Name
Chamberlain University
NR-585: Research Methods and Evidence-Based Practice for Advanced Nursing Practice
Prof. Name
Date
Frontera, J. A., Wang, E., Phillips, M., Radford, M., Sterling, S., Delorenzo, K., Saxena, A., Yaghi, S., Zhou, T., Kahn, D. E., Lord, A. S., & Weisstuch, J. (2021). Protocolized urine sampling is associated with reduced catheter-associated urinary tract infections: A pre-and postintervention study. Clinical Infectious Diseases, 73(9), e2690–e2696. https://doi.org/10.1093/cid/ciaa1152
The primary purpose of this study was to investigate whether the timing and method of urine sample collection in patients with indwelling urinary catheters influenced the likelihood of obtaining false-positive urinalysis (UA) results. The researchers aimed to determine if implementing a standardized urine collection protocol could reduce misdiagnosis of catheter-associated urinary tract infections (CAUTIs).
The study followed a pre-intervention and post-intervention design, conducted across two hospitals over an 18-month period. Data were collected in two separate 9-month phases, enabling a direct comparison between conventional urine sampling practices and the newly introduced standardized protocol.
The central research question was: Does implementing a standardized urine sampling protocol decrease the incidence of false-positive CAUTI diagnoses and reduce infection rates among patients with indwelling catheters?
The researchers hypothesized that protocolized urine sampling would minimize the risk of detecting colonization rather than true infection, leading to fewer reported CAUTI cases.
The study had two primary aims:
Main Aim: To evaluate whether a structured urine collection protocol reduced CAUTI infection rates and urinary catheter days in patients at higher risk.
Secondary Aim: To compare reductions in CAUTI rates between the test campus implementing the protocol and a control campus maintaining routine practices.
Both hospitals adhered to the Centers for Disease Control and Prevention (CDC) guidelines for CAUTI prevention, which included:
Avoiding unnecessary urinary catheter placement.
Using sterile techniques during catheter insertion.
Ensuring proper maintenance of indwelling catheters.
Urine specimens were collected from a disinfected needleless port using a sterile syringe, consistent with CDC-approved procedures.
Table 1. Sample Characteristics
| Category | Description |
|---|---|
| Sampling Method | Protocolized urine collection via sterile aspiration from a disinfected port |
| Sample Size | Data drawn from two hospitals (combined bed capacity: 1,100) |
| Inclusion Criteria | Adult patients (>18 years) admitted to ICU, medical, surgical, or neurology units |
| Exclusion Criteria | Pediatric patients; patients on specialty service floors |
| Duration | 18 months (9 months pre-intervention, 9 months post-intervention) |
The independent variable was the urine sampling protocol. One hospital campus (test site) adopted the new standardized protocol, while the other (control site) continued with conventional urine collection practices.
Primary Outcome: Incidence of catheter-associated urinary tract infections (CAUTIs).
Secondary Outcome: Number of urinary catheter days among patients.
Table 2. Variables of the Study
| Variable Type | Description |
|---|---|
| Independent Variable | Implementation of protocolized urine collection at test campus |
| Dependent Variables | CAUTI infection rates; urinary catheter days |
The findings from this study can be applied directly to clinical nursing practice. By adopting a protocol-driven approach to urine sample collection, healthcare units can significantly lower the rates of CAUTIs. This evidence suggests that colonization is often misclassified as infection when conventional sampling methods are used, resulting in unnecessary antibiotic administration and prolonged catheterization.
In practice, integrating this standardized protocol could:
Enhance patient safety by reducing avoidable infections.
Shorten hospital stays due to fewer complications.
Improve antibiotic stewardship by preventing inappropriate prescribing.
Lower healthcare costs by decreasing the burden of hospital-acquired infections.
Overall, implementing the urine sampling protocol represents a cost-effective and evidence-based intervention that can improve client outcomes and quality of care in settings with high catheter use.
