Lipsky B A, Inui T S
Med Care. 1983 Jun;21(6):655-60. doi: 10.1097/00005650-198306000-00007.
Graphic instructions for the collection of clean-voided urine specimens were posted in outpatient clinic bathrooms. These signs were intended to supplant clinic staff verbal instructions and to improve patients' ability to perform this procedure correctly. To assess the impact of the signs, the contamination rates were determined for urine culture specimens for the 6-month periods immediately preceding and following their introduction. The contamination rate for 306 consecutive specimens submitted before the signs were hung (12 per cent) was significantly lower (p = 0.004) than for the 360 specimens submitted afterward (20.6 per cent). Further, the incidence of true bacteriuria was significantly higher before the signs were posted (21.8 per cent) than afterward (15.2 per cent) (p = 0.02). There was no reported change in the provision of verbal instructions by clinic personnel, and the signs provoked some negative reactions from patients and visitors. This unexpected adverse outcome of a well-intended patient education effort is reported so that others may profit from the authors' mistakes.
门诊卫生间张贴了采集清洁中段尿标本的图文说明。这些标识旨在取代诊所工作人员的口头指示，并提高患者正确执行该操作的能力。为评估这些标识的影响，测定了标识引入前后6个月期间尿培养标本的污染率。在标识悬挂前提交的306份连续标本的污染率（12%）显著低于（p = 0.004）之后提交的360份标本的污染率（20.6%）。此外，真正菌尿症的发生率在张贴标识前（21.8%）显著高于之后（15.2%）（p = 0.02）。诊所工作人员提供的口头指示没有报告变化，并且这些标识引发了患者和访客的一些负面反应。报告这一善意患者教育努力的意外不良结果，以便其他人能从作者的错误中获益。
