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Response to Mr. Babar’s Letter to the Editor regarding “Healthcare worker attitudes on routine non-urological preoperative urine cultures: a qualitative assessment”

Published online by Cambridge University Press:  19 March 2025

Julia E. Friberg Walhof
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
Marin L. Schweizer
Affiliation:
William S. Middleton VA Hospital, Madison, WI, USA University of Wisconsin-Madinson, Madison, WI, USA
Kalpana Gupta
Affiliation:
Division of Infectious Diseases, VA Boston Healthcare System, Boston, MA, USA Center for Healthcare Organization and Implementation Research (CHOIR), Boston Campus, VA Boston Healthcare System, Boston, MA, USA Department of Medicine, Boston University School of Medicine, Boston, MA, USA
Madisen Brown
Affiliation:
Center for Healthcare Organization and Implementation Research (CHOIR), Boston Campus, VA Boston Healthcare System, Boston, MA, USA
Daniel Suh
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
Judith Strymish
Affiliation:
Center for Healthcare Organization and Implementation Research (CHOIR), Boston Campus, VA Boston Healthcare System, Boston, MA, USA
William J. O’Brien
Affiliation:
Center for Healthcare Organization and Implementation Research (CHOIR), Boston Campus, VA Boston Healthcare System, Boston, MA, USA
Jeffrey Chan
Affiliation:
Center for Healthcare Organization and Implementation Research (CHOIR), Boston Campus, VA Boston Healthcare System, Boston, MA, USA
Kelly Miell
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA, USA
Vanessa Au
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
Barbara W. Trautner
Affiliation:
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
Kimberly C. Dukes*
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA Division of General Internal Medicine, Carver College of Medicine, Iowa City, IA, USA
*
Corresponding author: Kimberly C. Dukes; Emails: [email protected]; [email protected]
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Abstract

Type
Letter to the Editor
Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© Veterans Health Administration, 2025

We would like to reply to Mr. Babar’s Letter to the Editor Reference Babar1 in response to our recently published article, “Healthcare worker attitudes on routine non-urological preoperative urine cultures: a qualitative assessment.” Reference Friberg Walhof, Schweizer and Gupta2 We appreciate the interest in our paper and agree that this is an initial step toward improving urine culturing practices. The work described was actually the prelude to an intervention to de-implement routine testing that includes multidisciplinary teamwork, personalized case-based education, and directed feedback.

We have presented ongoing work that further explores attitudes toward interventions to reduce preoperative urine testing in non-urological surgeries. Reference Dukes, Walhof and Brown3 This research focuses on questions asked of clinician participants about the acceptability of 4 prospectively identified potential interventions to de-implement routine preoperative urine testing for asymptomatic bacteriuria: substitution of another infection prevention intervention, lab restrictions on ordering urine tests, audit and feedback on guideline concordance, and interactive workshops on evidence.

We agree that cognitive behavior modification is a necessary, yet difficult step to reducing the number of unnecessary urine tests and subsequent antibiotics. All members of the multidisciplinary team want the patient to experience the best outcomes possible while utilizing evidence-based practices. Receipt of unnecessary antibiotics can lead to worse outcomes for individual patients. Our research team aims to develop and implement interventions that help all team members achieve this common goal, while also reducing unnecessary testing and treatment and ultimately decreasing the global burden of antimicrobial resistance.

Acknowledgments

The contents presented herein do not represent the views of the US Department of Veterans Affairs or the US Government.

Financial support

This work was funded by the US Department of Veterans Affairs Health Services Research and Development Service (grant no. IIR 18-057; PIs: KG and MLS).

K.G. reports receiving consulting fees in the previous 36 months from GSK, Iterum Therapeutics, Utility Therapeutics, Spero Therapeutics, Qiagen, PhenUtest Diagnostics, and CarbX and royalties from UpToDate.

B.W.T.’s work is supported in part by the US Department of Veterans Affairs Health Services Research and Development Service (grant no. CIN 13-413) at the Center for Innovations in Quality, Effectiveness, and Safety. B.W.T. reports receiving consulting fees from Phiogen and honoraria for the George Washington Infectious Disease Board Review Course and the Warren Alpert Medical School at Brown University.

References

Babar, A. Response to “Healthcare worker attitudes on routine non-urological preoperative urine cultures: a qualitative assessment.” Infect Control Hosp Epidemiol Published online 2024;1. https://doi.org/10.1017/ice.2024.187 CrossRefGoogle Scholar
Friberg Walhof, JE, Schweizer, ML, Gupta, K, et al. Healthcare worker attitudes on routine non-urological preoperative urine cultures: a qualitative assessment. Infect Control Hosp Epidemiol Published online 2024;16. https://doi.org/10.1017/ice.2024.85 Google ScholarPubMed
Dukes, K, Walhof, J, Brown, M, et al. Acceptability of proposed stewardship interventions to reduce preoperative screening and treatment of asymptomatic bacteriuria. Open Forum Infect Dis 2021;8:S140. https://doi.org/10.1093/ofid/ofab466.237 CrossRefGoogle Scholar