Reducing urine culture specimen contamination rate by patient education using a visual aid: a quality improvement project
Creators: name: Koshy, Jooly
Publisher: name: No Publisher Supplied
Year: 2019

description: PurposeThe method of collection of lab specimen is significant in one's disease management. Inappropriate collection of urine culture specimen often leads to repetition of lab tests or inappropriate antibiotic treatment (Caterino et al., 2017). The evident need for reducing the specimen contamination rate at the study setting, an urban teaching hospital emergency department, guided the primary investigator to pursue this quality improvement project.This quality improvement project aims at reducing the rate of urine culture specimen contamination in the emergency department by using video guided patient education on the process of midstream urine specimen collection to patients who need urine culture study.MethodologyPatient instruction using a visual aid (video) on the collection process of midstream clean catch urine culture specimen is given to emergency department patients who met the inclusion criteria for a period of two months. Inclusion criteria are ambulatory ED female patients over the age of 18 years who can understand instructions. The rate of specimen contamination which is reported as mixed flora on the culture results was determined over two months during the pilot study period for comparison to historical controls from the previous two months.ResultsDuring the pre-study period from 08/01/18 to 09/30/2018, 318 urine cultures studies were completed, and 74 of them were contaminated (23.27%) The number of urine culture studies completed during the pilot study period was 469 and 105 specimens were contaminated (22.38%). The primary investigator provided video education to 83 patients who met the inclusion criteria during the eight weeks of the pilot study, and 15 of those specimens were contaminated (18.07%) which includes the total number of specimen (469) collected during the pilot study period. The rate of specimen contamination during pre and during the study was analyzed, and it was found that the specimen contamination during the pilot study period (22.38%) was lower than the pre-study period (23.27%). Baseline data for this quality improvement project was derived from the laboratory reports on urine culture results from the study setting which displayed a specimen contamination rate of 20.3%. Implication for practiceThis project could not demonstrate the impact of video instruction in reducing the rate of contamination of urine culture specimens obtained in the ED due to the lack of a statistically significant result. However, the reduced rate of contamination during the study period can be considered as a possibility for positive study implications. The implications of decreasing the rate of contamination include efficient access to clinically meaningful results, reduced patient inconvenience from the provision of a repeat specimen, and reduced costs to the organization due to reduced need for re-testing. Effective patient education helps in patient engagement in their own health care. The idea of video-guided patient instructions can be incorporated into many healthcare settings especially in outpatient areas. The PI recommends the use of homogenous data to analyze the study for statistical significance in the future. Limitations for this study include the use of heterogeneous data and inability to use the inclusion criteria in retrospective data from the pre-study period.