Impact of Implementing a Specific Protocol for Urine Culture Requests in a Tertiary Private Hospital

Urine cultures are widely requested tests in hospitals; however, they are often ordered without appropriate criteria, resulting in low positivity rates, inefficient use of laboratory resources, and inappropriate treatment of possible asymptomatic bacteriuria, interfering with antimicrobial stewardship programs. Standardizing practices through educational interventions can reduce this issue (1–4). To evaluate the impact of an educational intervention (implementation of a specific protocol for urine culture collection) carried out by the Hospital Infection Control Service (HICS) in relation to the volume of test requests and positivity rate. Prospective interventional study conducted in a tertiary private hospital in São Paulo, Brazil. In August 2024, baseline data on the number of urine cultures and positivity rate (by sector and hospital-wide) were collected. In the same month, an intervention was performed: a specific protocol with defined criteria for urine culture collection was developed and disseminated to the entire clinical staff of the hospital. From August through January, data on the number of tests collected and positivity rate were monitored monthly. The baseline period (August 2024) was compared with the subsequent months (September 2024 to January 2025). Statistical analysis was performed using the chi-square test to compare periods. STATA v.17 software was used. In August (pre-intervention period), 490 urine cultures were performed, with a positivity rate of 20%. After the intervention, there was a reduction in the total number of tests (571 tests over 5 months, an average of 114 tests per month) and an aggregated positivity rate of 59.9%. The difference was statistically significant (p < 0.001). Emergency department sectors contributed most to the reduction. The creation of a protocol with specific criteria for urine culture requests proved to be an effective strategy to reduce unnecessary test collection, which was reflected in an increased positivity rate.