62 'Spending a penny, but keeping it clean' – Reducing the rate of contaminated non-invasive urine samples in the paediatric department. (17th August 2022)

• Record Type: Journal Article
• Authors: O'Gorman, Jennifer; Clarke, Joe; Robinson, Martin
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A429
• Page End: A430
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.698
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: As the diagnosis of a urinary tract infection (UTI) has potenitally significant consequences it is important to ensure that the urine sample used is as free from contaminants as possible. Contaminated samples can lead to delays to diagnosis, repeated testing and inappropriate antibiotics, as well as unnecessary follow-up. NICE recommend using a clean catch sample as their preferred method of urine collection but also allows for the use of urine pads, 1 Reported contamination rates for non-invasive urine samples range from 14.3-26% for clean catch samples, 2 and from 12.2-29% when using pad samples. 3, 4 We hypothesised that our baseline contamination rate for non-invasive urine samples was higher than this. Our aim was to reduce contamination rates by 50% from baseline over a 6 month period. Methods: Data was collected weekly using a labatory database search. Primary outcome measure was the number of contaminated non-invasive urine samples per PDSA cycle as a percentage of total non-invasive urine samples. Exclusion criteria: > 16 years; samples requested from other sources; patients with a mixed growth urine culture who were treated as a having a UTI based on positive microscopy or nitrate-positive urinalysis, clinical presentation and clinician decision-making. Change ideas aimed at reducing the rate of contaminated non-invasive urine samples were introduced (Drive Diagram, figure 1 ). 1. Staff & parent focus groups 2. Introduction of a parent information leaflet 3. Trial of the 'Quick-Wee' method 5 4. Staff education session and use of infographic 5. New method for urine pad use 4 Results: Our baseline contamination rate was 42.8-47%. We demonstrated sustained improvement, achieving our target by PDSA cycle 3. Shift in consecutive data points below the median indicated non-random variation. The contamination rate in subsequent cycles remained below the median, however there is a tendency towards increasing contamination rate, (Run Chart, figure 2 ). Conclusion: We used multiple small tests of change and engaged front line users to achieve our goal. Continuous improvement takes time and sustained effort - the increasing contamination rate in PDSA cycles 4 and 5 correlates with the project lead no longer working in the department. The project has been handed over, and there are change cycles planned to further optimise the use of urine pad samples when used as second preference, as well as expansion of these improvement methods to the emergency department. References: NICE Guidance: Urinary tract infection in under 16s: diagnosis and management. Clinical guideline [CG54]. Updated 31 October 2018. Tosif S et al. Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: An observational cohort study. Journal of Paediatrics and Child Health . 2012;48:659-664. Butler CC. Nappy pad urine samples for investigation and treatment of UTI in young children: the 'DUTY' prospective diagnostic cohort study. British Journal of General Practice . 2016;66(648):e516-e524. Rao S et al. An improved urine collection pad method: a randomised clinical trial. Archives of Disease in Childhood . 2004;89(8):773-5. Kaufman J et al. Quick-Wee: A novel non-invasive urine collection method for infants in the emergency department. Paediatrics & Child Health. 2016 Jun 1;21(5):E95