Managing Infectious Disease
Managing Infectious Disease: Steps to Success 189 case Study . ………….43958543545.’ The case study for this chapter is a continuation of Marilyn Nelson’s investigation of the UTI issue in the ambulatory clinics of the Western States University Hospital. . . . . . . .. ………………………. After flowcharting the process for collecting urine specimens (depicted in figures 10.2 through 10.6), Marilyn and her colleagues recognized how complex the issue was within their organization. They decided to collect data from all process paths evident in the flow chart. Because so many people were involved in the processes and because significant delays could be involved, they also began to wonder what role contaminated specimens played in the situation. Figure 10.6. Example of a flow chart-page 5 Clinical lab techs Tech receives UA specimen and lab requisition Tech performs Multistix and microscopic UA Prepare C&S specimen Document UA results in LIS Read C&S results Document No C&S Process C&S results positive? complete in LIS Yes Communicate positive results to clinicians in clinic Document C&S results in LIS Process complete
Chapter 10 Preventing a plough it was an expensive project, the team designed an investigate studdialect data, Urine and were routinely tested by nursing personnel or house staff in the chine to matoradars each specimen Peg Specific gravity and to classify each specimen according to its color, clarity, afree Presence of gross hem s Ply Each specimen was then tested with Multistix to determine whether microscopic ba Scopic bacteria, red blood cells, Des were present. When a specimen failed any of the Multistix screens, it was relent ed to Clinical Labors OF Services for microscopic analysis, culture, and sensitivity analysis by a laboratory technician. First, the team collected data regarding time elapsed between collection of the specimen, point-of testing with Multistix, and receipt of the specimen in Clinical Laboratory Services. In addition, the fare Investigated the sequence of events that occurred in the interim. A summary of the data collected isan vided in table 10.1. Table 10.1. Average time to point-of-care screening with confidence intervals (in minutes) General Orthopedic Surgery Obstetrics Gynecology | Specialty Point-of-Care Training Internal Pediatrics Surgery Clinic Clinic Clinic Clinic Clinic & Processing Medicine Clinic Clinic 6.25 6.0 3.25 3.0 3.0 5.0 4.25 Nurse (5.0, 7.5) (5.0, 7.0) (2.75, 3.75) (2.0, 4.0) (4.0, 6.0) (3.0, 5.5) (2.0, 4.0) 12.13 11.0 6.5 6.0 8.0 7.5 House staff 10.0 (4.0, 9.0) (4.0, 8.0) (7.0, 13.0) (6.0, 10.0) (10.0, 14.25) (9.0, 13.0) (5.5, 9.5) Second, on a temporary and random basis, the team obtained urine specimens from each clinic imma diately following collection and had a complete analysis performed STAT in the clinic labs. This analysis identified pH, specific gravity, color, clarity, cell counts, and bacterial counts almost immediately after the specimen was delivered by the patient or collecting clinician. All specimens that showed microscopic bacteria either on Multistix or on microscopic analysis were cultured. A summary of the data collected is provided in table 10.2. Table 10.2. Random STAT processing of clean-catch/cath urine specimens (percentage of positive specimens for culture) Internal General Orthopedic Medicine Pediatrics Surgery Surgery Obstetrics Gynecology Specialty Collector Clinic Clinic Clinic Clinic Clinic Clinic Clinic Nurse or patient 5.6 13.2 House staff or patient 4.2 6.2 Parent 27.5 25.2 Third, the team compared the incidence of UTI identified in the randomly collected specimens with the incidence identified in specimens going through the usual process. A summary of the data collected is provided in table 10.3. culture) Table 10.3. Routine processing of clean-catch/cath specimens (percentage of positive specimens for Internal Medicine General Orthopedic Collector Pediatrics Clinic Surgery Clinic Surgery Clinic Obstetrics Gynecology Specialty Nurse or patient Clinic Clinic 12.4 Clinic Clinic House staff or patient 36.8 25.6 Parent 14.2 25.6 12.2 10.0 Co 23.0
Review Questions 191 Case Study Questions examination of tie data sets, Marilyn Nelson and her colleagues identified several areas who UP alysis revealed situations that were probably contributing to the clinic’s high UTI rate. Look at " rate for children whose parents had collected the specimen versus the rate for children who "’s been catheterized by nursing personnel to collect the specimen. What might be the reason for the higher rate in children whose parents had collected the specimen? Are there any other areas in the data that reveal important aspects that may be contributing to the high UTI rates? What might be the reasons for these higher rates? Upon discussion of the findings and examination of the flowcharted processes, the laboratory manag noted a subtle change in clinic processes that probably was contributing to the problem. House staff had begun at some point to Multistix the specimens in the original collection containers. Thus, what had been a clean-catch specimen could become a contaminated one when staff opened the container to perform the Multistix. What really should have been done was to pour off a small amount or aliquor of the specimen into another container, reseal the original container for the laboratory, and perform the Multistix on the aliquot container. This process would minimize the possibility of contaminating the original specimen. How would this change in process be represented in the flow charts presented in the case study?
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