ICHE’s reviews on surgical infections, unnecessary urine tests, and nurses' role in antibiotic stewardship

Reviewed by James Ives, M.Psych. (Editor)Feb 22 2019

SIMPLE CHANGE TO STANDARD ORDERS REDUCES URINE TESTING IN ASYMPTOMATIC PATIENTS

Title: Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: Analysis from a large academic medical center

Conclusions: Changes to standard urine orders in a computer physician order entry (CPOE) system, resulted in a 45% reduction in unnecessary urine cultures ordered, a change that is expected prevent unnecessary treatment of asymptomatic patients whose bacteria counts are above normal.

Background: Urinalysis and urine culture are commonly ordered tests among hospitalized patients suspected of urinary tract infection (UTI). However, these tests are often ordered for patients without clinical suspicion of UTI, leading to unnecessary testing and increased hospital costs. Positive urine cultures are a major driver for antibiotic treatment. Despite research and professional society recommendations against antibiotic prescriptions for asymptomatic bacterial infections, treatment is still common. This study looked at the impact of simple changes to inpatient urine orders in a computer physician order entry system on the urine culturing practices in a larger urban medical center.

SURGICAL SITE INFECTIONS ARISE FROM PATIENT'S MICROBIOME

Title: Surgical site infections and the microbiome: An updated perspective

Conclusions: Almost all Surgical Site Infections arise from the patient's microbiome. The occurrence of surgical site infections can be viewed as a perioperative failure to control the microbiome.

Background: A literature review examining recognized sources of bacteria causing surgical site infections showed that, depending on key assumptions, approximately 70 to 95 percent of all SSIs arise from the microbiome of the patients' skin or nose. Data suggest that the infecting bacteria were present at the incision site at the time of surgery.

BEDSIDE NURSES ROLE IN ANTIBIOTIC STEWARDSHIP

Title: Integrating bedside nurses into antibiotic stewardship: A practical approach

Summary: A growing number of medical professional organizations and public health agencies endorse the role of nurses as partners in antibiotic stewardship, but practical guidance of how to best integrate nurses into stewardship is lacking. Authors present specific examples of the potential role of bedside nurses in antimicrobial stewardship activities, and provide a framework for integrating bedside nurses into stewardship activities, including elements needed to integrate nurses into stewardship efforts as well as obstacles.