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Intervention Can Reduce Orders for Inpatient Urine Cultures

FRIDAY, Feb. 22, 2019 -- An intervention that makes changes to urine testing orderables can reduce the urine culturing rate, according to a study published online Feb. 21 in Infection Control & Hospital Epidemiology.

Satish Munigala, M.B.B.S., M.P.H., from the Washington University School of Medicine in St. Louis, and colleagues examined the impact of changes to urine testing orderables in computerized physician order entry systems on urine culturing practices. The intervention was implemented in April 2017 and consisted of notifications to providers, changes to order sets, and inclusion of new urine culture reflex tests in frequently used order sets.

A total of 18,954 inpatients had 24,569 urine cultures ordered. The researchers found that 27 percent of the urine cultures were positive. From the preintervention to the postintervention period, there was a significant decrease in the urine culturing rate for any specimen type (38.1 to 20.9 per 1,000 patient days; P < 0.001; 45.1 percent decrease), clean catch (30.0 to 18.7; P < 0.001), and catheterized urine (7.8 versus 1.9; P < 0.001). There was a decrease in urine culture rates for all specimen types using an interrupted time series model (P < 0.05). No significant change was seen in catheter-associated urinary tract infection (UTI) rates (0.30 to 0.30 per 1,000 patient days; P = 0.871).

"Everyone always worries that by ordering fewer urine cultures we might miss some UTIs, but we showed that we did not," a coauthor said in a statement.

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Posted: February 2019

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