Teamwork and safety climate affect antimicrobial stewardship for asymptomatic bacteriuria

Area of Science:

• Infectious Diseases
• Healthcare Quality and Safety
• Medical Education

Background:

• Antibiotic stewardship interventions require understanding of current provider knowledge and attitudes.
• Asymptomatic bacteriuria (ASB) management is a key area for antibiotic stewardship.
• Teamwork and safety climate influence clinical practice and patient outcomes.

Purpose of the Study:

• To assess knowledge and attitudes regarding ASB management among providers, nurses, and CNAs.
• To evaluate teamwork and safety climate within healthcare teams involved in ASB care.
• To inform the development of a multisite antibiotic stewardship intervention.

Main Methods:

• Prospective survey conducted across 4 Veterans' Affairs facilities.
• Utilized the Kicking CAUTI survey for ASB knowledge/attitudes and the Safety Attitudes Questionnaire (SAQ).
• Collected data from providers, nurses, and clinical nurse assistants (CNAs).

Main Results:

• Identified cognitive biases in ASB management, such as increased antibiotic prescribing for resistant organisms.
• Over 80% of nurses and CNAs considered foul smell an indication for urine culture.
• Significant interprofessional differences in teamwork and safety climate were observed, with CNAs scoring highest and resident physicians lowest.

Conclusions:

• Substantial misunderstanding of ASB management exists across all professional groups.
• Education and empowerment are essential to reduce unnecessary urine culturing and inappropriate antibiotic use.
• Addressing these knowledge gaps is vital for successful antibiotic stewardship.