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The clinical impact of a urinary tract infection management bundle in a tertiary-care teaching hospital

Published online by Cambridge University Press:  03 December 2018

Timothy D. MacLaggan Open the ORCID record for Timothy D. MacLaggan [Opens in a new window] ,
Christopher P. Le ,
Kristen A. Iverson ,
Chelsey L. Ellis ,
Jacques Allard ,
Tammie J. Wilcox-Carrier  and
Daniel J. Smyth
Timothy D. MacLaggan*
Affiliation:
Department of Pharmacy Services, Horizon Health Network, Moncton, New Brunswick, Canada
Christopher P. Le
Affiliation:
Family Practice, Fraser Health, New Westminster, British Columbia, Canada
Kristen A. Iverson
Affiliation:
Dalhousie University Department of Medicine, Halifax, Nova Scotia, Canada
Chelsey L. Ellis
Affiliation:
Department of Laboratory Medicine, Horizon Health Network, Moncton, New Brunswick, Canada
Jacques Allard
Affiliation:
Département de mathématiques et statistique, Université de Moncton, Moncton, New Brunswick, Canada (retired)
Tammie J. Wilcox-Carrier
Affiliation:
Department of Laboratory Medicine, Horizon Health Network, Moncton, New Brunswick, Canada
Daniel J. Smyth*
Affiliation:
Department of Internal Medicine, Horizon Health Network, Moncton, New Brunswick, Canada
*
Author for correspondence: Dr Timothy MacLaggan, Clinical Resource Pharmacist, Infectious Disease, Horizon Health Network, 135 MacBeath Ave., Suite 6400, Moncton, NB, E1C 6Z8. E-mail: Timothy.MacLaggan@HorizonNB.ca Or Dr Daniel Smyth, Infectious Diseases/Internal Medicine, Horizon Health Network, 135 MacBeath Ave, Suite 6400, Moncton, NB, E1C 6Z8. E-mail: dr.daniel.smyth@horizonnb.ca
Author for correspondence: Dr Timothy MacLaggan, Clinical Resource Pharmacist, Infectious Disease, Horizon Health Network, 135 MacBeath Ave., Suite 6400, Moncton, NB, E1C 6Z8. E-mail: Timothy.MacLaggan@HorizonNB.ca Or Dr Daniel Smyth, Infectious Diseases/Internal Medicine, Horizon Health Network, 135 MacBeath Ave, Suite 6400, Moncton, NB, E1C 6Z8. E-mail: dr.daniel.smyth@horizonnb.ca
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Abstract

Objective

The aim of this study was to assess the impact of a urinary tract infection (UTI) management bundle to reduce the treatment of asymptomatic bacteriuria (AB) and to improve the management of symptomatic UTIs.

Design

Before-and-after intervention study.

Settings

Tertiary-care hospital.

Patients

Consecutive sample of inpatients with positive single or mixed-predominant urine cultures collected and reported while admitted to the hospital.

Methods

The UTI management bundle consisted of nursing and prescriber education, modification of the reporting of positive urine cultures, and pharmacists’ prospective audit and feedback. A retrospective chart review of consecutive inpatients with positive urinary cultures was performed before and after implementation of the management bundle.

Results

Prior to the implementation of the management bundle, 276 patients were eligible criteria for chart review. Of these 276 patients, 165 (59·8%) were found to have AB; of these 165 patients with AB, 111 (67·3%) were treated with antimicrobials. Moreover, 268 patients met eligibility criteria for postintervention review. Of these 268, 133 patients (49·6%) were found to have AB; of these 133 with AB, 22 (16·5%) were treated with antimicrobials. Thus, a 75·5% reduction of AB treatment was achieved. Educational components of the bundle resulted in a substantial decrease in nonphysician-directed urine sample submission. Adherence to a UTI management algorithm improved substantially in the intervention period, with a notable decrease in fluoroquinolone prescription for empiric UTI treatment.

Conclusions

A UTI management bundle resulted in a dramatic improvement in the management of urinary tract infection, particularly a reduction in the treatment of AB and improved management of symptomatic UTI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 1 , January 2019 , pp. 72 - 78
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Retired.

PREVIOUS PRESENTATION: Preliminary abstract was presented as a poster for the 2016 AMMI Canada Annual conference and was published as Smyth D, Iverson K, Le C, Hussain Z, MacLaggin T, Wilcox T, Ellis C. The clinical impact of a UTI management bundle in a tertiary-care teaching hospital. JAMMI 2016;1.1:73 (IP13).

Cite this article: MacLaggan TD, et al. (2019). The clinical impact of a urinary tract infection management bundle in a tertiary-care teaching hospital. Infection Control & Hospital Epidemiology 2019, 40, 72–78. doi: 10.1017/ice.2018.276

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