REDUCING CATHETER ASSOCIATED URINARY TRACT INFECTIONS CLINICAL EXCELLENCE COMMISSION 2015 URINE COLLECTION, CULTURE and CATHETERISATION IN ACUTE SETTINGS.

REDUCING CATHETER ASSOCIATED URINARY TRACT INFECTIONS

CLINICAL EXCELLENCE

COMMISSION

2015

URINE COLLECTION, CULTURE and

CATHETERISATION IN ACUTE SETTINGS

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“…. Over-testing may lead to overdiagnosis, the circumstance where people without symptoms are diagnosed with a disease that ultimately will

not cause them to experience symptoms or early death.

This can lead to unnecessary treatment, adding to the risk of patient harm.”

- Morgan & Coleman, 2014

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Advice on unnecessary laboratory testing

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General principles for rational specimen collection and ordering

1) Only test if there is a clear purpose: Diagnosis Treatment Disease or therapy monitoring Assessment of adverse event of side event Exclusion of possible diagnosis Assessment or management of comorbidity Disease screening

AND

2) Only test if clinically indicated: Acute/immediate patient care is required As part of a clinical pathway/standard of care for patients with that

condition Fulfils a public health objective To assist with good patient flow

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A rational approach to urine collection and culture

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In 1993, only 24% of CSUs collected were because of UTI signs and symptoms!

See: Rao, G.G. et al. Journal of Hospital Infection, 1993. 25: p. 219-22.

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Collect urine specimen only if UTI signs and symptoms also are present or if septic workup is also required

What if:

Urine is malodorous, cloudy or has blood?

Dipstick +ve for leukocytes, protein, blood or nitrite?

As part of routine admission screening?

Identify purpose and clinical indication for specimen collection

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A urine culture is required from an adult catheterised patient if:

A septic work up is needed

OR The patient has UTI signs and symptoms

Adults with a UTI may present with ≥1 of the following symptoms with no other recognised cause: fever, suprapubic tenderness, costovertebral angle pain or tenderness, delirium or hypothermia (<35.5oC core).

Identify purpose and clinical indication for specimen collection

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NO, a septic work up is not requiredand

NO, the patient doesn’t have UTI symptoms

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YES, septic work up is requiredOR

YES, the patient has UTI symptoms

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Identify specimen to collect

Q: Does the patient still need their catheter?

Is the original indication for catheterisation still present?

Has a new indication for catheterisation emerged?

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No, the IDC is no longer required

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No, the patient can’t produce a clean MSU

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Yes, the patient can produce a clean MSU

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CSU - What’s the difference?

Used to identify urinary tract infection (UTI)

Urine sample collected via a urinary catheter

May be known as a ‘catheter urine’

Not the same as a mid stream urine (MSU)

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Identify specimen to collect

Q: Does the patient still need their catheter?

Is the original indication for catheterisation still present?

Has a new indication for catheterisation emerged?

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Yes, the IDC is still longer required

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Handling urine specimens

Collect the specimen aseptically

Get the specimen to the lab quickly

Refrigerate (4-10oC)

Packaging for transport

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Testing the urine specimen

Initial cell count of microorganisms and WBC

Culture for 24 hours

Identify growth and colony count

Each urine specimen costs $22.50 to culture on the MBS

Acinetobacter spp. growing on sheep’s blood agar.Image courtesy of CDC/Amanda Moore, Todd Parker, Audra Marsh

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Documentation of urine specimen collection

Indication for collection Date and time of collection Specimen collected

- MSU- CSU from current catheter- CSU from newly inserted catheter

Medical record

Lab order Indication for collection Date and time of collection Specimen collected

- MSU- CSU from existing catheter- CSU from newly inserted catheter

Catheter type (and dwell time of catheter)- Indwelling or SPC (at insertion or ≥48hrs)- In/out catheter (at insertion or at catheter change)

Start date and indication for catheterisation +/- UTI symptoms

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Thank you

For further information:

[email protected]