Q&A with Tamer Elsockary, Vice President and Global Platform Leader, Lab Specimen Management, BD

Would you please explain what risks and inefficiencies there are with testing open urine collection samples?

If we think about urine testing in general, this is a cornerstone of diagnostic care, and a noninvasive tool used for testing conditions like pregnancy, urinary tract infections, metabolic disorders, and many others. Though urine testing is important, many clinicians still rely on an open collection method. With open collection, there is the risk of contamination, which can contribute to false positives or repeated collections, leading to delayed results, or wrong diagnosis, a missed diagnosis and even in certain situations, unnecessary antibiotic prescriptions. So, this can be a cause of antibiotic resistance and compromises patient safety. So just an example on that, E. coli typically doubles every 20 minutes if your sample is not properly preserved.

In addition to the clinical impacts, open collection itself has major operational inefficiencies like manual pouring or having to manually transfer samples from one container to another or repeating collections. That all consumes a lot of time of a very valuable resource in the lab, which is the people, and this adds a lot of avoidable cost too to the system and those all can be eliminated the more we adopt closed collection that is the innovation that BD have been introducing the past few years. And we cannot forget about the patient. This is for one purpose, serving patients and giving the right diagnosis and the right decision at the right time. So these risks can inefficiently translate into repeated visits, delayed treatment, or unnecessary anxiety if another urine sample is requested.

Could you please expound on the benefits of a three-tube urine collection kit over BD’s current closed collection kit, BD Vacutainer?

The three-tube urine kit is an an extension of the original innovation. Let's start first with the values that closed collection offers: sample preservation, integrity of the sample, minimizes contamination, supports infection control, and supports antibiotic stewardship.

We decided on the three-tube kit to provide standardization, which is an important process in the lab. BD is embracing and introducing kitting to provide consistency and standardization depending on the clinical applications of the care setting and optimizing collection and transport and improving the workflow. Also, those kits deliver a complete solution in one package eliminating the need to resource separate components and logistically manage multiple components that is needed for the testing. All that streamlining minimizes steps, reduces recollection, and accelerates turnaround time, which at the end, serves the patient and the healthcare systems. So, within that continuum BD decided to introduce the three-tube kit to provide incremental value beyond the standard kits by expanding additional diagnostics flexibility and reduce the burden on healthcare practitioners so they do not need to keep thinking about what tube to use at which time.

What education or training will be provided to laboratorians and clinicians to counter any perceptions of this being too complex?

I wouldn't say it would be perceived as being too complex. It actually should simplify and standardize the process and help the healthcare practitioners and patients, but we are fully aware that there might be lack of awareness or some organizations may underestimate the contamination impact and the financial impact that comes with it. Some healthcare practitioners are used to open collection. But with the use of closed systems, with the use of the three-tube urine collection kit, that actually makes the testing process simpler by taking the guess work out of the sample collection process.

Without that closed system, there is potential for erroneous results or a need for recollection that adds work to the healthcare system. But in addition to all of the above, we are aware the education piece is very important for adoption of new technologies. We have a team of clinical specialists who can support the customer with training, education, and workflow assessments so it is an easy adoption.

Would you please share your viewpoint on how laboratory leadership could justify any cost concerns with a new urine collection kit? 

We are fully aware what healthcare systems and the laboratory leadership are going through — healthcare budget situations and the need of doing more, with less. Healthcare leaders are always thinking, “where can we save some cost” and “where can we drive financial efficiencies” but what is more important is focusing on what is the total cost of ownership of an entire solution, what are the efficiencies across the chain that can justify the savings, rather than thinking about what is the cost of a cup, a closed collection system versus open collection. Just thinking from the clinical side, the reduction of incidents of contamination, the reduction of false positives, the reduction of unnecessary antibiotic prescription, that is cost savings to the system. For the lab, there is value in the reduction of manual work, so highly qualified lab professionals are not spending time transferring urine from one container to another, or from one tube to another, saving time which is very valuable. This time savings can be directed to more value-added activities in the lab that could also be quantified and focused on. The fact that there is no need to do recollection or retesting, which adds cost to the healthcare system, can also be justified.

And, let's not forget why we are all doing what we're doing — it is for the patient — being able to provide those results to the patient at the right time, the right diagnosis, and with the right medication prescription.