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Improving clean-catch contamination rates: A prospective interventional cohort study
Sharon Teo1, John A Cheek1,2,3,4, Simon Craig1,2,4
1Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia.
Insights
Providing a pre-made urine collection pack and handout did not significantly reduce clean-catch urine contamination rates in young children. Further strategies are needed to improve urine sample quality in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Diagnostics
- Urology
Background:
- The clean-catch method for urine collection in children often results in high contamination rates.
- Contaminated urine samples can lead to misdiagnosis and unnecessary antibiotic use.
Purpose of the Study:
- To evaluate if providing a parent handout and a pre-made urine collection pack reduces contamination rates for clean-catch urine samples in pediatric patients.
- To assess the impact of an intervention on the quality of urine specimens obtained in a tertiary pediatric emergency department.
Main Methods:
- A single-center prospective cohort interventional study was conducted in a pediatric emergency department.
- The intervention involved providing a standardized information handout and a pre-made urine collection pack.
- The primary outcome was the change in urine contamination proportion for clean-catch samples before and after the intervention.
Main Results:
- A total of 621 urine specimens were analyzed (288 pre-intervention, 333 post-intervention).
- Contamination rates were 14.9% pre-intervention and 11.4% post-intervention, a difference that was not statistically significant (P=0.19).
- Female patients had higher contamination rates (16.4%) compared to males (10.5%).
Conclusions:
- The implementation of a pre-made urine collection pack with written instructions did not significantly decrease the contamination rate of clean-catch urine samples.
- Alternative or supplementary methods may be necessary to effectively reduce urine sample contamination in pediatric populations.
Objectives:
The clean-catch method of urine collection carries a high contamination rate. This study aims to evaluate the effects on contamination rate of providing a parent handout and pre-made urine collection pack for clean-catch urine collection.
Methods:
We conducted a single-centre prospective cohort interventional study in a tertiary paediatric ED. All children younger than 24 months who presented from April 2013 to June 2014 requiring a urine sample to be obtained were included. The intervention was provision of a pre-made urine collection pack including a standardised information handout. The primary outcome measure was the difference in proportion of urine contamination in samples obtained via a clean-catch pre- and post-intervention.
Results:
The total number of urine specimens included was 288 in the pre-intervention group and 333 in the post-intervention group. Contamination rates were 14.9% in the pre-intervention group and 11.4% in the post-intervention group. There was no statistically significant reduction in contamination (P = 0.19). The contamination rates appeared to be associated with gender, with (pooled) female contamination rates being 16.4% (44/269) and male contamination rates being 10.5% (37/352). Most specimens of urine were collected via the clean-catch method (81.2%), followed by catheter urine specimen (13.7%) and suprapubic aspirate (5.1%). The contamination rate in our study for clean-catch urine collectively was 13%, catheter urine specimen 3.8% and suprapubic aspirate 0%.
Conclusion:
The contamination rate of clean-catch urine did not improve with the implementation of a pre-made urine collection pack including standardised written instructions.
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