--- title: What is Diagnostic Stewardship? description: What is diagnostic stewardship, and how does it impact infection control and prevention? --- [Health.Care. | An Educational Blog on Healthcare Associated Conditions ](https://blog.eoscu.com/blog) # [What is Diagnostic Stewardship?](https://blog.eoscu.com/blog/what-is-diagnostic-stewardship) Written by [Erica Mitchell](https://blog.eoscu.com/blog/author/erica-mitchell) | April 18 2025 In the field of **infection prevention and control (IPC)**, diagnostic stewardship is emerging as a critical strategy for reducing **healthcare-associated infections (HAIs)** and combating antimicrobial resistance. While antimicrobial stewardship focuses on the appropriate use of antibiotics, **diagnostic stewardship** ensures that the right tests are ordered, performed correctly, and interpreted accurately—preventing misdiagnosis, overdiagnosis, and unnecessary antibiotic use.   #### **What is Diagnostic Stewardship?** Diagnostic stewardship involves the **thoughtful selection, collection, processing, and interpretation** of diagnostic tests. It aims to: - Ensure **clinically appropriate testing** to avoid overuse or underuse. - Prevent **false positives or false negatives** that can lead to mismanagement. - Minimize **unnecessary antibiotic prescriptions**, reducing antimicrobial resistance risks. - Improve the accuracy of HAI surveillance data by avoiding false HAI diagnoses. In essence, diagnostic stewardship enhances the **reliability and clinical utility** of diagnostic tests, leading to better patient outcomes and more effective infection control. #### **Why Does Diagnostic Stewardship Matter in Infection Control?** Inappropriate diagnostic testing can result in **incorrect HAI diagnoses**, unnecessary treatments, and the overuse of isolation precautions—all of which strain healthcare resources. Examples include: - **Overtesting:** Frequent or indiscriminate use of diagnostic tests (e.g., urine cultures) can lead to false positives, triggering unnecessary antibiotic treatments. INEQUALITIES/DISPARITIES ISSUE - **Undertesting:** Failure to order appropriate tests (e.g., delayed blood cultures) can result in missed or delayed diagnoses, leading to untreated infections. - **Misinterpretation:** Diagnostic errors or contamination of specimens can create confusion, prompting unnecessary infection control measures or inappropriate treatments. Effective diagnostic stewardship helps healthcare teams **distinguish true infections from colonization or contamination**, enabling more precise infection prevention efforts. #### **Examples of Diagnostic Stewardship in IPC** ##### **1. Improving Blood Culture Practices to Prevent False Positives** Blood cultures are essential for diagnosing bloodstream infections, but when performed incorrectly, they can yield **false positives** due to skin flora contamination. This can lead to inappropriate antibiotic use and unnecessary infection precautions. - **Diagnostic stewardship strategies:** - Using **dedicated phlebotomy teams** trained in proper aseptic technique. - Implementing **blood culture diversion devices** to reduce contamination. - Limiting the number of blood cultures to avoid overtesting. - **Impact:** Reducing false positives lowers unnecessary antibiotic exposure and prevents the mislabeling of patients with HAIs. ##### **2. Urine Culture Stewardship to Reduce CAUTI Misdiagnosis** **Catheter-associated urinary tract infections (CAUTIs)** are common HAIs, but overtesting leads to frequent false-positive results due to asymptomatic bacteriuria (ASB). Treating ASB with antibiotics increases resistance risks without clinical benefit. - **Diagnostic stewardship strategies:** - Using **symptom-based urine testing algorithms** to prevent unnecessary cultures. - Restricting automatic urine cultures for catheterized patients unless clinically indicated. - Implementing **reflex testing protocols** where only positive urinalysis results trigger urine cultures. - **Impact:** Reducing unnecessary urine cultures prevents overdiagnosis of CAUTIs and inappropriate antibiotic treatment. ##### **3. Molecular Testing for C. difficile: Balancing Sensitivity with Accuracy** Molecular tests for **Clostridioides difficile (C. diff)** are highly sensitive but can detect colonization rather than true infection. Overdiagnosis can lead to unnecessary isolation precautions and treatment. - **Diagnostic stewardship strategies:** - Implementing **two-step testing algorithms** (e.g., GDH/EIA followed by PCR for positives) to improve diagnostic accuracy. - Using **clinical criteria** (e.g., symptoms + risk factors) to guide test ordering. - **Impact:** Reducing false positives ensures that only patients with true C. diff infections receive targeted treatment and infection control measures. Effective diagnostic stewardship directly contributes to infection prevention and control by: - **Reducing HAIs:** Accurate diagnoses prevent mislabeling of patients as HAI cases, improving the validity of infection surveillance data. - **Minimizing antibiotic overuse:** Avoiding false-positive results prevents unnecessary antibiotic prescriptions, slowing antimicrobial resistance. - **Improving patient safety:** Accurate diagnoses ensure appropriate treatment and infection control measures. - **Optimizing resource use:** Reducing unnecessary testing conserves laboratory and infection control resources. #### **Key Takeaway: Precision in Diagnosis, Precision in Prevention** Diagnostic stewardship is a powerful yet often underutilized tool in infection prevention and control. By **optimizing diagnostic testing practices**, hospitals can reduce the overdiagnosis of HAIs, promote responsible antibiotic use, and enhance patient safety. For IPC teams, implementing diagnostic stewardship strategies is essential for achieving **more accurate HAI surveillance, better antimicrobial stewardship, and improved overall infection prevention outcomes**. [View full post](https://blog.eoscu.com/blog/what-is-diagnostic-stewardship) ```json { "@context" : "http://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Erica Mitchell" }, "dateModified" : "2025-04-18T20:15:26.292Z", "datePublished" : "2025-04-18T20:15:10Z", "headline" : "What is Diagnostic Stewardship?", "image" : { "@type" : "ImageObject", "height" : 350, "url" : "https://216314.fs1.hubspotusercontent-na1.net/hubfs/216314/Marketing/EOScu_Blog/Blog_Headers/2025%20Diagnostic%20Stewardship-01.jpg", "width" : 750 }, "mainEntityOfPage" : "https://blog.eoscu.com/blog/what-is-diagnostic-stewardship", "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "height" : 60, "url" : "/hs/hsstatic/content_shared_assets/static-1.4092/img/default-amp-logo.png", "width" : 60 }, "name" : "Health. Care. | An Educational Blog" } } ```