A-271 Standardization of a Single Sterile Urine Collection Tube: Diagnostic Stewardship Applied to the Pre-Analytical Phase

Abstract

Background Urine tests, including routine urinalysis and culture, are widely used in the diagnosis and monitoring of urinary tract infections. Pre-analytical factors, including specimen collection and container adequacy, play a pivotal role in ensuring analytical accuracy. Since we receive samples already collected, recurrent pre-analytical errors were observed when urine cultures are mistakely collected in non-sterile containers. This workflow failure generates negative consequences, such as pre-analytical waste, additional financial costs, delays in diagnosis and treatment, postponed medical appointments and impact on patient safety. The aim of this study was to evaluate the impact of standardized urine specimen collection by adopting a single sterile tube suitable for both urinalysis and culture in urinary samples received at a clinical laboratory in the city of São Paulo, Brazil. Methods A total of three outpatient units were selected for the study. As part of a strategy to improve the laboratory process through the replacement of supplies, a standardized sterile collection system was introduced for both routine urinalysis and urine culture. Recollection rates for these tests were compared for each unit located in São Paulo over three distinct periods: (i) Pre-implementation (January-March 2025): two tubes were used—one for routine urinalysis and a separate sterile tube for urine culture. (ii) Implementation (April 2025): the two-tube system was replaced by a single sterile tube. (iii) Post-implementation (May-July 2025): the single tube system was consistently used in all scenarios. Results During the implementation phase, improvements in the process were already noticeable, with reductions in recollection rates associated with the adoption of a single tube. Recollections decreased by 40.6%, 39.2%, and 11.5% in units 1, 2, and 3, respectively. After full consolidation of the new process, recollection rates decreased even further by 97.9%, 78.3%, and 71.6%, respectively, representing a substantial reduction across the evaluated units and overall reduction of 83%. The few inappropriate recollections were possibly related to residual use of non-sterile containers distributed before the change in supplies. Conclusion In healthcare systems where specimen collection is decentralized and frequently performed outside the laboratory, pre-analytical errors represent a major source of diagnostic delay. Standardizing the use of a single sterile container for both routine urinalysis and urine culture aligns with Lean principles and proved to be an effective strategy for reducing recollection rates. Overall, the strategy enhanced laboratory workflow efficiency, increased patient and user satisfaction, and strengthened diagnostic practices with a clear focus on patient safety.