QAPI 106 - Effect of Utilizing Standard Criteria for Ordering Urine Cultures in Catheterized Patients in an Academic Medical Center

Background: Prevention of catheter-associated urinary tract infections (CAUTIs) reduces healthcare facilities' morbidity, mortality, and cost. Being a major academic medical center, we are challenged with excessive urine culture orders without a precise medical indication which falsely increases the number of CAUTIs and superfluous antibiotics treatment.

Methods: This quality improvement project was conducted at a 953 - bed- level 1 trauma teaching facility. In January 2019, a novel urine culture ordering tool was built into the Electronic Medical Record (EMR) after obtaining approval from the executive medical committee. The tool outlined indications required for ordering urine culture as being at least one of the following: the patient being pregnant, being Neutropenic, has urologic procedure/surgery, has a Kidney transplant, suffers from urinary retention, unexplained suprapubic or flank pain.

Results: The number of ordered urine cultures significantly declined from 10952 in 2019, 7505 during 2020, to 7484 in 2021. Compared to 11956 collected urine cultures before implementing the urine culture ordering criteria in 2018. Statistically, a significant reduction in the number of CAUTIs was reported since the application of the tool in 2019, as indicated by standardized infection ratio (SIR) of 0.7, 0.4, and 0.3, associated with significant P-value of 0.000 during 2019, 2020, and 2021 respectively. Compared to SIR values of 1 and 0.8, associated with a non-significant P-value of 0.5 during 2017 and 2018, respectively.

Conclusions: Applying standard indications for urine culture collection in an academic facility reduced CAUTI and eliminated redundant antibiotic treatment.