Urine specimen collection and transport.

is started on a new antibiotic, always take an “antibiotic timeout” and reassess the patient after the first 48 to 72 hours of antimicrobial therapy to assure that the patient has responded to the antimicrobial therapy, as many of the uropathogens are multidrug-resistant. A urinalysis and culture should be collected based on the patient’s symptoms and not solely based on the urine’s characteristics, such as the color, odor, sediment, or turbidity. When a urinalysis and culture are ordered, it is important that the specimen be collected aseptically, accurately, and transported in a manner that supports accurate test results, to determine if a true UTI is present. For a patient with an indwelling catheter, first identify the date that the catheter was inserted. If the indwelling catheter has been in place for 2 weeks or longer at the onset of the CAUTI (and the catheter is still needed), replace the indwelling catheter with a new one and obtain the urine specimen (Hooten et al., 2009). After an indwelling catheter has been in place for some time, biofilms develop and as a result, a urine culture obtained from a patient whose indwelling catheter has a biofilm may not accurately reflect the bacteriology of bladder urine. If the indwelling catheter has been in place for less than 2 weeks, aspirate the urine from the indwelling catheter using the needleless sampling port with a sterile syringe or use a cannula adapter (Gould et al., 2009). The BD Vacutainer® Luer-LokTM Access Device allows the urine sample to be transferred directly from the indwelling catheter to the vacutainer tube that contains a preservative. Before collecting the specimen from the sampling port, cleanse the port with a disinfectant, such as an alcohol prep pad and allow the disinfectant to dry. Don’t collect the urine sample by breaking the junction between catheter and collection tubing and don’t collect a urine sample for culture from a drainage bag. Only large volumes of urine for special analysis may be aseptically obtained from the drainage bag (Gould et al. 2009). For a patient without an indwelling catheter in place, the urine specimen of choice is the first morning void because it is generally more concentrated as a result of the length of time the urine was in the bladder. Because urine is so easily contaminated with normal bacteria, specimens collected for culture of urinary pathogens should focus on minimizing contamination from the perineal area and from superficial mucosa. This can be done by cleansing the skin prior to urine collection with an antiseptic wipe, such as a benzalkonium chloride, and obtaining a clean-catch urine specimen. Catheter-associated urinary tract infections (CAUTIs) are one of the most common infections among home care patients and the most adverse outcome of indwelling urinary catheter use. Guidelines from the Centers for Disease Control and Prevention, the Society for Healthcare Epidemiology of America, and the Infectious Disease Society of America all contain strategies to prevent a CAUTI (Gould et al., 2009; Hooton et al., 2009; Lo et al., 2014). In home care, if a patient develops symptoms suggestive of a urinary tract infection (UTI) (i.e., fever, suprapubic pain, etc.), a urine specimen is often not collected and the patient is instead treated empirically with antibiotics. Collecting and transporting urine specimens for analysis, and culture and sensitivity have often not been conducted due to a myriad of logistical problems related to getting the specimen to the lab without delay and lack of refrigeration, both of which can result in bacterial overgrowth and false positives. Before antimicrobial therapy is started, it is important to obtain a urine specimen for analysis and culture, if ordered by the physician. This allows the prescriber the ability to tailor the drug therapy based on the antimicrobial susceptibility data and assure appropriate antimicrobial use. When a patient