Catheter associated UTI’s (CA–UTI) are preventable and high impact secondary to associated costs and poor outcomes. Our UTI prevention group has worked to prevent CA–UTIs, implementing a nursing driven foley removal protocol, prevention guidelines and education around morbidity and mortality associated with a CA–UTI. There are no studies that comprehensively look at inpatient methods of obtaining urine cultures for diagnosis and specimen integrity. Our monthly UTI prevention meetings identified gaps in practice prompting the development of a survey. Our aim was to evaluate the standard practice of urine collection and analysis in order to validate improvement processes at reducing CA–UTI.
An online and paper survey was provided to dedicated UTI prevention RNs, unit managers and staff. The survey included front line providers responsible for obtaining urine cultures from patients. Questions included nationally standardized methods for obtaining specimens, aseptic technique and documentation of specimen type and transport of sample to the lab.
We had a total of 210 respondents. Four specimen labeling questions identified 72% of all respondents would not label the specimen correctly; including specimen taken from a foley catheter, a straight cath, a bagged specimen or current antibiotic therapy for the patient. 9% of respondents reported they do not obtain the urine sample in an aseptic manner. 13% thought it acceptable to take a sample from a foley bag. 66% indicated they would obtain a sample from the foley bag if it was a newly inserted foley. 19% claimed they would obtain a sample from a new bedpan and 4% said they would do so from a cleaned bed pan. For patients unable to collect a clean catch mid stream, 19% of respondents indicated they would not obtain a straight cath order, but instead have the patient collect the sample themselves and then send for testing.
Urine sampling is fraught with errors as highlighted by our survey. We are retraining and assuring competency of providers tasked with collecting urine cultures. Training includes reassessment in 6 months to ensure consistent implementation of appropriate practice with oversight by UTI prevention champions. Current data available to hospitals may be inaccurate leading to reporting of erroneous infection rates. It is also extremely likely that urine sampling in hospitals across the nation is leading to misuse and overuse errors with respect to antibiotic treatment of infections that may not exist. This invariably has a knock–on effect increasing cost of care, exposing patients to unnecessary antibiotics, and contributing to increased risk of MDR organisms. Every intervention to reduce the rates of catheter associated UTI infection rates in hospitals will be severely limited because of gaps in practice and unless these are addressed at institutions we will not see a decline in nosocomial infection rates.