If healthcare workers in long-term care communities can reduce unnecessary urine culture testing on residents, they can also lower the amount of unneeded antibiotics, according to a new report in The BMJ.
The problem originates when a resident tests positive on a urine culture but actually doesn’t have an infection. Instead, they can have asymptomatic bacteriuria (ASB) in which there are bacteria but no symptoms and no pyuria (white blood cells in the urine). Testing people when they don’t have symptoms prompts unnecessary antibiotic treatment, the study noted.
Long-term care facilities need to adopt strategies to reduce unneeded urine cultures. These strategies include targeted education that’s accompanied by system changes such as modification of order sets and routine panels, elimination of urine dipsticks, and changes to laboratory processing and reporting.
The changes involve staff member education. The authors advise using brochures and posters to remind staff members to reduce ordering urine cultures. In-person training, webinars and one-on-one coaching can also help. And it’s important to educate family members that withholding testing when symptoms aren’t present does not mean their loved one isn’t getting care; rather, it’s a way to avoid unnecessary antibiotics, they added.
“In settings that utilize order sets, these should be updated to remove all non-evidence based urine testing outside of minimum accepted UTI symptoms,” the authors wrote. “Removing access to urine dipsticks in long-term care homes can reduce unnecessary urine cultures.”
How labs report the results can also affect whether antibiotics are administered, the report said. “One example is increasing the threshold for defining significant growth in urine culture based on data suggesting that low colony counts are only rarely associated with infection in older adults admitted to hospital wards,” the authors added.
