Damini Saxena, MD,
Resident Physician
Beth Israel Lahey Health
Burlington, Massachusetts
Disclosure information not submitted.
Susan Stempek, PA-C, MMSc, MBA
Dir. Advanced Practice
Lahey Hospital & Medical Center, United States
Disclosure information not submitted.
Robin Rossignoll, RN
Nurse Manager
Beth Israel Lahey Health, United States
Disclosure information not submitted.
James Dargin, MD, FCCM
Assistant Clinical Professor
Lahey Hospital & Medical Center, United States
Disclosure information not submitted.
Title: Effects of a new urine testing algorithm on catheter associated urinary tract infections in the ICU
Introduction: Catheter associated bacteriuria rarely causes fever or bloodstream infection. National consensus guidelines suggest providers perform clinical assessments to evaluate for fever, rather than routinely ordering urinalysis and urine culture, with exchange of urinary catheters prior to culturing the urine. We hypothesized that application of an evidence-based urine testing algorithm would reduce testing, improve compliance with catheter exchange, and reduce rates of catheter associated urinary tract infection (CAUTI) in the ICU.
Methods: The study was performed at a tertiary care center with 5 subspecialty ICUs totaling 52 beds. A urine testing algorithm for patients with urinary catheters was approved by hospital governing bodies in October 2020. Education on the algorithm was provided for attending physicians, advanced practitioners, nurses, residents, and fellows working in the ICUs. Best practices advisory notifications were enacted in the electronic medical record to reinforce this algorithm. Outcomes of interest, including the number of urine cultures ordered per 100 urinary catheter days, the number of CAUTIs, and the percentage of catheters exchanged prior to sending a urine culture, were examined 7 months prior to (4/2020-10/2020) and after (11/2020-5/2021) the rollout of the urine testing algorithm. Outcomes were compared using the Chi-square test.
Results: Over the course of the study, 13,208 urinary catheter days were observed (6,581 pre-intervention; 6,627 post-intervention). The number of urine cultures per 100 catheter days decreased from 2.57 to 1.07 after implementation of the intervention (p< 0.01). Compliance with urinary catheter exchange prior to sending cultures improved from 22.4% to 43.5% following the study intervention (p< 0.01). A total of 9 and 6 CAUTIs were observed prior to and after implementation of the algorithm, respectively, which was statistically insignificant in the rate of CAUTIs (0.14 vs 0.09 per 100 catheter days prior to and post-intervention, respectively; p=0.43).
Conclusions: Our data suggest that an evidence-based urine testing algorithm can reduce unnecessary urine testing and improve compliance with appropriate urine sampling. Though this intervention was not associated with a significant reduction in CAUTIs, the results are limited by a small sample size.