When taking a urine specimen from a patient with an indwelling urinary catheter?

There are a number of strategies that you can employ in your urine culture stewardship program. You can pick from the strategies detailed below to customize a plan that meets the needs of your facility, staff, and patients or you may develop your own strategies based on unique needs at your facility. Different strategies target different types of providers. For example, a urine culture collection protocol and prepackaged kit provides nurses with tools to support urine culture stewardship. An electronic medical record prompt helps physicians and advanced practice providers adhere to urine culture stewardship by ensuring the appropriate indications for culture are present.

Broadly these strategies encompass 2 areas:

• Educations and training
• Behavior support

Education and training

Educating and training staff are important. Education increases knowledge and awareness of the principles of urine culture stewardship while training helps staff acquire and maintain skills necessary to practice urine culture stewardship. You can use the information gathered from monitoring and audits (discussed in more detail below) to decide where to target education and training initiatives.

Two primary groups to include:

• Nursing staff involved with collecting and storing urine cultures.
• Physicians and other advanced practice providers who order and interpret urine cultures.

Education and training can be provided on a group or individual level and can range from live presentations and webinars to resources such as pocket cards that can be used to reinforce concepts in real time.

Education and training tools

• How and when nurses collect urine cultures on catheterized patients: A survey of 5 hospitalsexternal icon
  Survey of nurses showing a significant opportunity to improve nursing knowledge about urine culture stewardship
• A survey of resident physicians’ knowledge regarding urine testing and subsequent antimicrobial treatmentpdf iconexternal icon
  Survey of physicians showing a significant opportunity to improve nursing knowledge about urine culture stewardship
• Pocket cards for staff; includes indications for urine culture collection.
  • Pages 28-29 of the Supplementary Online Content for Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter–Associated Asymptomatic Bacteriuriapdf iconexternal icon.
  • Mayo Clinic Reduces Catheter-Associated Urinary Tract Infections Through a Bundled 6-C Approach. Pages AP1-AP4 at the end of the articlepdf iconexternal icon.

• Poster that can be displayed in units to remind staff of the key elements of urine culture stewardship.
  • Symptom-free Pee: Let It Be pdf icon[PDF – 1 page]external icon

Behavior support

A number of different strategies can be used to guide behavior and reinforce the concepts of urine culture stewardship.

Laboratory-based

For example, a laboratory might only process a urine culture if specific findings are present on urinalysis or an indication for culture is included. Or urine culture results may only be provided if an ordering provider contacts the microbiology laboratory requesting the result.

Collection

Ensure the appropriate equipment is in stock and easily accessible by staff. For example, urine culture collection kits contain the equipment needed for as well as step-by-step instructions on appropriately collecting urine cultures.

Appropriate indications

The electronic medical record (EMR) can help confirm an appropriate indication is present before a provider orders a urine culture. For example, a mandatory stop can be inserted into the electronic medical record and a provider must select an appropriate indication before a urine culture can be ordered.

Examples of urine culture stewardship initiatives

These include strategies to guide and support healthcare personnel behavior.

• The Story of Kicking CAUTI: Achieving Clinical Impact through Interdisciplinary Team Workexternal icon
  The VA “Kicking CAUTI” Campaign was implemented at VA medical centers to improve antibiotic stewardship for CA-ASB.

• Achieving Clinical Impact Through Interdisciplinary Teamwork pdf icon[PDF – 57 pages]external icon
• Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter–Associated Asymptomatic Bacteriuriaexternal icon
• Mayo Clinic Reduces Catheter-Associated Urinary Tract Infections Through a Bundled 6-C Approach.external icon
  Mayo Clinic Bundled 6-C Approach was implemented at Mayo Clinic in Rochester, Minnesota and involved a bundle of six elements to reduce CAUTIs.
• A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on “Stewardship of Culturing”external icon
  An intervention that involved aligning urine culturing practice among Intensive Care units at a single institution resulted in improved CAUTI rates.

What is the proper way to collect a urine sample for a patient with an indwelling catheter?

When collecting a urine specimen from an indwelling urinary catheter which action is most likely to ensure that sufficient urine is collected?

How should you place the urine collection bag of an indwelling catheter?