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ICHE Roundup: Unnecessary urine tests, surgical infections, nurses' role in stewardship

February 21, 2019


Title: Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: Analysis from a large academic medical center

Conclusions: Changes to standard urine orders in a computer physician order entry (CPOE) system, resulted in a 45% reduction in unnecessary urine cultures ordered, a change that is expected prevent unnecessary treatment of asymptomatic patients whose bacteria counts are above normal.

Background: Urinalysis and urine culture are commonly ordered tests among hospitalized patients suspected of urinary tract infection (UTI). However, these tests are often ordered for patients without clinical suspicion of UTI, leading to unnecessary testing and increased hospital costs. Positive urine cultures are a major driver for antibiotic treatment. Despite research and professional society recommendations against antibiotic prescriptions for asymptomatic bacterial infections, treatment is still common. This study looked at the impact of simple changes to inpatient urine orders in a computer physician order entry system on the urine culturing practices in a larger urban medical center.


Title: Surgical site infections and the microbiome: An updated perspective

Conclusions: Almost all Surgical Site Infections arise from the patient's microbiome. The occurrence of surgical site infections can be viewed as a perioperative failure to control the microbiome.

Background: A literature review examining recognized sources of bacteria causing surgical site infections showed that, depending on key assumptions, approximately 70 to 95 percent of all SSIs arise from the microbiome of the patients' skin or nose. Data suggest that the infecting bacteria were present at the incision site at the time of surgery.


Title: Integrating bedside nurses into antibiotic stewardship: A practical approach

Summary: A growing number of medical professional organizations and public health agencies endorse the role of nurses as partners in antibiotic stewardship, but practical guidance of how to best integrate nurses into stewardship is lacking. Authors present specific examples of the potential role of bedside nurses in antimicrobial stewardship activities, and provide a framework for integrating bedside nurses into stewardship activities, including elements needed to integrate nurses into stewardship efforts as well as obstacles.
About ICHE

Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility.

The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society's work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at, and @SHEA_Epi.

Society for Healthcare Epidemiology of America

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