Volume 40 Number 4 | August 2026
Summary
The article discusses an innovative educational approach called “Be the IP” designed to enhance frontline staff understanding of specimen collection’s impact on infection prevention, antibiotic use, and patient outcomes in long-term care. This approach engages staff with real-world scenarios and promotes specimen stewardship as a multidisciplinary responsibility.
Infection Control Prevention in Long-Term Care
Angela Ferrano, LPN, BSPH, Volunteer Contributor
While conducting infection prevention rounds in long-term care, I began noticing a trend that extended beyond infection prevention alone. Cultures were being collected, antibiotics were being started, and laboratory results were being reviewed, yet many frontline staff did not always fully understand how specimen collection, contamination, timing, and communication could directly affect resident care. Staff often knew how to collect a specimen but did not always understand why proper collection and provider communication mattered.
As an infection control preventionist in a skilled nursing and rehabilitation setting, this raised an important question: How do we move beyond teaching staff to simply complete a task and instead help them understand how their actions affect laboratory results, antibiotic use, and patient outcomes?
Why Specimen Stewardship Matters
In long-term care, specimen collection is a routine part of resident care, but what happens before a specimen reaches the laboratory can directly affect the quality of results, treatment decisions, antibiotic use, and resident outcomes. Unlike acute care, long-term care residents often present with chronic illnesses, wounds, indwelling devices, cognitive impairment, or nonspecific symptoms, making it harder to determine when an infection may truly be present.
During infection prevention rounds and antibiotic stewardship reviews, I noticed staff often knew how to collect a specimen but were sometimes unsure why a culture was being ordered or how contamination could affect results. I saw this most often with urine and wound cultures.
“Once conversations shifted from ‘What do I do?’ to ‘Why does this matter?’ staff engagement started to look very different.”
At times, specimen collection became more about “getting the culture done” than understanding the reason behind it. Staff did not always realize that contamination or poor collection techniques could affect results and potentially lead to repeat testing, antibiotics that may not be needed, or confusion about whether a resident truly had an infection.
Teaching Staff to Think Beyond the Task
I developed an interactive activity called “Be the IP” (infection preventionist) as part of a two-week infection prevention skills fair involving around 200 staff members. Instead of lectures or yearly competencies, staff were shown real photographs taken during infection prevention rounds and asked to explain what was wrong, why it mattered, and how it could affect patient care.
One example involved photographs showing urine collection hats (toilet specimen collectors) stored improperly. Some were found on bathroom floors, resting on grab bars in shared resident bathrooms, or placed next to open specimen cups on sinks. Staff were asked to identify what was concerning and talk through how specimen results might be affected. Discussions often focused on external contamination and how inaccurate results could potentially lead to antibiotics being prescribed for an infection a resident may not actually have.
We also reviewed situations involving Foley catheter urine collection. Staff were asked, on the spot, how they would obtain a specimen and why each step mattered. Using photographs and group discussion, we walked through appropriate and inappropriate collection methods and discussed how improper technique could affect results.
Time was spent discussing the process of collecting urine from a secure unit for patients with dementia, as I realized that specimens collected from these units were returning more frequently with contamination issues. Staff members indicated that many of their residents are challenged by the catheterization procedure and/or have difficulty following direction, creating additional challenges in obtaining samples. The discussion included methods that staff utilize when attempting to obtain specimens and techniques used to collect them and how they may be impacted by the specimen collection method.
Unexpected Lessons
One thing I did not expect from the “Be the IP” activity was how often staff brought up barriers they were dealing with during everyday resident care. Instead of only identifying concerns, staff started explaining why certain things happened and what challenges they ran into on the units. A lot of the conversations came from everyday things staff were dealing with. Some staff shared that sometimes cultures just became part of the routine without always thinking about how contamination or collection technique could affect the results.
Staff seemed to enjoy learning this way more than traditional education. Since many of the examples came from situations they recognized, people were more comfortable asking questions and talking through concerns. One thing I realized quickly was that staff seemed more engaged when they understood the reason behind what they were doing. Once conversations shifted from “What do I do?” to “Why does this matter?” staff engagement started to look very different.
One thing this experience reinforced for me was that specimen stewardship starts long before a sample reaches the laboratory. Frontline staff play an important role in specimen quality and communication, and staff seemed more engaged when they understood why their role mattered.
We also learned that education does not always have to come from PowerPoint or yearly competency. Staff responded better when education focused on real situations they recognized from day-to-day care and were given time to ask questions and talk through barriers.
Throughout this process, it became clear that specimen stewardship is not something one department handles by itself. Nursing staff, providers, infection prevention, and laboratory professionals all play a role.
Angela Ferrano is an Assistant Director of Nursing and Infection Control Preventionist working in long-term care in New Jersey.