The evidence is clear: using antimicrobials for asymptomatic bacteriuria is unnecessary. Despite this fact, they are still frequently prescribed leading to antibiotic associated adverse events. To help reduce the use of antimicrobials in the emergency department, Michael Garron Hospital (MGH), a large community hospital in East Toronto, has come up with a novel solution.
It’s an innovation from MGH’s Antimicrobial Stewardship program that involves a unique two-step model of care for urine collection. Led by Dr. Jeff Powis, infectious diseases physician at MGH and Antimicrobial Stewardship Director, the research team modified the typical urine collection process in the emergency department. First urine was collected by nurses in a specialized container containing a preservative which allowed the urine to remain at room temperature for up to 48hrs. These samples were then sent to the lab. However, they were only sent for urine culture if a physician ordered a “Step 2” after clinical assessment which determined it was necessary.
The team found that this two-step model for urine collection resulted in a decrease in unnecessary urine cultures, callbacks for positive results and antimicrobial use without evidence of untreated urinary tract infections. Although the new urine collection tubes were more expensive than the old ones, the new process saved money by reducing the number of urine cultures sent and reduced physician time spent calling patients with asymptomatic bacteriuria.
For the full study, please click:
http://qualitysafety.bmj.com/content/early/2017/05/03/bmjqs-2016-006250.full
See the project posted here:
https://quorum.hqontario.ca/en/home/projects/Impact-of-two-step-urine-culture-ordering-in-the-Emergency-Department.