Successful Implementation of Single Urine Polymerase Chain Reaction Test for Evaluating Suspected Cytomegalovirus Infection in Neonates

Overuse of laboratory investigations is viewed as medical waste. In the past, to diagnose congenital cytomegalovirus (CMV) infection, consecutive urine culture samples were obtained. With the advent of polymerase chain reaction (PCR) technology, 1 urine specimen should be enough. We conducted this quality improvement study to look at the effect of a practice change from 3 to 1 urine specimen for PCR testing. METHODS: The authors instituted a single PCR urine test for CMV in their neonatal intensive care unit (NICU) in May 2021. We reviewed the data on all the urine CMV PCRs obtained on neonates for 1 year, May 1, 2020, to April 30, 2021 (Epoch 1), and compared it with the data obtained from May 1, 2021, to February 28, 2022 (Epoch 2). RESULTS: A total of 3,612 neonates were born during the study period—1,816 infants were born during Epoch 1 and 1,796 infants during Epoch 2. A total of 97 neonates (5.3%) were evaluated for congenital CMV infection during Epoch 1 and 149 infants (8.2%) during Epoch 2. The single urine sample CMV evaluation rate during Epoch 1 was 53.6% (52 infants out of 97 infants evaluated), which increased to 98.6% in Epoch 2 (147 infants out of 149 infants), P < 0.001. The monthly average cost per infant declined from a mean value of 70.1 dollars to a mean value of 39.5 dollars. CONCLUSIONS: We increased the single specimen urine CMV PCR test from 53.6% to 98.6%. The intervention resulted in reducing waste and improving resource utilization.