Changing the culture of urine culturing: A hard stop approach to catheter-associated urinary tract infections (CAUTI) reduction.

BACKGROUND

We evaluated an electronic health record (EHR) "hard stop" intervention to reduce inappropriate urine culture (UC) orders in patients with indwelling urinary catheters (IUCs).

METHODS

In this pre-post quasi-experimental retrospective study, outcomes were compared between a pre-intervention period (January 2019-December 2020) and an intervention period (April 2021-December 2024) across a five-hospital health system in Southeast Michigan. The intervention, implemented in March 2021, tiggered a UC ordering hard stop 24 hours after admission for patients with an IUC in place for more than one day and remained active until four days after catheter removal. Overrides required medical director approval following case review, with real-time clinician education provided. Outcomes included catheter-associated urinary tract infection (CAUTI) rates per 1,000 patient days, UC order rates per 1,000 catheter days, Standardized Utilization Ratio (SUR), and Standardized Infection Ratio (SIR). Safety outcomes assessed pyelonephritis or bacteremia within three days and sepsis readmission within 30 days when UC was deemed unnecessary.

RESULTS

CAUTI rates declined from 0.523 to 0.071 (86%; P < .001). UC order rate decreased from 191.3 to 77.5 per 1,000 catheter days (59%; P < .001). SUR declined from 0.809 to 0.769 (5%; 95% CI, 0.943-0.956; P < .001). SIR decreased from 0.400 to 0.081 (81%; 95% CI, 0.124-0.32; P < .001). Of 67 override requests, 65 (94%) were denied without adverse outcomes.

CONCLUSIONS

An EHR-based hard stop with real-time review and education significantly reduced inappropriate UC ordering and CAUTI rates without compromising patient safety.