Screening UTIs Using Urine Bag Analysis in Well-Appearing Infants with a FWS in a Children’s Midwest ED: A Quality Improvement Project
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Authors
Jessica, Graff
Issue Date
2023-05-11
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Abstract
Purpose: To implement a quality improvement pilot study assessing a screening process for well-appearing febrile infants (29-60 days) at risk for potential UTIs utilizing the AAP evidence-based guidelines for cleaning and specimen collection for screening methods
Background: UTIs carry a significant risk for infants, including increased mortality, morbidity, and poor outcomes if not identified early. Evidence shows that the risk for urosepsis decreases as newborns age, which may allow for less invasive specimen collection. New standards for infants 29 days and older allow screening for UTIs utilizing a bag specimen before deciding if a catheter sample is needed.
Sample/Setting: Well-appearing, febrile infants age 29-60 days in a pediatric emergency department.
Methods: An algorithm was adapted from the AAP guidelines to include screening for a UTI utilizing a urine bag for specimens and updated cleaning processes before collection. Prior to implementation, education was provided to all staff. After seven weeks, EMR data evaluated UA results, collection measures, specimen results, and return visits.
Results: A total of 22 participants met the criteria; 2 were eliminated related to unclear collection measures. Only 3 patients clearly followed the new protocol. The majority of the patients had catheter samples collected. One patient met the criteria for diagnosis of a UTI, defined as >100,000 colonies.
Conclusion: Clinical practice changes where the long-standing standards of care changes is complex in healthcare. The process of unlearning old habits and adopting new standards can take many years. A barrier identified includes concern for missed diagnosis of UTI. Method documentation of specimen collection was inconsistent in the EMR. The 3 patients that followed the algorithm had no concerns on their UA micro and had no return visits for fever concerns. This finding remains consistent with the recommendations of the current 2021 AAP guidelines for screening well-appearing infants.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University