Using implementation science to develop and implement a guideline to reduce unnecessary preoperative testing for...

Area of Science:

• Urology
• Orthopaedic Surgery
• Infectious Disease

Background:

• Guidelines do not recommend routine preoperative testing for asymptomatic bacteriuria (ASB) before elective arthroplasty.
• Despite recommendations, preoperative urine testing remains common in orthopaedic practice.

Purpose of the Study:

• To develop and implement a guideline to reduce unnecessary preoperative testing for ASB before elective arthroplasty.
• To challenge and change outdated clinical practices in preoperative urine testing.

Main Methods:

• A mixed-methods, stepwise quality improvement project was conducted.
• Current practices were reviewed, the association between urine culture and prosthetic joint infection (PJI) pathogens was examined, and a guideline was co-designed and implemented.

Main Results:

• Preoperative mid-stream urine (MSU) testing was inconsistent (49%), with varied antimicrobial prescribing for urinary tract infections (UTIs) and ASB.
• No association was found between urine organisms and joint aspirate pathogens in PJI cases.
• Guideline implementation led to rapid uptake, adherence, and sustained reduction in unnecessary testing at 6 months.

Conclusions:

• Implementation science methodology effectively reduced unnecessary preoperative urine testing for ASB.
• The project demonstrated a sustained change in clinical practice, aligning with current guidelines.