If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria
Abstract Objective: Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2023-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X23001663/type/journal_article |
| _version_ | 1797819738633535488 |
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| author | Marisa L. Winkler Joanne Huang Jessica Starr David C. Hooper Molly L. Paras Alyssa R. Letourneau Erica S. Shenoy |
| author_facet | Marisa L. Winkler Joanne Huang Jessica Starr David C. Hooper Molly L. Paras Alyssa R. Letourneau Erica S. Shenoy |
| author_sort | Marisa L. Winkler |
| collection | DOAJ |
| description |
Abstract
Objective:
Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture. This was a before-and-after intervention study.
Methods:
Prior to the intervention, screening for ASB was included in the preoperative check list for all patients undergoing CABG. We assessed the proportion of patients undergoing screening for ASB in the 6 months prior to and after the intervention. We estimated cost savings from averted laboratory analyses, and we evaluated changes in antibiotic prescriptions. We additionally examined the incidence of postoperative surgical-site infections (SSIs), central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs) and Clostridioides difficile infections (CDIs).
Results:
Comparing the pre- and postintervention periods, urinalyses decreased by 76.5% and urine cultures decreased by 87.0%, with an estimated cost savings of $8,090.38. There were 50% fewer antibiotic prescriptions for bacteriuria after the intervention.
Conclusions:
Removal of urinalysis and urine culture from preoperative checklists for cardiac surgery led to a statistically significant decrease in testing without an increase in SSIs, CLABSIs, CAUTIs, or CDI. Challenges identified included persistence of checklists in templated order sets in the electronic health record.
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| first_indexed | 2024-03-13T09:27:01Z |
| format | Article |
| id | doaj.art-3a963685687448e7b4d894355108f37d |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-03-13T09:27:01Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-3a963685687448e7b4d894355108f37d2023-05-26T08:07:38ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2023-01-01310.1017/ash.2023.166If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuriaMarisa L. Winkler0https://orcid.org/0000-0002-9785-5034Joanne Huang1https://orcid.org/0000-0001-6601-0365Jessica Starr2David C. Hooper3Molly L. Paras4Alyssa R. Letourneau5Erica S. Shenoy6https://orcid.org/0000-0001-8086-1123Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts Department of Microbiology, Brigham and Women’s Hospital, Boston, Massachusetts Infection Control Unit, Massachusetts General Hospital, Boston, MassachusettsDepartment of Pharmacy, Massachusetts General Hospital, Boston, MassachusettsDepartment of Cardiac Surgery, Massachusetts General Hospital, Boston, MassachusettsDivision of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts Infection Control Unit, Massachusetts General Hospital, Boston, MassachusettsDivision of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, MassachusettsDivision of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, MassachusettsDivision of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts Abstract Objective: Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture. This was a before-and-after intervention study. Methods: Prior to the intervention, screening for ASB was included in the preoperative check list for all patients undergoing CABG. We assessed the proportion of patients undergoing screening for ASB in the 6 months prior to and after the intervention. We estimated cost savings from averted laboratory analyses, and we evaluated changes in antibiotic prescriptions. We additionally examined the incidence of postoperative surgical-site infections (SSIs), central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs) and Clostridioides difficile infections (CDIs). Results: Comparing the pre- and postintervention periods, urinalyses decreased by 76.5% and urine cultures decreased by 87.0%, with an estimated cost savings of $8,090.38. There were 50% fewer antibiotic prescriptions for bacteriuria after the intervention. Conclusions: Removal of urinalysis and urine culture from preoperative checklists for cardiac surgery led to a statistically significant decrease in testing without an increase in SSIs, CLABSIs, CAUTIs, or CDI. Challenges identified included persistence of checklists in templated order sets in the electronic health record. https://www.cambridge.org/core/product/identifier/S2732494X23001663/type/journal_article |
| spellingShingle | Marisa L. Winkler Joanne Huang Jessica Starr David C. Hooper Molly L. Paras Alyssa R. Letourneau Erica S. Shenoy If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria Antimicrobial Stewardship & Healthcare Epidemiology |
| title | If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria |
| title_full | If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria |
| title_fullStr | If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria |
| title_full_unstemmed | If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria |
| title_short | If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria |
| title_sort | if you don t test they will not treat impact of stopping preoperative screening for asymptomatic bacteriuria |
| url | https://www.cambridge.org/core/product/identifier/S2732494X23001663/type/journal_article |
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