Analysis of Urinalysis and Urine Culture Methods: Preventing False Positive Urine Specimens

Abstract

An important but sometimes overlooked component to a robust infection prevention strategy includes hands-on evaluation of current practices and procedures. The reason this is often overlooked is because systems may appear to be working when in reality they are broken. Hands-on analysis of infection prevention strategies provides opportunities to improve the organization and enhance the quality of care. Beginning January 2015, hospitals will be required to report house-wide catheter-associated-urinary-tract-infection (CAUTI) rates. False positive urine results can cause patients to be treated when treatment is not indicated, prolong convalescence, and affect hospital infection rates. Microorganisms present in urine will continue to multiply if the specimen container does not have a preservative to arrest mircobial growth. This can lead to a false positive urinary tract infection. Hospitals will not be reimbursed for CAUTIs, therefore an accurate lab result is critical. 20 nurses on 4 units were asked to demonstrate the urine collection process to the Infection Preventionist (IP). 14/20 nurses (70%) collected urine from the Foley port but used specimen containers that lacked preservative to prevent microbial overgrowth. Evaluation of procedures must include demonstrations by staff who perform the procedures and may not always reflect policy/procedure. Education and standardization of urine collection processes include; when to use a specimen container with preservative (for a urine culture) and when preservative is not needed (for urinalysis). Proper collection can prevent; (1) incorrect identification of a CAUTI, and (2) false positive results by inhibiting microbial overgrowth, (3) overuse of antimicrobial drugs when there is no infection, (4) increases accuracy of laboratory results, (5) improves quality of care and (6) facilitates appropriate reimbursement of patient care by preventing false positive CAUTIs. Our survey highlights the role of the IP as a main driver in ensuring appropriate reimbursement for patient care by preventing false CAUTIs and saving hospitals money.