Winkler Marisa L, Huang Joanne, Starr Jessica, Hooper David C, Paras Molly L, Letourneau Alyssa R, Shenoy Erica S
Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts.
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Antimicrob Steward Healthc Epidemiol. 2023 May 26;3(1):e95. doi: 10.1017/ash.2023.166. eCollection 2023.
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.
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 infections (CDIs).
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.
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.
除接受侵入性泌尿外科手术的患者及孕期女性外，不建议对无症状菌尿（ASB）进行筛查。尽管国家指南不建议筛查ASB，但这种做法仍很普遍。我们展示了针对马萨诸塞州波士顿一家三级护理医院——麻省总医院接受冠状动脉搭桥手术（CABG）的患者进行质量改进干预的结果，在该医院，术前检查清单被修改以去除常规尿液分析和尿培养。这是一项干预前后的研究。
在干预前，对所有接受CABG的患者，ASB筛查包含在术前检查清单中。我们评估了干预前后6个月内接受ASB筛查的患者比例。我们估计了避免实验室分析所节省的成本，并评估了抗生素处方的变化。我们还检查了术后手术部位感染（SSI）、中心静脉导管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）和艰难梭菌感染（CDI）的发生率。
比较干预前后时期，尿液分析减少了76.5%，尿培养减少了87.0%，估计节省成本8090.38美元。干预后，针对菌尿的抗生素处方减少了50%。
从心脏手术的术前检查清单中去除尿液分析和尿培养，导致检测在统计学上显著减少，且未增加SSI、CLABSI、CAUTI或CDI。确定的挑战包括电子健康记录中模板化医嘱集里检查清单的持续存在。
