Abolishing the bag: A quality assurance project on urine collection

Objective: To audit practice in diagnosis of urinary tract infection (UTI) and implement a protocol to reduce the number of falsely diagnosed or missed UTI in febrile children. Methodology: Data were obtained from the microbiology database on the number of urine samples collected for culture, the methods of collection and the culture results over a 3 month period. Using these data and published evidence, a protocol was developed for the collection of urine in febrile children. An education program was instituted which included the adoption of the protocol. Further data were collected and compared with those obtained before the program. Results: Total urine samples sent for culture decreased from 219 in 1998 to 143 in 1999. The percentage collected by bag fell from 60% (n = 132) to 14% (n = 20). The number of definite UTI diagnosed was 15 in both time periods. The number of children given antibiotics before an appropriate sample could be collected fell from nine to two for the respective 3-month periods. Conclusions: Through the development of a new protocol, its introduction and an education program, a change in management was effected and a reduction in the chance of missed or mistaken diagnosis of UTI occurred.