What is the best technique for collecting a sterile urine specimen from an indwelling urinary catheter?

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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

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.