Authors (including presenting author) :
Leung CYM(1), Szeto SMR(1), Ng ML(1), Ng LK(1)
Affiliation :
(1)Department of Surgery, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Mid-stream urine (MSU) is collected when a urine culture is ordered to identify microorganisms causing urinary tract infections. The ideal MSU sample is one that accurately represents the bladder bacterial count with minimized contamination by bacteria colonizing the distal urethra and genital mucosa. Proper collection technique is taken to ensure that the specimen is as free as possible from contamination by microorganisms around the urinary meatus.
There were quite a few contaminated MSU samples reported in microbiology laboratory test results in Surgical A8 Ward in 2018.
Objectives :
1.To consolidate nurses and supporting staff’s knowledge and skill on proper MSU collection.
2. To promote better patient education on MSU clean-catch technique with written instructions.
3. To minimize contamination of MSU specimen in ward.
Methodology :
The program was conducted in RTSKH Surgical A8 ward from July 2018 to January 2019. 18 surgical nurses and 9 supporting staff were recruited in the program.
Phase 1: Pre-program data collection
1.1 Journals and protocols on urine collection for diagnostic tests were reviewed for update.
1.2 Questionnaires about MSU collection procedure were conducted by surgical nurses and supporting staff.
1.3 Knowledge tests were conducted by nurses to assess their knowledge on diagnostic tests and diseases.
1.4 Laboratory results of urine culture were reviewed, number of contaminated specimens were recorded.
Phase 2: Improvement measures implementation
2.1 Two sets of educational slide shows were tailor-made to nurses and supporting staff respectively. Educational talks, which were about preparation of essential equipment, updated skills on MSU clean-catch technique, journals sharing, knowledge of diagnostic tests and UTI diseases, were delivered.
2.2 An “Instruction sheet for MSU collection” was designed to aid patient education.
Phase 3: Post-program evaluation
3.1 Post-program questionnaires and knowledge tests were conducted by frontline staff. The results were evaluated.
3.2. Audit on the rate of MSU specimen contamination was conducted.
Result & Outcome :
Total 27 questionnaires and 18 knowledge tests were given out, the response rate was 100% in pre- and post-program. 100% participants felt more confident and familiar with MSU collection procedure and giving patient instructions after the program. The average score of nurse knowledge test increased by 30%. The pre-program MSU contamination rate was 9%. (12 specimens contamination out of 132 urine test results from July18 to Oct18.) The post-program MSU contamination rate was 0%. (No contamination was reported in 120 urine test results from Oct18 to Jan19.)
Illustrated MSU collection instruction sheet was useful for ambulatory patients who were able to follow directions as it ensured them to perform correct procedure. Nurses’ and supporting staff’s improved knowledge and skills promote proper techniques of urine collection for patients who required assistance. Rate of specimens contamination was significantly reduced in A8 Ward, it helped accurate bacterial identification in urinary tract infections.
