https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/06/22/dites-adieux-aux-bandelettes-reactives
Choosing Wisely Canada’s recommendations to reduce inappropriate urine dipstick use
By Amna Zafar, Deb Schick, & Julie Weir
June 22, 2026
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Urine dipsticks are commonly used as a point-of-care test to detect bacteriuria in the process of diagnosing bladder infection. However, for many populations, asymptomatic bacteriuria is a normal finding that does not require treatment.
Takeaway messages
- Do not use urine dipsticks to diagnose urinary tract infections (UTI) in people 65 years and older. Instead, actively monitor and assess for minimum signs of bladder infection as well as signs of other possible causes of the health change.
- To enact real change, it is essential that nurses are involved in ensuring quality improvement and addressing low-value care.
- Choosing Wisely Canada’s recommendations support the sharing of best practices, such as the opportunity to reduce inappropriate urine dipstick use.
Nurses are uniquely positioned to make lasting change across the health-care sector. This includes the long-term care (LTC) sector where nurses often serve as the onsite supervisor, responsible for care provision. As such, nurses can function as catalysts for quality of care improvement, starting at the bedside (Beks et al., 2024).
Urine dipsticks are commonly used as a point-of-care test to detect bacteriuria in the process of diagnosing bladder infection. However, for many populations, asymptomatic bacteriuria is a normal finding that does not require treatment. These populations include older persons who have a higher prevalence of asymptomatic bacteriuria due to age-related changes. Despite this, dipsticks continue to be incorrectly used in LTC as a diagnostic tool for bladder infection. This overuse leads to misdiagnosis and incorrect treatment of asymptomatic bacteriuria as a bladder infection (Nicolle et al., 2019). This can result in unnecessary use of antibiotics, contributing to the global health concern for antimicrobial resistance. Furthermore, this exposes residents to potentially harmful side effects associated with the unnecessary prescription of these antibiotics.
Recommendations for practice
To help address the inappropriate use of urine dipsticks in LTC homes, Choosing Wisely Canada issued a joint statement on urine testing, endorsed by 10 societies, associations, and organizations. Specifically, these groups recommend that in the investigation of older adults, LTC homes should not purchase, store, or use urine dipsticks. They also recommend that urine dipsticks should not be used in people 65 years and older who present to a clinic, an emergency department, or any other health-care setting. Despite these recommendations, urine dipsticks continue to be used for UTI diagnosis in LTC homes.
At Sherbrooke Community Centre in Saskatoon, nurse leader Deb Schick has spent 33 years working as a nurse and in various leadership roles. Through her work as leader of professional practice, she continues to advocate for evidence-informed practice and quality improvement by making intentional changes. Schick led change as a nurse leader by implementing a multipronged approach to stop urine dipstick use in this facility.
Educational materials were developed using the Saskatchewan Ministry of Health guidelines and provided to nurses in didactic sessions. Nurses were instructed to actively monitor the resident for the first 24–48 hours after noticing behaviour or health changes instead of using a dipstick. This includes assessing for other causes, such as infection or dehydration. During this time the nurse should monitor for empirical signs and symptoms of UTI, such as fever, urinary frequency or urgency, and pain. Nurses can also begin interventions such as regularly monitoring vital signs and encouraging fluid intake. If symptoms do not improve within 48 hours, the nurse should communicate with the health-care provider for further planning.
Resident councils get involved
Families and residents of the Sherbrooke Community Centre were also provided with education and were involved in this change. Virtual sessions were held for families to ask questions or give suggestions for improvement. The information about asymptomatic bacteriuria was very helpful for families, particularly during active monitoring. It also provided a foundation for nurses to talk to families about what they were doing to support the resident and provide reassurance. Discussions also took place at the resident council to better inform the residents of the changes and why.
This nurse-led advocacy effort at Sherbrooke led to the complete removal of the supply of urine dipsticks at the site. This was the most effective way to eliminate the unnecessary use of dipsticks.
About Choosing Wisely Canada
Choosing Wisely Canada (CWC) is the national voice for reducing unnecessary tests and treatments. This clinician-led initiative collaborates with national clinical societies and associations to develop recommendations on frequently overused tests and treatments that can expose patients to potential harm, consume valuable health-care resources, and contribute to the climate crisis. CWC mobilizes health-care providers and their organizations to adopt the recommendations and integrate them into routine practice. In 2024, CWC released the Ditch the Dipstick resources to help institutions reduce their dipstick use and find alternatives to provide better care. The resources include a printable poster, a page of frequently asked questions for residents/families, and a four-step guide to ruling out bladder infections.
References
Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., Eckert, L. O., Geerlings, S. E., Köves, B., Hooton, T. M., Juthani-Mehta, M., Knight, S. L., Saint, S., Schaeffer, A. J., Trautner, B., Wullt, B., & Siemieniuk, R. (2019). Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 68(10), e83–e110. https://doi.org/10.1093/cid/ciy1121
Beks, H., Clayden, S., Wong Shee, A., Manias, E., Versace, V. L., Beauchamp, A., Mc Namara, K. P., & Alston, L. (2024). Low-value health care, de-implementation, and implications for nursing research: A discussion paper. International Journal of Nursing Studies, 156, 104780. https://doi.org/10.1016/j.ijnurstu.2024.104780
Amna Zafar, RN, BScN, BSc, was a CWC summer student and is a new graduate nurse working at Stollery Children’s Hospital, in Edmonton, Alberta.
Deb Schick, RN, MSN, is the leader of professional practice at Sherbrooke Community Centre and site administrator at Central Haven Special Care Home, in Saskatoon, Saskatchewan.
Julie Weir, RN, BM, MN, ICP, LTC-CIP, is a PhD student and the clinical director of operations, patient flow and ambulatory care at Horizon Health Network, in Moncton, New Brunswick.
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