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surgical facilities. Tests can be falsely positive, especially in the elderly, leading to overdiagnosis and overtreatment. Up to 50% of all nursing home patients have positive urine tests, even though the vast majority have no symptoms of disease. We also have strong evidence that in patients with no symptoms, there's no ben- efit to treatment. In fact, the side effects may actually harm patients by enabling more harmful bacteria in the event of a future infection. As people age and have more comorbid illnesses, urine cultures become almost useless unless patients have real symp- toms. The tests can also unnecessarily delay surgery. Don't use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence. If you give a 2 nd course of antibiotics to patients who've previously had C. diff, about 1 in 4 will develop it again. So the risk-benefit ratio is way off unless the evidence of need is compelling, as it would be with, say, pneumonia, a surgical site infection or cellulitis. Those infections you do need to treat, even though you're putting the patient at higher risk for recur- rence of C. diff. Avoid invasive devices (including central venous catheters, endotracheal tubes and urinary catheters) and, if required, use no longer than necessary. Invasive devices pose a major risk for infections. This isn't a ground- shaking recommendation, but grouping these items together may help people recognize the similarity. Over time, we've become increasingly aware that catheters are the primary risk factor for certain major infections, and that the only way to prevent that risk is to use them less often. Meanwhile, there's also a growing recognition that the 2 3 F E B R U A R Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 3 3