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Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges

  • Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
  • Published:
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Abstract

Purpose of Review

The goal of this article is to highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interventions to improve urine culture practices in the acute care setting.

Recent Findings

Quality improvement initiatives aimed at reducing inappropriate treatment of asymptomatic bacteriuria often focus on optimizing urine test utilization (i.e., urine culture stewardship). Urine culture stewardship interventions in acute care hospitals span the spectrum of quality improvement initiatives, ranging from strong systems-based interventions like suppression of urine culture results to weaker interventions that focus on clinician education alone. While most urine culture stewardship interventions have met with some success, overall results are mixed, and implementation strategies to improve sustainability are not well understood.

Summary

Successful diagnostic stewardship interventions are based on an assessment of underlying key drivers and focus on multifaceted and complementary approaches. Individual intervention components have varying impacts on effectiveness, provider autonomy, and sustainability. The best urine culture stewardship strategies ultimately include both technical and socio-adaptive components with long-term, iterative feedback required for sustainability.

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Acknowledgements

We would like to thank Dr. David Weber, Professor of Medicine, Infectious diseases, University of North Carolina, for review of the manuscript.

Funding

SA reports grants from the CDC, NIH NIDDK K12 (K12DK100024), SHEA and consulting fees from IPEC Experts, LLC (co-owner) and IDSA. VV reports grants from AHRQ, Gordon and Betty Moore Foundation, NHBLI, NIA, and SHEA.

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  1. Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA

    Sonali Advani

  2. Duke Infection Control Outreach Network, Durham, NC, USA

    Sonali Advani

  3. Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Valerie M. Vaughn

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Correspondence to Sonali Advani.

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Advani, S., Vaughn, V.M. Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges. Curr Infect Dis Rep 23, 16 (2021). https://doi.org/10.1007/s11908-021-00760-3

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