LAUSR

Introduction Screening for asymptomatic bacteriuria is an essential aspect of antenatal care. Urinalysis using dipsticks is most commonly performed for the identification of proteinuria and is cheap and easy to do. However, often too much weight is put on other components of the dipstick testing for the identification or exclusion of infection. National guidelines do not advocate the use of urine dipstick in screening for infection. Objective We constructed a project to assess the current pathway in our high-risk Obstetrics clinics, the impact of collection methods on contamination rates as well as the usefulness of urine dipstick results for identification of bacteriuria. Methods We analysed patient encounters in two specific clinics from January to June 2017. We looked at urine dipsticks and cultures if they were performed. The association between dipstick data and positive cultures was then assessed. Results Of 883 patient encounters with full data available, 486 cultures were sent. There was a 18.9% contamination rate and 1.85% had significant growth of a pathogenic organism identified. The presence of protein or leucocytes did not correlate with bacteriuria, however the presence of nitrites did predict a positive culture result (PPV 0.71). Discussion There was a high contamination rate in the culture samples that were analysed. Our data support national guidelines that state that dipsticks are a poor indicator for bacteriuria. We therefore implemented some significant changes: Changed our default container for urine collection. Production of a standard operating procedure for urine sample collection. Production of a patient information leaflet for urine collection. Construction of new Trust guidelines about the investigation and treatment of bacteriuria in pregnancy. Education sessions for all staff. These above interventions and a post-implementation survey will be presented.