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Vagrants were everywhere in Victorian culture. They wandered through novels and newspapers, photographs, poems and periodicals, oil paintings and illustrations. They appeared in a variety of forms in a variety of places: Gypsies and hawkers tramped the country, casual paupers and loafers lingered in the city, and vagabonds and beachcombers roved the colonial frontiers. Uncovering the rich Victorian taxonomy of nineteenth-century vagrancy for the first time, this interdisciplinary study examines how assumptions about class, gender, race and environment shaped a series of distinct vagrant types. At the same time it broaches new ground by demonstrating that rural and urban conceptions of vagrancy were repurposed in colonial contexts. Representational strategies circulated globally as well as locally, and were used to articulate shifting fantasies and anxieties about mobility, poverty and homelessness. These are traced through an extensive corpus of canonical, ephemeral and popular texts as well as a variety of visual forms.
Urine cultures have poor specificity for catheter-associated urinary tract infections (CAUTIs). We evaluated the effect of a urine-culture stewardship program on urine culture utilization and CAUTI in adult intensive care units (ICUs).
A quasi-interventional study was performed from 2015 to 2017.
Setting and patients:
The study cohort comprised 21,367 patients admitted to the ICU at a teaching hospital.
The urine culture stewardship program included monthly 1-hour discussions with ICU house staff emphasizing avoidance of “pan-culture” for sepsis workup and obtaining urine culture only if a urinary source of sepsis is suspected. The urine culture utilization rate metric (UCUR; ie, no. urine cultueres/catheter days ×100) was utilized to measure the effect. Monthly UCUR, catheter utilization ratio (CUR), and CAUTI rate were reported on an interactive quality dashboard. To ensure safety, catheterized ICU patients (2015–2016) were evaluated for 30-day readmission for UTI. Time-series data and relationships were analyzed using Spearman correlation coefficients and regression analysis.
Urine culture utilization decreased from 3,081 in 2015 to 2,158 in 2016 to 1,218 in 2017. CAUTIs decreased from 78 in 2015 to 60 in 2016 and 28 in 2017. Regression analysis over time showed significant decreases in UCUR (r, 0.917; P < .0001) and CAUTI rate (r, 0.657; P < .0001). The co-correlation between UCUR and CAUTI rate was (r, 0.625; P < .0001) compared to CUR and CAUTI rate (r, 0.523; P = .004). None of these patients was readmitted with a CAUTI.
Urine culture stewardship program was effective and safe in reducing UC overutilization and was correlated with a decrease in CAUTIs. Addition of urine-culture stewardship to standard best practices could reduce CAUTI in ICUs.