Educational In-Service on a Pre-Analytic Diagnostic Stewardship Protocol to Reduce Urine Contamination: A Quality Improvement Project

Background: Urine contamination is a widely established clinical problem that can generate unreliable results leading to misdiagnosis and improper or delayed treatments. Diagnostic stewardship programs focus on the pre-analytic phase with an aim to improve patient outcomes by reducing contamination rates and improving specimen collection and processing.
Methods: Utilizing Edward Deming’s Plan-Do-Study-Act model for quality improvement, a retrospective chart review was conducted to evaluate if an educational in-service, introducing a 3-step pre-analytic diagnostic stewardship protocol, would affect the rates of urine contamination. Data collected was analyzed by a pre- and post-implementation method using Chi-Square test for independence.
Results: This project did not demonstrate a significant relationship between educational in-services on a pre-analytic protocol, and urinalysis contamination rates, (χ² (1, n = 1303) = .01, p = .93, phi = -.01). However, there was a significance association identified amongst culture contamination rates and implementation of such education sessions (χ² (1, n=791) = 3.78, p = 0.05, phi = -.07).
Conclusion: This project demonstrates that education can reduce urine contamination rates. These results, and those previously published in the literature, suggest that education in addition to mandating a pre-analytic protocol can prove to be both statistically and clinically significant. Future projects that have the ability to evaluate such combined methods may deliver a larger clinical impact.