Reducing infant catheterization in the emergency department through clean-catch urine collection

Area of Science:

• Pediatrics
• Quality Improvement
• Infectious Disease

Background:

• Urethral catheterization is the traditional method for obtaining urine cultures in infants for urinary tract infection (UTI) evaluation.
• Catheterization is associated with adverse effects and discomfort for infants.
• Clean-catch urine methods have shown promise for obtaining reliable urine cultures.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative to decrease urethral catheterizations in the emergency department (ED).
• To introduce and assess the efficacy of a clean-catch urine collection technique, termed 'Bladder Massage,' for infant urine cultures.
• To compare the contamination rates of urine cultures obtained via bladder massage versus catheterization.

Main Methods:

• A 'Bladder Massage' clean-catch technique was implemented for infants aged 0-6 months requiring urine cultures.
• Exclusion criteria included critical illness, known urologic abnormalities, or prior UTI diagnosis.
• Educational initiatives were the primary intervention, with retrospective data collection on bladder massage usage and contamination rates.

Main Results:

• In the first year, bladder massage was attempted on 40.7% of eligible infants, with a 64% success rate, avoiding catheterization in 26.1% of patients.
• The contamination rate for catheterization was 1.6%, compared to 12% for bladder massage (P < 0.001).
• A majority of bladder massage contaminants (9/10) were from female patients.

Conclusions:

• The Bladder Massage technique was successfully introduced in the pediatric ED, reducing the need for urethral catheterization in well-appearing infants.
• Ongoing efforts are necessary to minimize contamination rates, particularly in female infants.
• Further improvements include increasing technique adoption and optimizing electronic health record documentation to support continued use.