Performance of a urine-screening protocol

The performance of a urinalysis protocol using screening Chemstrip-9 dipstick analysis with selective sediment microscopy and culture is reviewed. Sediment microscopy performed on urine samples positive for leukocyte esterase, nitrite, protein, or blood, or when specifically ordered (15% of urinalyses) was reduced by 57.1%. Protocol urine culture performed when more than 5 WBC/high-powered field (HPF), more than 10 bacteria/HPF, or yeasts were found on sediment microscopy or with a positive nitrite test was done for 9.8%. Urine culture was specifically ordered for another 13.6%. Percent significant bacteriuria (greater than or equal to 10(5) colony-forming units/mL) was higher for protocol-generated cultures (37.1%) versus ordered cultures (17.2%). For urinalyses with ordered cultures, the protocol would have detected 89.8% of cases with significant bacteriuria. The protocol has facilitated detection of significant bacteriuria with good acceptance by clinicians. Cost savings achieved by reduction of sediment microscopy was partly off-set by some increase in urine cultures performed.