205. To culture or not to culture: a survey of resident physicians and nurses on diagnosis and management of catheter associated urinary tract infections
Session: Poster Abstract Session: Catheter-associated UTIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Final%20IDSA%20poster[1].jpg (855.3 kB)
  • Background: The diagnosis and management of catheter associated urinary tract infections (CAUTIs) starts by obtaining a urine culture, often triggered by subjective observations that may not relate to infection.

    Methods: We conducted two surveys of resident physicians (RPs) and nurses. The surveys addressed when and how to obtain a urine culture, and management of catheterized patients with positive urine cultures. A score for correct answers on what triggers obtaining a urine culture was calculated (12 questions, each question 1 point).

    Results: 265 participants [106 RPs (40%), 159 nurses (60%)] completed the survey. Only 32 (30.2%) RPs compared to 73 (45.9%) of nurses rated their knowledge regarding CAUTI as excellent or above average (p=0.01). Both RPs and nurses showed poor knowledge on what triggers ordering a urine culture in patients with an indwelling catheter (Table). The mean scores (of 12 points) assessing what triggers a urine culture were 6.92.3 for RPs compared to 4.91.9 for nurses (p<0.001). In addition, RPs tended to order more urine cultures the higher the number of urine white cell counts: for 25 (n=71, 67%), for 100 (n=94, 88.7%), and for 500 (n=101, 95.3%). 112 (70.9%) nurses reported obtaining urine culture specimen from sampling port in >90% of the time.

    Conclusion: There are significant opportunities for improvement in training RPs and nurses regarding the appropriate reasons for collecting urine cultures, diagnosis and management of CAUTI. Hospitals may consider evaluating their health care workers' knowledge and practice.

    Table: Examples of conditions that may trigger obtaining a urine culture for resident physicians (RP) and nurses in a catheterized patient.

    Scenarios (correct answer)

    RP answered correctly (%)

    Nurse answered correctly (%)

    P-value

    Foul smelling urine (no)

    31 (29.2)

    6 (3.8%)

    <0.001

    Cloudy urine (no)

    22 (20.8%)

    8 (5%)

    <0.001

    Sediment in urine (no)

    49 (46.2%)

    19 (11.9%)

    <0.001

    For patients with a chronic indwelling urinary catheter (no)

    60 (56.6%)

    27 (17%)

    <0.001

    Lower abdominal pain (yes)

    82 (77.4%)

    113 (71.1%)

    0.26

    New onset confusion in elderly (yes)

    95 (89.6%)

    142 (89.3%)

    0.94

    Patient scheduled for a bladder tumor resection (yes)

    53 (50%)

    76 (47.8%)

    0.73

    Patient scheduled for colon surgery (no)

    64 (60.4%)

    62 (39%)

    0.001

    Jehad Sibai, MD, Infectious Diseases, St John Hospital and Medical Center, Grosse Pointe Woods, MI, Karen Jones, RN, BSN, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, Karen Straetmans, MSN-Ed, BSN, CNOR, St John Hospital and Medical Center, Detroit, MI and Mohamad Fakih, MD, MPH, St. John Hospital and Medical Center, Grosse Pointe Woods, MI

    Disclosures:

    J. Sibai, None

    K. Jones, None

    K. Straetmans, None

    M. Fakih, None

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