Preventing unnecessary urine cultures at a Veteran’s affairs healthcare system

• Published in: Infection control and hospital epidemiology 2024-08, Vol.45 (8), p.1015-1017
• Main Authors: Nix, Chad D., Messer, William B., Boda, Amy, MacKay, Kimberly T., Holmquist, Jennifer, Adams, La’Tonzia L., Gladwin, Eric, Pfeiffer, Christopher D.
• Format: Article
• Language: English
• Subjects: Algorithms; Antibiotics; COVID-19; Emergency medical care; Health care; Health care policy; Heterogeneity; Intervention; Medical tests; Pandemics; Pathology; Research Brief; Urinary tract infections; Urine; Veterans
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2024.44

Introduction An overarching goal of diagnostic stewardship is to improve the value of care delivery while avoiding patient harm.1 One strategy to decrease unnecessary urine cultures (UCx) is to implement conditional urine reflex culture (CURCx) for routine urinary tract infection (UTI) diagnosis.2 Currently no single accepted set of criteria for CURCx exists, and recent surveys indicate significant heterogeneity in its use.3,4 CURCx protocols have previously demonstrated success, primarily in inpatient settings, without evidence of harm.5,6 In this report, we sought to quantify the impact of a quality improvement project aimed at reducing unnecessary urine testing across the care spectrum at our center using an education intervention followed by electronic medical record (EMR) order menu revisions including a CURCx option; we hypothesized that we would only attain decreased urine testing to the latter. Methods Setting The VA Portland Health Care System (VAPORHCS) serves ∼95,000 Veterans and is comprised of an acute care hospital with 160 licensed beds, a 76-bed community living center (CLC) providing inpatient rehabilitation and skilled nursing care, and 10 outpatient clinics. Because growth of any amount could prompt antibiotic use, a positive UCx was defined as a culture that yielded any bacterial growth.