Reducing inappropriate urine cultures through a culture standardization program

Background: The objective of this study was to evaluate the impact of a urine culture standardization program that included order indications and urinalysis (U/A) with reflexive culture. The program applied to all adult and pediatric inpatients at an academic medical center; emergency department and ambulatory clinic patients were excluded. Methods: The analysis compared outcomes in the pre-implementation (January 2015-May 2016) and postimplementation (July 2016-September 2017) periods. The primary outcomes were urine culture and U/A orders per 1,000 patient days, catheter-associated urinary tract infection (CAUTI) rate per 1,000 catheter days, and urine culture contamination rate per 1,000 patient days. Catheter standardized utilization ratios (SURs) were also examined. Results: The intervention was associated with a significant decrease in urine culture rates by 6.9 cultures per 1,000 patient days (95% CI -4.44, -9.44; P <.0001). The U/A testing rate per 1,000 patient days significantly increased pre-intervention, was not affected acutely by the intervention institution, and significantly decreased post-implementation. The CAUTI rate was not significantly changed by the intervention but did significantly increase post-implementation by 0.2 per 1,000 catheter days (95% CI 0.01, 0.47; P =.04); SURs significantly decreased (0.03; 95% CI -0.003, -0.05; P =.03); and the urine culture contamination rate per month showed no significant change. Sixty-four percent of urine cultures ordered using the reflexive test did not reflex to culture by U/A criteria. Conclusions: A urine culture standardization program led to a significant reduction in urine cultures and did not lead to an increase in U/A testing rates. CAUTI rates increased post-implementation, which may have been confounded by reduced catheter utilization. (C) 2019 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.