Reduction of patient harm through decreasing urine culture contamination in an emergency department using multiple process improvement interventions (31 March 2023)

Summary

Physicians raised a concern to the Quality Department about patients who were diagnosed in the emergency department (ED) with a urinary tract infection (UTI) but who later were clinically reviewed and found to be without disease. These patients were often admitted and treated with potentially unnecessary antibiotics.

Content

Literature reviews show patient and staff education of a clean catch urine culture collection technique alone is not always effective at consistently reducing urine culture contamination. The intervention team hypothesised that an effective multifactorial method to reduce urine culture contamination would be a combination of staff education on appropriate midstream and straight catheter collection techniques, verbal and visual education for patients, and staff and physician identification of patients who would provide more accurate urine cultures via straight catheterisation than clean catch.

The goal of this process improvement was to reduce unintended patient consequences of unnecessary admissions, unnecessary antibiotic treatment, and repeat urine cultures through reducing contaminated ED urine samples to ≤10% monthly contamination.

The results found that combined interventions resulted in a six-month decrease of contaminated urine samples from the initial 51% to <10%, resulting in an 80% decrease.

The authors concluded that urine culture contamination in an acute care ED was sustainably decreased through multiple process improvement interventions. Secondary outcomes included reduction in unnecessary antibiotic use and unnecessary admissions.