Acceptability of proposed stewardship interventions to reduce preoperative screening and treatment of asymptomatic
Kimberly C Dukes1, Kalpana Gupta2, Julia Friberg Walhof3
1Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA.
Background:
The Infectious Diseases Society of America Clinical Practice guidelines do not recommend screening patients for asymptomatic bacteriuria (ASB) before nonurological surgeries.
Methods:
We conducted semistructured interviews at 5 Veterans Affairs hospitals about the acceptability of 4 prospectively identified potential interventions to deimplement routine preoperative urine testing for ASB: substitution of another infection prevention intervention, laboratory restrictions on ordering urine tests, audit and feedback on guideline concordance, and interactive workshops. We coded responses as acceptable, not acceptable, or possibly acceptable and noted recommendations for modifications.
Results:
We interviewed 35 clinicians. Clinicians expressed concerns about deimplementing routine urine testing for specific procedures and specialties. Some actively sought to identify and treat ASB. Interviewees found audit and feedback and substitution of different infection control practices most acceptable. Interviewees suggested changes to make interventions more acceptable or feasible and identified new potential interventions.
Discussion:
Understanding clinical decision-making about preoperative urine screening and treatment can help design effective interventions to facilitate guideline concordance and support antibiotic stewardship.
Conclusions:
Interventions to optimize preoperative urine screening and treatment may require tailoring for surgical specialties and should address clinical concerns about intervention feasibility. Developing a suite of interventions could allow sites to choose intervention(s) that would work for them.
Insights
Deimplementing routine urine screening for asymptomatic bacteriuria (ASB) before nonurological surgery requires understanding clinician decision-making. Audit/feedback and alternative infection control practices were most acceptable interventions.
Area of Science:
- Infectious Diseases
- Clinical Practice Guidelines
- Antibiotic Stewardship
Background:
- Current guidelines do not recommend screening for asymptomatic bacteriuria (ASB) before nonurological surgeries.
- ASB screening is a common practice despite guideline recommendations against it.
Purpose of the Study:
- To explore clinician acceptability of interventions aimed at deimplementing routine preoperative urine testing for ASB.
- To understand barriers and facilitators to guideline concordance for ASB screening.
Main Methods:
- Semistructured interviews were conducted with 35 clinicians across 5 Veterans Affairs hospitals.
- Interventions explored included substitution, laboratory restrictions, audit/feedback, and workshops.
- Responses were coded for acceptability, and modifications were noted.
Main Results:
- Clinicians expressed concerns regarding deimplementation for specific procedures/specialties.
- Audit and feedback, along with substitution of infection control practices, were most acceptable.
- Clinicians suggested modifications and identified new intervention possibilities.
Conclusions:
- Understanding clinical decision-making is crucial for designing effective interventions.
- Interventions may need tailoring for surgical specialties and should address feasibility concerns.
- A suite of interventions can support antibiotic stewardship and guideline concordance.
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