Promoting Adherence to Best Practice Related to Urine Reflex to Culture Testing

Over a two week period, the infection control nurse, from a trauma designated facility located in norther California, planned a practice improvement project in collaboration with the laboratory microsystem to educate referring physicians and increase adherence to the Centers for Disease Control (CDC) protocol, which delineates recommended best practices related to urine reflex to culture testing. Urinalysis (UA) is a test that triggers a reflex urine culture when pyuria is present. Frequent urine culturing without the presence of pyuria can cause unnecessary treatment with antimicrobials. From January 2017 to December 2017, 10% of UAs from 200 urine samples from asymptomatic patients yielded the presence of a microorganism, necessitating antimicrobial treatment. A single center study applied a best practice and used a reflex urine culture protocol that prompted the laboratory staff to perform a UA followed by a urine culture if pyuria (WBC \u3e10/HPF) was present. Currently, the facility’s laboratory uses WBC \u3e5/HPF as a criterion. To gain physician support over a 2-week period, 25 physicians were educated using a flowchart that defines the new clinical and pyuria criteria (Appendix A). The long-term goal is to ensure that the number of urine cultures triggered by the new pyuria value aligns with Urinary Tract Infection (UTI) symptomatology, which consequently reduce unnecessary antimicrobial treatment. The project resulted in referring physicians’ engagement and adoption of the CDC protocol and agreement to monitor the number of reflex urine tests prospectively and analyze patterns that triggered treatment with antimicrobials of asymptomatic patients over a six month period