9693 ‘A pee-culiar concern - are we collecting urine sample for suspected sepsis in infants under 3 months?’

Résumé fourni par la source

Why did you do this work? According to NICE guidelines (1), urine collection is an essential component of the septic screen in infants under three months. The prevalence of urinary tract infection (UTI) in neonates ranges from 5–20%, with a 15% risk of renal scarring following the first UTI. An audit conducted in our Children’s Emergency Department (CED) in 2023 revealed that 63% of infants coded as suspected sepsis did not have a urine sample collected in CED, and 32% had no urine sample taken at all during their hospital admission. These findings highlighted a significant gap in practice and led to recommendations for improving urine collection and enhancing staff training in in-and-out catheterisation. This quality improvement (QI) project (April–July 2025) was therefore designed with the following aims: To re-evaluate urine collection practices in infants under three months presenting with suspected sepsis in CED. To increase staff competence and confidence in performing in-and-out catheterisation for urine collection. What did you do? Delivered structured education and hands-on training sessions for medical staff (ACP/SHO/Registrar) in both CED and the Children’s Hospital (CH) on in-and-out catheterisation for urine collection. Advocated the importance of urine collection in septic screening through departmental emails, posters in CED, and educational updates. Undertook retrospective data collection for all infants under three months coded as ‘sepsis’ attending CED between 1 April and 31 July 2025. What did you find? Between 1 April 2025 and 31 July 2025: 55 infants <3months were treated as suspected sepsis. 91% (50/55) had a urine sample collected, representing a marked improvement compared to 2023. 61.8% (34/55) had samples collected in CED, with a further 34.6% (19/55) at CH. Methods of collection: In-and-out catheter: 9.1% (5 cases) Clean catch: 25.5% (14 cases) Not documented: 58.2% (32 cases) Missed/unsuccessful/declined attempts: 5.4% (3 cases combined) We also assessed: Time between urine collection and antibiotic administration. Time between patient arrival and urine collection. What does it mean? This QI project demonstrated a marked improvement in urine collection since the 2023 audit, with 91% compliance compared to 37%. Staff competence and awareness regarding in-and-out catheterisation also improved. However, challenges remain: over half of cases lacked documentation of collection method, and delays between arrival and urine sampling were significant. Conclusion Targeted training and advocacy improved urine collection in suspected sepsis under 3 months. Ongoing QI is required to: Standardise documentation of collection methods. Reduce time delays to sample collection. Sustain training in in-and-out catheterisation. References NICE guidance: Fever in <5s, Neonatal Infection, Managing UTI in Under 16s. Shaikh, Ewing, Bhatnagar, Hoberman. risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 2010;126(6):1084–1091. Branagan A, Canty N, O’Halloran E, Madden M, O’Neill MB. Evaluation of the quick wee method of inducing faster clean catch urine collection in pre-continent infants: a randomized controlled trial. World J Pediatr. 2022 Jan;18(1):43–49. Kaufman J, Knight AJ, Bryant PA, et al. Liquid gold: the cost-effectiveness of urine sample collection methods for young pre-continent children. Archives of Disease in Childhood 2020;105:253–259. Fox H, Gupta M (2017) G375(P) Analysis of doctors and nurses confidence with the use of in and out urinary catheters for collection of urine samples.

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