1. MetroWest Medical Center Residents Infection Control ID service. Felipe Barbosa,MD Jungwoon Yoon,MD Gail Cormier,RN Chinhak Chun,MD Thomas Treadwell, MD Nikolaos Mavrogiorgos,MD

2. Accurate diagnosis of urinary tract infection Avoid unwarranted use of antibiotic Appropriate choice of antibiotic if indicated Dispel myths – Delirium, confusion, falls, and myriads of nonspecific conditions attributed to the urinary tract Goals

3. What we did Staff education: ER, residents, hospitalists, and attending physicians – Education about the symptoms of urinary tract infection – Education campaign about not “treating” abnormal Urinalysis and urine culture without the symptoms Limit availability of reflex urine cultures C. diff case tracing CAUTI bundles

4. Preliminary results Distribution of 81 patients treated for UTI

5. Preliminary results Patient origin or destination Patient presented with urinary catheter?

6. Preliminary results Symptoms? Positive Cultures and Symptoms

7. Preliminary results Percentage of patients with specific symptoms and positive urine culture by month

8. What next Continue data gathering and analysis – Consecutive ER patients > 70 years – Symptoms(s), antibiotic use, u/a, and u c/s Expand data – Antibiotic indicated? – Antibiotic appropriate? (pathogen, sensitivity, etc.) – Identify factors for unwarranted antibiotic use and “wrong” antibiotic choice

9. What next Continue education on symptom based decision making Remove reflex orders (ER, CPOE) Survey to assess knowledge/awareness – Find areas of weakness and reinforce

10. Thank you!