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Original article
Educational intervention to reduce treatment of asymptomatic bacteriuria in long-term care
  1. Christine Lee1,
  2. Casey Phillips2,
  3. Jason Robert Vanstone2,3
  1. 1 College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  2. 2 Antimicrobial Stewardship Program, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  3. 3 Research and Performance Support, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  1. Correspondence to Dr Jason Robert Vanstone; jason.vanstone{at}saskhealthauthority.ca

Abstract

Objective To determine if an educational intervention can decrease the inappropriate antibiotic treatment of long-term care (LTC) residents with asymptomatic bacteriuria (ASB).

Design Prospective chart audit between May and July 2017.

Setting Seven LTC facilities in Regina, Saskatchewan, Canada.

Participants Chart audits were performed on all LTC residents over 18 years of age with a positive urine culture. Educational sessions and tools were available to all clinical staff at participating LTC facilities.

Intervention Fifteen-minute educational sessions were provided to LTC facility staff outlining the harms of unnecessary antibiotic use, antibiotic resistance and the diagnostic criteria of a urinary tract infection (UTI). Educational sessions were complimented with posters and pocket cards that summarised UTI diagnostic criteria.

Main outcome measure The primary outcome measure was the number of residents who received inappropriate antibiotic treatment for ASB. Secondary outcome measures included the appropriateness of urine culture tests, number of tests and cost associated with inappropriate treatments.

Results In the preintervention period, 172 urine culture and sensitivity (UC&S) tests were performed, 62 (36.0%) were positive and 50/62 (80.6%) residents had ASB based on chart review. In the postintervention period, 151 UC&S tests were performed, 50 (33.1%) were positive and 35/50 (70.0%) residents had ASB. There was a statistically significant decrease in the number of residents treated with antibiotics for ASB, from 45/50 (90%) preintervention to 22/35 (62.9%) postintervention (χ2=9.087, p=0.003).

Conclusions An educational intervention was associated with a statistically significant decrease in inappropriate antibiotic treatment of LTC residents with ASB.

  • bacteriuria
  • urinary tract infections
  • anti-bacterial agents
  • early intervention (education)
  • antimicrobial stewardship

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2018-000483

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    Footnotes

    • Contributors All authors contributed to the conception and design of the study. CL performed chart audits, educational interventions and data analysis. All authors contributed to the final manuscript.

    • Funding This work was supported by the Regina Qu’Appelle Health Region – Regina Summer Student Programme.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study received ethics approval from the Regina Qu’Appelle Health Region Research Ethics Board (REB-17–40).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.