Contamination rates in urine samples using Peezy Midstream
Quality Improvement Audit: Specimen mixed growth reduced from 17% to 1.5%
A comparative historic Quality Improvement Audit of specimens collected in Urology Clinic, with results recorded in Microbiology: Peezy Midstream was used by patients required to provide a midstream urine specimen (MSU). The lids of the urine specimen containers were marked with a coloured sticker before sending to microbiology for analysis, making them easily identifiable. The microbiology lab recorded contamination rates in 66 patient sample, which showed a dramatic reduction in urine specimen mixed growth from over 17% to just 1.5%.
Midstream Urine in Obstetrics: reduction from 6.7% to 2.5%
- Royal Surrey County Hospital NHS Trust, Guildford
Dr Michelle Jie, ST1 Obstatrics & Gynaecology
Dr Michael Adamczyk, ST3 Obstetrics & Gynaecology
Dr Karen Morton, Consultant Obstetrician & Gynaecologist
Urinary tract infection (UTI) can affect up to approximately one fifth of women at some point in their life1. The incidence is even higher in the obstetric population, affecting 8% of pregnant women at any one time2. Of those, many UTI can be asymptomatic and is estimated to occur in 2-5% of pregnant women. It is very important to identify and promptly treat such infections as they may progress to pyelonephritis and subsequently increase the risk of preterm birth3.
Diagnosis should be made on a clean catch midstream urine (MSU) to culture organisms. The conventional method for obtaining MSUs can be difficult to perform and more often than not, patients are not instructed properly, thus increasing the risk of sample contamination and hindering diagnosis.
Review of historical microbiological data was performed to examine numbers of MSUs sent from obstetrics. A retrospective audit with a sample size of 100 was undertaken in a DGH with a birth rate of ~3200/year. Inclusion criteria: any pregnancy booked prior to 12 weeks gestation with continuation of their care until delivery at the Royal Surrey. This comprised of patient notes retrieval, correlation with computerized microbiology results and data analysis. National guidelines regarding the investigation and management of urinary tract infections in pregnancy were identified and compared. Cost analysis was performed.
A short prospective quality improvement study was performed with a sample size of 40 in which any antenatal woman who dipped positive for nitrite and/or leucocyte in their urine dipstick had a MSU sent off using a novel midstream urine collection device (Peezy PE50) designed to reduce the rate of contamination. A patient questionnaire was also completed at the time.
Approximately 340 MSU samples are sent per month from obstetrics. 1141 urine dips were analysed, this averages to 11.4 urine dips per pregnancy. Of those, 227 were sent to the laboratory. 15.9% MSUs were inappropriately sent (not testing positive for nitrite and/or leucocyte), costing £5120.
4% had a positive culture rate equating to 95.5% treated unnecessarily at a cost of £25847 for tests alone. The laboratory defined contamination rate was 6.7%.
The results of quality improvement study showed a reduction of laboratory defined contamination rate to 2.5%. The positive culture rate was 5%. 70% of patients state they would be happy to use the device again.
There needs to be better education into the role of MSU and when it is appropriate to send one. The urine dipstick test clearly yields an extremely high false positive rate.
The Peezy PE50 has been shown to reduce laboratory defined contamination rates but there is clearly scope for further research into reducing contamination of initial samples used for dipstick test.
Peezy at Ease: 106 patient experience using innovative device for collection of urine
- Result: reduction in mixed growth from 23% to average 5%
- Patient satisfaction indicates that the Peezy Midstream is a welcome innovation. Spillage is minimised and toilet hygiene maintained for general infection prevention.
- The improvement in reliable results was impressive suggesting a significant financial saving due to the common nature of the investigation in LUTS assessment.
NHS National Institute for Health Research Usability Study
The NHS NIHR Usability Study was commissioned by the West Midlands AHSN I collaboration with Birmingham University NHS Trust and the Trauma Management Healthcare Technology Cooperative.
100% Patients found instructions clear
94% Peezy collects Midstream easily
94% Patients were confident using Peezy
88% Needed no further instruction
88% Would be comfortable using Peezy again
70% Would recommend Peezy is used in future
Peezy Midstream is a welcome innovation with clinicians and health leaders alike. Here you can read a variety of testimonials from a cross section of medical opinion formers and commentators.
Professor Frank Chingwundoh Consultant Urological Surgeon Read Testimonial
Barts & The Royal NHS Trust / Spire Healthcare
We have used Peezy Midstream with patients in clinic. Comparison with historical specimen results show that it collects a better specimen with lower contamination, which means fewer repeats. Patients are happy with the hygiene because urine goes into the tube and not on their hands. The lab is happy to receive a proper MSU in a clean tube that fits their analysers. The system delivers accuracy, efficiency and hygiene for all parties; I would like to see it used routinely across the NHS.
Professor James Barlow Professor of Technology and Innovation Management... Read Testimonial
Peezy Midstream is one of those valuable, simple, low cost and no-brainer innovations that I’m always amazed don’t get adopted faster and more widely.
* the Peezy journey features in Prof Barlow’s new book on healthcare innovation, out Sept ‘16
Louise de Winter CEO, The Urology Foundation Read Testimonial
“Urine samples are used to diagnose a broad variety of conditions and to be able to deliver an accurate diagnosis it is vital that the samples are not contaminated. Research strongly indicates that using the Peezy Midstream specimen collection device can dramatically reduce the contamination rate, thus leading to more accurate readings and reducing the need for repeat tests. This will undoubtedly have a significant time and cost savings for the NHS and must surely be a sensible innovation to adopt.
Gail Adams Head of Nursing, UNISON Read Testimonial
Health and safety in any medicine is of vital importance to those who work on the frontline and the collection of urine samples is a daily necessity for many. The adoption of innovative solutions, such the Peezy Midstream, allows a safe and hygienic alternative to more traditional methods, improving not just the experience of our members but also enhances the dignity of the patients they serve.