{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:43:39Z","timestamp":1777412619130,"version":"3.51.4"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X23000302_as1\"><jats:title>Objective:<\/jats:title><jats:p>Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000302_as2\"><jats:title>Methods:<\/jats:title><jats:p>This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present &gt;7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000302_as3\"><jats:title>Results:<\/jats:title><jats:p>The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; <jats:italic>P<\/jats:italic> &lt; .001) and antibiotic use for UTI indications (2.3% decrease per month; <jats:italic>P<\/jats:italic> = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000302_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2023.30","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T09:33:39Z","timestamp":1680082419000},"page":"1582-1586","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":12,"title":["Using clinical decision support to improve urine testing and antibiotic utilization"],"prefix":"10.1017","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-1519","authenticated-orcid":false,"given":"Michael E.","family":"Yarrington","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0366-1328","authenticated-orcid":false,"given":"Staci S.","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tray","family":"Dunkerson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabienne","family":"McClellan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R.","family":"Polage","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebekah W.","family":"Moehring","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Becky A.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Seidelman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah S.","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5162-6482","authenticated-orcid":false,"given":"Sonali D.","family":"Advani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2023,3,29]]},"reference":[{"key":"S0899823X23000302_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)67150-9"},{"key":"S0899823X23000302_ref2","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2021.260"},{"key":"S0899823X23000302_ref9","doi-asserted-by":"publisher","DOI":"10.1017\/S0899823X00193845"},{"key":"S0899823X23000302_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(00)00531-3"},{"key":"S0899823X23000302_ref14","unstructured":"14. Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) events. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/7psccauticurrent.pdf. Accessed October 1, 2022."},{"key":"S0899823X23000302_ref1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz021"},{"key":"S0899823X23000302_ref18","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2020.37"},{"key":"S0899823X23000302_ref4","doi-asserted-by":"publisher","DOI":"10.1086\/675718"},{"key":"S0899823X23000302_ref19","doi-asserted-by":"crossref","first-page":"392","DOI":"10.12788\/jhm.2892","article-title":"The use of clinical decision support in reducing diagnosis of and treatment of asymptomatic bacteriuria","volume":"13","author":"Keller","year":"2018","journal-title":"J Hosp Med"},{"key":"S0899823X23000302_ref8","doi-asserted-by":"publisher","DOI":"10.1086\/650482"},{"key":"S0899823X23000302_ref12","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1017\/ice.2020.295","article-title":"Sustainably reducing device utilization and device-related infections with DeCATHlons, device alternatives, and decision support","volume":"41","author":"Lesho","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X23000302_ref20","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.301"},{"key":"S0899823X23000302_ref15","unstructured":"15. A guide to the SUR. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/nhsn\/pdfs\/ps-analysis-resources\/nhsn-sur-guide-508.pdf. Accessed February 25, 2023."},{"key":"S0899823X23000302_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1152"},{"key":"S0899823X23000302_ref5","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz305"},{"key":"S0899823X23000302_ref17","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1197\/jamia.M2049","article-title":"Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial","volume":"13","author":"McGregor","year":"2006","journal-title":"J Am Med Inform Assoc"},{"key":"S0899823X23000302_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15517"},{"key":"S0899823X23000302_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyy430"},{"key":"S0899823X23000302_ref16","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1093\/cid\/ciab356","article-title":"Effects of a collaborative, community hospital network for antimicrobial stewardship program implementation","volume":"73","author":"Moehring","year":"2021","journal-title":"Clin Infect Dis"},{"key":"S0899823X23000302_ref13","first-page":"CD011115","article-title":"Policies for replacing long-term indwelling urinary catheters in adults","volume":"7","author":"Cooper","year":"2016","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X23000302","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T03:16:34Z","timestamp":1716520594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X23000302\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,29]]},"references-count":20,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["S0899823X23000302"],"URL":"https:\/\/doi.org\/10.1017\/ice.2023.30","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,29]]},"assertion":[{"value":"\u00a9 The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}