A pilot study on improving the appropriateness of urine specimen collection among catheterised patients in acute aged care

Abstract

Abstract Background The culture of a urine specimen is one of the most common diagnostic investigations undertaken in the acute care environment. However, often urine specimen collection and culture is unnecessary, clinically inappropriate, leads to substantial over treatment and is a wasteful use of pathology. Furthermore urine specimen collection from patients with urinary catheters presents an opportunity for microorganisms to colonise the drainage system and cause clinical infection. Unnecessary specimen collection can also drive inappropriate antimicrobial use. A new decision support tool was developed to inform clinically appropriate urine specimen collection and culture for patients with urinary catheters. The aim of this study was to test the effect and practicality of this tool in an acute aged care setting. Methods Specimen collection, catheter utilisation and infection rates were collected for eight weeks pre- and post-implementation of the tool. Implementation of the tool was carried out for four weeks and included the provision of targeted nursing and medical education. Results The collection of catheter specimen urine (CSU) specimens and all urine specimens reduced after the implementation of the tool. Implementation of the new tool was also associated with a significant reduction in catheter days and catheter utilisation. Conclusion Implementation of the new decision support tool, together with the provision of targeted education, was associated with reducing the number of urine specimens collected and catheter dwell times in the unit.