Diagnostic Stewardship Protocol to Reduce Urine Contamination: A Quality Improvement Project

• Published in: Journal for nurse practitioners Vol. 17; no. 4; pp. 399 - 404
• Main Authors: Broyles, Jennifer L., Friberg, Elizabeth, Hall, Keri K., DeGuzman, Pamela B.
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01.04.2021; Elsevier Limited
• Subjects: Antibiotics; Chart reviews; Clinical outcomes; Committees; Contamination; Cost control; culture; diagnostic stewardship; Educational programs; Emergency services; Hospitalists; Hospitals; Labeling; Laboratories; Management; Medical diagnosis; Methods; Misdiagnosis; Patients; preanalytical; Quality improvement; Quality management; urinalysis; Urinary tract infections; Urine; urinalysis; urine; culture; diagnostic stewardship; preanalytical; contamination
• ISSN: 1555-4155; 1878-058X
• DOI: 10.1016/j.nurpra.2020.12.007

Specimen contamination generates unreliable results, leading to potential misdiagnosis and improper treatments. The purpose of this multidisciplinary continuous quality improvement project was to implement an evidence-based diagnostic stewardship program to reduce urine specimen contamination rates. We conducted educational in-service sessions introducing a 3-step preanalytical protocol within the emergency department. Pre- and postintervention chart review was used to evaluate the impact on urine contamination. Urine culture contamination rates were significantly reduced between the pre- and postintervention phases (χ2 = 3.78, P = .05). An evidence-based preanalytical protocol supplemented with an educational intervention reduced the contamination of urine specimens. •Contaminated specimens can lead to misdiagnosis and unnecessary antibiotic use.•Multidisciplinary diagnostic stewardship programs can reduce contamination rates.•Focusing on the initial pre-analytic phase of specimen origination is recommended.•Projects that mandate protocol steps are recommended for greater clinical impact.