Reduction of Patient Harm Through Decreasing Urine Culture Contamination in an Emergency Department Using Multiple Process Improvement Interventions

BACKGROUND: From August 2018 to January 2019, the baseline urine sample contamination rate at an acute care hospital emergency department (ED) was 51%. Urine culture contamination is associated with unnecessary antibiotic use, repeat culture costs, and unnecessary inpatient admissions. These outcomes can lead to additional cost to the patient and healthcare system while leading to additional poor outcomes. METHODS: Culture results were reviewed and the project definition of contamination was applied. Contaminated cultures were reviewed further via manual electronic health record review of ED notes to determine documentation of collection source, education prior to clean catch collection, the cognitive and physical documented descriptions of the patient, and the name of the staff member who collected the sample. INTERVENTION: Staff were educated on appropriate midstream and straight catheter collection techniques, verbal along with picture education for patients, and appropriate identification of patients who may benefit from straight catheterization instead of clean catch. RESULTS: The combined interventions resulted in a six-month decrease of contaminated urine samples from the initial 51% to <10%, resulting in an 80% decrease. CONCLUSION: Urine culture contamination in an acute care ED was sustainably decreased through multiple process improvement interventions. Secondary outcomes included reduction in unnecessary antibiotic use, repeat urine cultures, and unnecessary admissions.