Mind the Midstream: Nurse and Patient Perspectives on Diagnostic, Infection Prevention, and Antimicrobial Stewardship for Urinary Tract Infections in Oman

Background: Urinary tract infections (UTIs) are a major driver of laboratory testing and antimicrobial prescribing, yet inappropriate urine collection and specimen handling, due to limited patient and nursing engagement, can compromise diagnostic accuracy and contribute to unnecessary or inappropriate antibiotic use. This study evaluated knowledge, attitudes, and practices (KAPs) related to pre-analytical diagnostic stewardship (DS), infection prevention and control (IPC), and antimicrobial stewardship (AMS) amongst nurses and hospitalized patients evaluated for urinary tract infection or undergoing urine culture workup. Methods: A cross-sectional study was conducted at two tertiary hospitals in Oman between September 2022 and August 2023. Three structured, internally validated questionnaires assessed pre-analytical DS, IPC, and AMS amongst nurses and patients. A total of 172 nurses were approached, with 165 completing the pre-analytical DS questionnaire and 162 completing the IPC/AMS questionnaire (with overlapping respondents across modules); 77 hospitalized patients evaluated for urinary tract infection or undergoing urine culture workup completed the patient questionnaire (out of 79 initially assessed, with two excluded due to incomplete clinical data). KAP domain scores were standardized to a 0–100 scale and summarized as mean ± SD. MANOVA assessed the effects of covariates on combined KAP outcomes. Mann–Whitney U, Kruskal–Wallis tests compared KAP scores across demographic and professional groups. Results: Patients demonstrated strong awareness of the importance of correct urine collection (91%); however, only 7.9% reported receiving midstream urine instructions, contrasting with 86.1% of nurses who reported providing them, pointing to a discordance between nurse-reported practice and patient-reported experience. Patients demonstrated high IPC engagement with 88.3% willing to prompt hand hygiene/glove use among doctors and nurses, and 74% would question antibiotic necessity. Amongst nurses, gaps persisted in inserting new catheters before culture (66.7%) and refrigeration of specimens if delay was expected (36.4%). Work experience significantly influenced nurses’ pre-analytical diagnostic stewardship knowledge and practice scores (p = 0.002 for MANOVA global effect; univariate practice score p < 0.001). Knowledge amongst nurses was high for hand hygiene, IPC prevention and antibiotic resistance drivers; however, 56.3% incorrectly associated antibiotics with pain/inflammation. Institutional affiliation significantly influenced overall KAP outcomes (p = 0.004 for MANOVA global effect, with univariate practice scores showing p < 0.001). Overall, findings revealed motivated stakeholders alongside discrete, actionable weaknesses in diagnostic and antimicrobial stewardship workflows. Conclusions: This study identifies a critical but modifiable gap between perceived and patient-experienced pre-analytical DS practices in UTIs. Strengthening microbiology and nursing collaborative diagnostic stewardship, standardizing patient instructions, improving specimen-handling infrastructure, and actively engaging patients represent practical, high-impact strategies to enhance diagnostic accuracy, infection prevention, and antimicrobial stewardship in Oman.