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An improved urine collection pad method: a randomised clinical trial
1Department of Child Health, Rotherham General Hospital, Rotherham, Yorkshire, UK.
Insights
Changing the urine collection pad (UCP) every 30 minutes significantly reduces bacterial contamination in samples from young children, improving the accuracy of diagnosing urinary tract infections (UTIs). This simple modification enhances diagnostic reliability for infants.
Area of Science:
- Pediatrics
- Clinical Microbiology
- Diagnostic Methods
Background:
- Urinary tract infections (UTIs) are common in young children.
- Accurate urine sample collection in infants is challenging due to contamination.
- The urine collection pad (UCP) method is used but can be prone to bacterial contamination.
Purpose of the Study:
- To assess a modified urine collection pad (UCP) method for reducing bacterial contamination in infant urine samples.
- To improve the reliability of UTI diagnosis in young children using UCPs.
Main Methods:
- Febrile children under 2 years with suspected UTI were randomized into two groups.
- Single UCP group: UCP remained in the diaper until urine passed.
- Replaced UCP group: UCP was replaced every 30 minutes until urine passed. A moisture alarm signaled urine passage.
Main Results:
- Satisfactory samples were obtained in 68 out of 80 children.
- Heavy mixed bacterial growth (>10^5 organisms/ml) was significantly lower in the replaced UCP group (3%) compared to the single UCP group (29%) (p=0.008).
- No adverse effects were reported from the moisture alarm.
Conclusions:
- Replacing the UCP every 30 minutes drastically reduces heavy mixed bacterial contamination.
- This modification substantially increases the confidence in excluding UTI diagnoses from UCP results.
- The improved UCP method is a simple, clinically valuable tool for diagnosing and excluding UTI in infants in various healthcare settings.
Aim:
To evaluate a modified urine collection pad (UCP) method for its ability to reduce heavy mixed growth bacterial contamination of UCP samples in young children with suspected urinary tract infection (UTI).
Method:
Febrile children under 2 years of age were randomised to two UCP METHODS: the same UCP kept in the nappy until urine was passed (single UCP group), or the UCP replaced with a fresh one every 30 minutes until urine was passed (replaced UCP group). In both groups a moisture sensitive audio alarm was used to signal passage of urine.
Results:
Eighty children were enrolled and a satisfactory sample was obtained in 68 (37 in the single UCP group and 31 in the replaced UCP group). In 12 children (15%), collection failed, mainly because of faecal soiling of the pad. UTI occurred in three children (4%). In the remaining 65 samples, heavy mixed growth (> 10(5) organisms/ml) occurred in 1/31 (3%) in the replaced UCP group compared with 10/35 (29%) in the single UCP group (p = 0.008). There were no adverse effects from the use of the moisture sensitive audio alarm.
Conclusion:
Changing the UCP every 30 minutes almost eliminates heavy mixed growth contamination of UCP samples and substantially increases the proportion of UCP results that confidently exclude UTI. This represents a simple and clinically important improvement to the UCP method which is reliable for diagnosing and excluding UTI in young children still in nappies. It has potential for use in outpatient clinics, in the primary healthcare setting, or at home.
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