2017 Barts NHS Hospital London: Urine sample contamination from 23% to 1.5% 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%.
2017 Royal Surrey NHS County Hospital: 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.
2013 Pennine Hospital NHS: Peezy at Ease: urology clinic mixed growth reduction from 23% to 5%
- 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.
- Download the Abstract here.
2017 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
2018: West Hertfordshire Antenatal Clinics: 70% reduction of false-positive dipped urines
West Hertfordshire NHS Trust Routine Antenatal Screening
Peezy Midstream is proven to deliver a 70% reduction in false-positive dipped urines in antenatal setting, with commensurate financial savings on unnecessary microbiology investigations, repeat tests, repeat appointments and associated resources.
Sylvia Bone, Patient Safety Midwife at NHS West Hertfordshire ran a trial across 645 women as part of their routine antenatal screening pathway. The results speak for themselves and the Trust now uses Peezy Midstream for all routine screening of pregnant women.
Read the full trial report on this link at All4Maternity.
2019 Northern Devon NHS Trust: Use of Peezy to improve quality of urine culture
Northern Devon NHS Trust and GIRFT Microbiology Report
Tom Lewis, Microbiology Consultant at Northern Devon NHS Trust and Microbiology Lead for NHS England’s Getting It Right First Time programme ran an evaluation to assess the efficacy of Peezy Midstream in a pre-operative orthopaedic setting.
The report concludes that Peezy Midstream reduces mixed growth, providing more accurate urine specimens for microbiology analysis. He describes his evaluation in greater detail on the GIRFTPathology Blog. Clink link to read the full paper.
2018 Loyola Chicago, USA: A clinical trial to ascertain reduced bacterial contamination in Peezy Midstream collected urine specimens
Loyola University Chicago Stritch School of Medicine, USA
The Clinical Trial, a collaboration between Departments of Microbiology, Urology and Obstetrics and Gynaecology, concludes that Peezy Midstream delivers a much better ‘clean catch’ midstream urine specimen than either traditional methods or the use of an antibacterial wipe used before a patient provides the specimen.
A Cross-sectional Pilot Cohort Study Comparing Standard Urine Collection to the Peezy Midstream Device for Research Studies involving Women is published in the Journal of Female Pelvic Medicine and Reconstructive Surgery and available on Researchgate.
2019 Public Heath Wales: Improving UTI diagnosis by introducing a UTI triage and clean catch MSU process
Results and Evidence
During the 6 months between March and July 2019, patients used the Peezy device to provide a urine sample for testing as part of the UTI triage process, a total of 41 patient samples were sent to the laboratory for culture and further investigation. We compared this to the same period in 2018, when Peezy was not being utilised, a total of 119 patient specimens were sent to the laboratory for the same period.
Between March and July 2019 using the Peezy as part of the UTI triage process delivered a 66% improvement from the same period in 2018.
Feedback provided by project lead Heather Crowley
Using the Peezy device in clinical practice has allowed us to completely transform how we approach caring for patients presenting with UTI symptoms. Care is now streamlined, avoiding the need for repeat samples and avoiding mixed growth culture results; meaning antibiotic prescriptions are far more appropriate. As a surgery it has allowed us to empower the non-clinical team to provide patients with clear and concise information at their first point of contact with the surgery. The advice given to patients is consistent due to the use of algorithms and scripts, and coupled with the Peezy device, has improved patient care dramatically. From a clinical perspective we have seen the number of prescriptions for antibiotics reduce as well as the number of mixed growth culture results; we are able to get the best outcomes for our patients in the quickest and safest manner.
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.
Sylvia Bone Patient Safety Midwife, West Hertfordshire NHS Trust Read Testimonial
Collecting a fresh, midstream urine specimen with a Peezy device, there were less false positive samples and 71.6% were ‘nothing abnormal detected’ [NAD] thus reducing the number sent to the laboratory. Women were much happier as the anxieties associated with UTI were no longer there, and it reduced staff workload as they were not wasting time filling out unnecessary lab forms. This subsequently saved the Trust a lot of unnecessary expenditure as markedly less samples were sent to the laboratory. Of a total of 655 patients, only 186 samples were sent to the lab as the rest were all NAD.
Tom Lewis GIRFT Microbiology Lead, Consultant Microbiologist Northern Devon NHS Trust Read Testimonial
As you know I am a considerable supporter of the Peezy and we have had good results in pre-op, moving out now to antenatal. I also use Peezy for complex patients who may genuinely have mixtures when it is important to be confident that contamination is not likely to be an issue.
Dr Mark Wilks Microbiology Manager, Barts NHS Trust Read Testimonial
Rubbish in, rubbish out. If you don’t make the effort to collect the specimen properly, all the clever stuff you do in the lab later, won’t work.
Michelle Jiu ST2 Doctor, Frimley Park NHS Foundation Trust Read Testimonial
Reduction in laboratory defined contamination has been shown and there is potential for use of Peezy in collecting all future Obstetric MSUs.