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Teamwork and safety climate affect antimicrobial stewardship for asymptomatic bacteriuria

Published online by Cambridge University Press:  24 July 2019

Dimitri M. Drekonja ,
Larissa Grigoryan ,
Paola Lichtenberger ,
Christopher J. Graber ,
Payal K. Patel ,
John N. Van ,
Laura M. Dillon ,
Yiqun Wang ,
Timothy P. Gauthier  and
Steve W. Wiseman
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Dimitri M. Drekonja
Affiliation:
Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, Minneapolis, Minnesota Minneapolis VA Health Care System, Minneapolis, Minnesota
Larissa Grigoryan
Affiliation:
Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
Paola Lichtenberger
Affiliation:
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida Miami VA Healthcare System and University of Miami, Miami, Florida
Christopher J. Graber
Affiliation:
Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California David Geffen School of Medicine at UCLA, Los Angeles, California
Payal K. Patel
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, Michigan VA Ann Arbor Healthcare System, Ann Arbor, Michigan
John N. Van
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Laura M. Dillon
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Yiqun Wang
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Timothy P. Gauthier
Affiliation:
Miami VA Healthcare System and University of Miami, Miami, Florida
Steve W. Wiseman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, Michigan VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Bhavarth S. Shukla
Affiliation:
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida Miami VA Healthcare System and University of Miami, Miami, Florida
Aanand D. Naik
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Sylvia J. Hysong
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Jennifer R. Kramer
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Barbara W. Trautner*
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
*
Author for correspondence:. Barbara W. Trautner, Email: [email protected]
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Abstract

Objective:

In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).

Design:

Prospective surveys during January–June 2018.

Setting:

All acute and long-term care units of 4 Veterans’ Affairs facilities.

Methods:

The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).

Results:

A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.

Conclusions:

Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 963 - 967
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

Cardenas, D, Hooton, T. Urinary tract infection in persons with spinal cord injury. Arch Phys Med Rehabil 1995;76:272–280.CrossRefGoogle ScholarPubMed
Zalmanovici Trestioreanu, A, Lador, A, Sauerbrun-Cutler, MT, Leibovici, L. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev 2015;4:CD009534.Google ScholarPubMed
Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. Morbid Mortal Wkly Rept 2014;63:194–200.Google ScholarPubMed
Grigoryan, L, Naik, AD, Horwitz, D, et al. Survey finds improvement in cognitive biases that drive overtreatment of asymptomatic bacteriuria after a successful antimicrobial stewardship intervention. Am J Infect Control 2016;44:1544–1548.Google ScholarPubMed
Trautner, BW, Petersen, NJ, Hysong, SJ, Horwitz, D, Kelly, PA, Naik, AD. Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care. Am J Infect Control 2014;42:653–658.CrossRefGoogle ScholarPubMed
Drekonja, DM, Abbo, LM, Kuskowski, MA, Gnadt, C, Shukla, B, Johnson, JR. A survey of resident physicians’ knowledge regarding urine testing and subsequent antimicrobial treatment. Am J Infect Control 2013;41:892–896.CrossRefGoogle ScholarPubMed
Lee, MJ, Kim, M, Kim, NH, et al. Why is asymptomatic bacteriuria overtreated? A tertiary care institutional survey of resident physicians. BMC Infect Dis 2015;15:289.CrossRefGoogle ScholarPubMed
Trautner, BW, Greene, MT, Krein, SL, et al. Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel. Infect Control Hosp Epidemiol 2017;38:83–88.CrossRefGoogle ScholarPubMed
Russell, D, Dowding, DW, McDonald, MV, et al. Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses’ knowledge and attitudes toward infection control. Am J Infect Control 2018;46:1211–1217.Google ScholarPubMed
Mody, L, Greene, MT, Meddings, J, et al. A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Intern Med 2017;177:1154–1162.CrossRefGoogle ScholarPubMed
Trautner, BW, Grigoryan, L, Petersen, NJ, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria. JAMA Intern Med 2015;175:1120–1127.CrossRefGoogle ScholarPubMed
Sexton, JB, Helmreich, RL, Neilands, TB, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006;6:44.CrossRefGoogle ScholarPubMed
Fan, CJ, Pawlik, TM, Daniels, T, et al. Association of safety culture with surgical site infection outcomes. J Am Coll Surg 2016;222:122–128.CrossRefGoogle ScholarPubMed
DiCuccio, MH. The relationship between patient safety culture and patient outcomes: a systematic review. J Patient Saf 2015;11:135–142.CrossRefGoogle ScholarPubMed
Meeks, DW, Lally, KP, Carrick, MM, et al. Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3? Am J Surg 2011;201:76–83.CrossRefGoogle ScholarPubMed
Hessels, AJ, Larson, EL. Relationship between patient safety climate and standard precaution adherence: a systematic review of the literature. J Hosp Infect 2016;92:349–362.CrossRefGoogle ScholarPubMed
Berry, JC, Davis, JT, Bartman, T, et al. Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. J Patient Saf 2016.CrossRefGoogle Scholar
Grigoryan, L, Naik, AD, Horwitz, D, et al. Survey finds improvement in cognitive biases that drive overtreatment of asymptomatic bacteriuria after a successful antimicrobial stewardship intervention. Am J Infect Control 2016;44:1544–1548.CrossRefGoogle ScholarPubMed
Naik, AD, Skelton, F, Amspoker, AB, Glasgow, RA, Trautner, BW. A fast and frugal algorithm to strengthen diagnosis and treatment decisions for catheter-associated bacteriuria. PLoS One 2017;12:e0174415.CrossRefGoogle ScholarPubMed
Trautner, BW, Bhimani, RD, Amspoker, AB, et al. Development and validation of an algorithm to recalibrate mental models and reduce diagnostic errors associated with catheter-associated bacteriuria. BMC Med Inform Decis Mak 2013;13:48.CrossRefGoogle ScholarPubMed
Saint, S, Greene, MT, Krein, SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med 2016;374:2111–2119.CrossRefGoogle ScholarPubMed