Acceptability of proposed stewardship interventions to reduce preoperative screening and treatment of asymptomatic bacteriuria.

Abstract

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.