Belinda Straube 1, Jan Gralton 2,3, Christine Cook 1, Kerrie Thomas 1, Peter Taylor 1,4,5, Alice Kizny Gordon 1,4, Peter Smerdely 1,3, Gwen Hughes 1, Margaret Louey 1, Paul Curtis 2
1 St George Hospital, Kogarah, NSW, Australia
2 Clinical Excellence Commission, Sydney, NSW, Australia
3 School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, Australia
4 South East Area Laboratory Services, St George Hospital, Kogarah, NSW, Australia
5 School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia
The collection of a urine specimen from a patient with a urinary catheter presents an opportunity for microorganisms to enter into drainage system and cause infection. Inappropriate urine specimen collection and culture can result in the misdiagnosis of urinary tract infections and the administration of unnecessary antimicrobial therapy. In turn, this limits the success of pathology and antimicrobial stewardship efforts.
Recently, the Clinical Excellence Commission (CEC) developed a new decision support tool to guide appropriate urine specimen collection and culture from patients with urinary catheters. This new tool was pilot tested for effectiveness and practicality in a 30-bed acute aged care unit of large metropolitan hospital.
A before and after time series study design was to pilot the tool. Specimen collection, catheter utilisation and infection rates were collected for eight weeks prior to the implementation of the tool. The tool was implemented over a four week period and involved the provision of targeted nursing and medical education. After the implementation period, data collection was repeated again for another eight weeks.
Significantly less catheter days were observed during the post-implementation period, suggesting a reduction in catheter dwell times. The total volume of all urine specimens collected during the post-implementation period was significantly less than what was collected during the pre-implementation period.
When coupled with targeted nursing and medical education, the new decision support tool was effective in reducing the total volume of urine specimens collected and catheter dwell times in the acute aged care setting.