403. Success of a 3-Day Hard Stop on Repeat Urine Cultures for the Reduction of Reported National Healthcare Safety Network (NHSN) Catheter-Associated Urinary Tract Infections (CAUTIs)
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • ID WEEK 2016 - 3-DAY HARD STOP UCXs (POSTER v4).pdf (264.1 kB)
  • Background: CAUTIs are the leading cause of healthcare associated infections. NHSN definitions condition CAUTI reporting. Unfortunately, urine cultures (UCXs) are often contaminated, so positive UCX may not reflect a true UTI, or CAUTI. However, if a positive UCX fulfills NHSN criteria for CAUTI it will be so classified. Unlike blood cultures which are often only intermittently positive during an infection, it is unlikely that a febrile patient with a negative UCX on day 1 of a multi-day febrile episode will have a positive UCX on day 2 or 3; unless the repeat UCX was contaminated. Unfortunately, many UCXs are sent as a reflex response to fever, without weighing the likelihood that there is a urologic source for the fever. This underpinned the implementation of a 3-day hard stop on repeat UCXs for inpatients at our institution.

    Methods: This is a single center pre-post observational study of the impact of a 3-day hard stop on repeat UCXs for inpatients. We tracked total and repeat UCXs, NHSN CAUTIs, calls to the microbiology lab for overrides of the hard stop, as well as adverse events, such as later recognition of UTIs and urosepsis.

    Results: After instituting the 3-day hard stop on repeat UCXs, there was a dramatic decrease in the number of repeat UCXs within the 3-day hard stop “black out” period (187/month vs 35/month, p<0.001)(Fig 1). There was also a general decrease in total number of UCXs over time (604/month vs 335/month, p<0.001)(Fig 1). Total positive UCXs and CAUTIs also decreased after the hard stop (2.30 vs 1.43/1000 Foley days, p=0.04, for CAUTIs). Override calls to the microbiology lab were common at first, but trailed off over time. We found no change in the number of sepsis events from a urologic source from the pre-post the hard stop.

    Conclusion: A 3-day hard stop on repeat UCXs played a key role in reducing the number of positive contaminated UCXs at our institution. Since many contaminant UCXs occur in febrile patients with a urinary Foley catheter they may meet NHSN definitions for CAUTIs, and be so classified. Reducing clinically not indicated repeat UCXs has been a successful intervention to help reduce CAUTIs reported to NHSN. The continued decline in total UCX orders over time may reflect increasing staff awareness for sending UCXs only as indicated, rather than as a reflex response to fever.

    Figure 1.

     

    Jorge P Parada, MD, MPH1, Shruti B Patel, MD1, Elaine Trulis, MS, BSN, RN2, Roman Golash, MS3, Ashley Boldyga, BSHSM4, Gayle M Payonk, RN2 and Paul C Schreckenberger, PhD3, (1)Medicine, Loyola University Medical Center, Maywood, IL, (2)Nursing, Loyola University Medical Center, Maywood, IL, (3)Microbiology, Loyola University Medical Center, Maywood, IL, (4)Center for Clinical Effectiveness, Loyola University Medical Center, Maywood, IL

    Disclosures:

    J. P. Parada, None

    S. B. Patel, None

    E. Trulis, None

    R. Golash, None

    A. Boldyga, None

    G. M. Payonk, None

    P. C. Schreckenberger, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.