Difficulties for primary health care staff in interpreting bacterial findings on a device for simplified urinary culture.

The reliability of interpretations of findings from dip-slide devices for culturing urine was investigated in a national Swedish external quality assessment (EQA) programme. Also investigated was the extent of improvement in the examination procedure achieved through personnel training programmes and information. According to Swedish national recommendations, dip-slide should only be used in primary health care (PHC) in cases of uncomplicated urinary tract infection (UTI) in females of childbearing age. The recommendations also define six possible outcomes of a dip-slide examination, outcomes that have formed the basis for the EQA programme since 2001. No improvement in ability to classify readings correctly into the six categories was noted for the period 2001 to 2006. Preparations containing 'mixed flora' presented participants with the greatest difficulty, with only 28 % correct reports. The EQA programme, with educational components and voluntary participation, has not improved quality. The disappointing results might be a reflection of the limited effort and resources allocated by clinical microbiology laboratories for training and for sustaining proficiency in the evaluation of dip-slides. For these reasons, we cannot at present recommend the dip-slide technique for use in PHC settings.