Page 56 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
PP-18

Reducing the Contamination Rate of Urine Culture among Infants in Klinik Kesihatan
Ketereh

Suhana H, Aliyaisma A, Zatul Itry M, Siti Nursyakirin SE, Nur Zalikha Z, Noor Hafizan MS
Makmal Kesihatan Awam Kota Bharu, Kelantan

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
A contaminated urine culture is defined as the presence of more than one organism at ≥100,000 CFU/ml. The
verification study showed a contamination rate of 60.8%. The consequences will generally affect parents’
satisfaction and patients’ management.

KEY MEASURES FOR IMPROVEMENT:
The key indicator used was the percentage of contaminated samples among infants and the standard set was
40% as per the College of American Pathologists (CAP).

PROCESS OF GATHERING INFORMATION:
A cross-sectional study was conducted using convenience sampling with 76 samples in two phases. Data to
identify the contributing factors were collected using a validated questionnaire given to 40 staff in KK Ketereh.
The non-compliance with sample rejection procedures by Makmal Kesihatan Awam Kota Bharu (MKAKB)
staff was identified from the laboratory forms.

ANALYSIS AND INTERPRETATION:
The pre-remedial study showed a urine contamination rate of 69.2%. The causes were due to poor knowledge
(5%), never attending CME on urine management (75%), improper practice on urine collection (95%), storage
(37.5%), and transportation (32.5%). Furthermore, 82.5% preferred using urine bags rather than the clean-catch
urine method for collection. Thirteen (13) samples fulfilled the criteria for sample rejection but proceeded for
culture.

STRATEGIES FOR CHANGE:
The strategies were CME and practical sessions on managing urine culture and bladder stimulation techniques
in infants. Flyers, CDs, and posters were also distributed. Other strategies used were creating awareness during
‘Hari Bersama Pelanggan MKAKB’, discussion with their Family Medicine Specialist (FMS), and conducting
an audit at their laboratory. The MKAKB staff have been monitored regularly to comply with the rejection
procedure.

EFFECT OF CHANGE:
The contamination rate decreased from 69.2% to 43.2% in cycle 1, then improved to 40.6% in cycle 2. Similarly,
Achievable Benefit Not Achieved (ABNA) has improved from 29.2% to 3.2% and 0.6%.

THE NEXT STEP:
We plan to expand this study and all the strategies to other health clinics in Kelantan.

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