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Don’t insert an indwelling urinary catheter or leave it in place without daily assessment.
Choosing Wisely Canada
Canadian Nurses Association
The use of indwelling urinary catheters among hospital patients is common. Yet it can also lead to preventable harms such as urinary tract infection, sepsis and delirium. Guidelines support routine assessment of appropriate urinary catheter indications—including acute urinary obstruction, critical illness and end-of-life care—and minimizing their duration of use. Strategies consistent with CAUTI (catheter-associated urinary tract infection) guidelines regarding inappropriate urinary ...
ver más ... 2017Don’t routinely obtain swabs during surgical procedures when fluid and/or tissue samples can be collected.
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Diseases Canada
Fluids and tissue specimens can usually be obtained in the controlled setting of the operating room and represent higher quality specimens than swabs. Culture of swab specimens is associated with increased false negative results, as they are inferior in recovering anaerobic bacteria, mycobacteria and fungi, and provide inadequate volumes to perform all necessary diagnostic tests. To encourage collection of fluid and/or tissue samples, consideration should be given to making swabs unavailable in ...
ver más ... 2017Don’t routinely order nucleic acid amplification testing on cerebrospinal fluid (e.g., herpes simplex virus, varicella zoster virus, enteroviruses) in patients without a compatible clinical ...
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Diseases Canada
Although nucleic acid amplification testing is the modality of choice for determining the viral etiology of meningitis/encephalitis, it should not be requested routinely on all cerebrospinal fluid specimens. The routine use of these tests in patients without compatible clinical syndromes can result in unnecessary empiric antiviral treatment, additional care, and prolonged length of hospitalization for patients awaiting testing results. Additionally, routine testing may result in depletion of ...
ver más ... 2017Don’t obtain swabs from superficial ulcers for culture as they are prone to both false positive and false negative results with respect to the cause of the infection.
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Diseases Canada
All wounds are colonized with microorganisms. Cultures should not be obtained from wounds that are not clinically infected (i.e., absence of classical signs of inflammation or purulence or increasing pain). For wounds that are clinically infected, the ideal specimens for culture are deep specimens that are obtained through biopsy or deep curettage following cleansing/debridement of the wound. Laboratories should consider use of screening criteria to reject such swabs without proceeding to ...
ver más ... 2017Don’t routinely collect or process specimens for Clostridium difficile testing when stool is non-liquid (i.e., does not take the shape of the specimen container) or when the patient has had a prior ...
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Diseases Canada
Only liquid stool specimens should be collected or processed for C. difficile detection, as a positive test in the absence of diarrhea likely represents C. difficile colonization. Diagnostic gains are minimal with repeat C. difficile nucleic acid amplification testing within 7 days of a negative test. Repeat C. difficile toxin testing by enzyme immunoassay within 7 days of a prior negative test is also of little incremental diagnostic yield but may be warranted in select cases. Test of cure in ...
ver más ... 2017