Evidence & Testimonials

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

Introduction
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.

Method
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.

Results
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.

Conclusion
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.

Highlights
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

Download the full findings here.

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.

Download the full paper here.

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.

Download the full Clinical Report here.

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.