Sustain Reductions Achieved with Your Program

Monitoring

Monitoring before, during, and after implementation of your program will help ensure that you target areas in need of improvement and allow you to adjust your program as needed if goals are not being met.

Monitoring can be performed at different levels starting at the highest (facility-level) down to the individual unit level. For example, evaluating rates in different Intensive Care Units in your facility may help you find the locations with the highest rates and allow you to target your program.

Areas to monitor

• Number of urine cultures among inpatients by unit, during a certain time period (e.g. monthly).
• Rate of urine cultures/1,000 patient days.
• Percent of urine cultures collected from patients with urinary catheters.
• Case-based audits for appropriateness of urine culture orders.
• Rate of catheter-associated urinary tract infections (CAUTIs)/1,000 patient days
• Patient harms (e.g. under treatment of CAUTI, rates of bloodstream infections due to Enterobacteriaceae)

Other quality improvement metrics

• Number of individuals that have documented completion of competency-based training
• Average time from collection of culture to arrival in laboratory.
• Average time between culture result and provider receipt of results.
• Percent of urine cultures reported as contaminated.

Competency assessments and audits

Competency assessments and audits of staff practices will help you target needs in your program and evaluate efficacy of your program.

Areas to audit include:

• Urine sample collection
• Documenting urine culture indication

Feedback

An important aspect of monitoring and audits includes feedback to staff on performance. This can be done at a group level using aggregated data or at an individual level. Written reports or in-person feedback are options. Some examples include:

• Providing an individual physician with feedback on lack of documentation of reasons for ordering urine cultures
• Presenting aggregate findings at monthly unit meetings regarding how frequently the reason for ordering urine culture was not documented.
• Identifying providers who order the highest number of urine cultures and how often the reason for the urine culture being ordered can be classified as appropriate or inappropriate. A written report can be sent to each provider along with education materials on the appropriate reasons for urine culture

Example script for obtaining feedback

• Page 30 of the Supplementary Online Content: for Effectiveness of an antimicrobial stewardship approach for urinary catheter–associated asymptomatic bacteriuria