The Importance of Knowing When To Order Urine Cultures AHRQ Pub No 1617 000316EF March 2017 Upon completion of this training participants will be able to Explain why unnecessary urine cultures can lead to increases in catheterassociated urinary tract infection CAUTI reporting ID: 705851
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Slide1
The Culture of Culturing—The Importance of Knowing When To Order Urine Cultures
AHRQ Pub. No.
16(17)-
0003-16-EF
March 2017Slide2
Upon completion of this training, participants will be able to—Explain why unnecessary urine cultures can lead to increases in catheter-associated urinary tract infection (CAUTI) reporting and resident harms
Determine when (or not) to order urine cultures
Utilize evidence-based communication strategies to more effectively communicate urine culture practices
Urine Culturing ׀ 2
Objectives
AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTISlide3
How Can Ordering Urine Cultures Lead To Resident Harms?
Urinary catheter present
Cloudy, odorous urine, sediments
Inappropriate use of urine culture
Overinflated CAUTI rates
Inappropriate treatment and antibiotic overuse
Miss the correct diagnosis
More resistant organisms,
Clostridium difficile
, increased cost, further health complications
Resident Harms
Urine Culturing
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AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTISlide4
What is Bacteriuria?Bacteria
in the urine
Bacteriuria means the resident has a positive urine culture
What is the main difference between bacteriuria and CAUTI?Bacteriuria can be symptomatic or
asymptomaticAsymptomatic bacteriuria
(ASB)
CAUTI requires presence of symptoms consistent with
UTI
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Bacteriuria Is Not the Same as CAUTI1
ASB
CAUTI
AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTISlide5
Common Signs That Are Inappropriate Triggers for Urine Cultures1
Chronically catheterized
patients have bacteriuria
99% of the time.Bacteriuria signs Urine color
Urine smellUrine sedimentCloudy urine
Pyuria (white blood cells or WBC in the urine)
Positive dipstick
Bacteriuria is not the same as CAUTI
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Pyuria Is Not Diagnostic of CAUTI2
Pyuria, like bacteriuria,
does not help
differentiate asymptomatic bacteriuria from CAUTI.Why?Pyuria in the urine is nonspecific
Pyuria can be from— The catheter itself
Bladder distension
Asymptomatic bacteriuria
Generally avoid
dipsticks in catheterized
residents
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AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTISlide7
Urine Culturing ׀ 7
What Are the Signs and Symptoms
of a CAUTI?3
ONE or MORE
of the following
:
AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI
CAUTI
Signs and Symptoms
Fever
Rigors
New confusion or functional decline
(with
NO
alternative diagnosis
AND
leukocytosis)
New suprapubic pain
or
costovertebral angle pain or tenderness
New onset hypotension
(with no
alternate noninfectious
cause)
Acute pain, swelling, or tenderness of the testes, epididymis, or prostate
Purulent (pus) discharge from around the catheterSlide8
CAUTI CriteriaNSHN* Definitions Pocket Card
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AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI
*National Healthcare Safety NetworkSlide9
Mrs. Bell is an 86-year-old resident of your facility. She is being transferred back from a weeklong stay in the hospital. She has an indwelling urinary catheter, but you are unsure why the catheter has been placed. Yesterday
her urine was clear and
yellow, but today her urine is
cloudy and smells bad. What
should be done next?UrinalysisUrine culture
Urinalysis and antibiotics
Culture and antibiotics
Nothing
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Case Scenario: Mrs. Bell
?
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Answer to Mrs. Bell’s Case
Nothing!
At least, don’t send urine for urinalysis or cultureDefinitely don’t start antibiotics!
You wouldn’t really do nothingAsk about what she ateLook at her medications
Assess for catheter traumaAssess to ensure she is at her baseline
Offer fluids; often
a better initial
step
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SBAR for Health Care Communication4,5
SBAR is a
TeamSTEPPs framework for team members to effectively communicate information to one anotherCommunicate the following information:
Situation―What is going on with the resident?Background―What is the clinical background or context?
Assessment―What do I think the problem is?
R
ecommendation―What would I recommend?
SBAR can be used with clinicians and with residents and families
Urine Culturing
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11 AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTISlide12
Using SBAR To Communicate With Residents and Families
Sometimes, residents and families push for urine cultures and antibiotics
SBAR can be used to improve communication with residents and families
When forming your SBAR make sure to considerWhat residents and their families are really asking forAlternatives to ordering cultures and using antibiotics
Possible side effects of antibiotic use
Promote
shared
decision making
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References
Nicolle LE,
Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria
in adults. Clin Infect Dis. 2005 Mar 1;40(5):643-54. PMID: 15714408.Gould CV, Umscheid CA, Agarwal RK, et al. Healthcare
Infection Control Practices Advisory Committee (HICPAC) Guidelines for the Prevention of Catheter-Associated Urinary Tract Infections 2009
. Centers for Disease Control and Prevention.
http
://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf
.
Centers
for Disease Control and Prevention. Identifying Healthcare-associated Infections (HAI) for NHSN
Surveillance. http://www.cdc.gov/nhsn/PDFs/pscManual/2PSC_IdentifyingHAIs_NHSNcurrent.pdf
.Team Formation Success Video - Sub-Acute Care. TeamSTEPPS® Long-Term Care Version.
Rockville, MD: Agency for Healthcare Research and Quality; April 2013. http://
www.ahrq.gov/teamstepps/longtermcare/video/06stry1_good/index.html.Communication: Instructor’s Slides. TeamSTEPPS® Long-Term Care
Version: Module 6. Rockville, MD: Agency for Healthcare Research and Quality; November 2012. http://
www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/module6/igltccommunication.html. Accessed October 1, 2015. Urine Culturing ׀ 13
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