions to help avoid the use of urinary catheters when they are not indicated including nurse-driven protocols for the removal of urinary catheters as soon as no longer required.
  • Were interventions targeting the collection of urine cultures included in your facility’s CAUTI reduction initiatives?

 

Resources to Help You Better Understand Your Organization’s Practices

  • Information collection methods information can be found in the Sustain Reductions section under these subheadings:
    • Monitoring
    • Competency Assessments and Audit

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