Urine Trouble: Reducing Midstream Clean Catch Urine Contamination Among Children 3-17 Years Old.

Area of Science:

• Pediatric Medicine
• Clinical Microbiology
• Quality Improvement

Background:

• Midstream clean catch urine culture is preferred over catheterization for pediatric urine samples.
• High contamination rates in midstream clean catch urine cultures can lead to unnecessary medical interventions and increased costs.
• A resident-led initiative aimed to decrease contamination in pediatric midstream clean catch urine cultures.

Purpose of the Study:

• To implement and evaluate a bundled intervention to reduce contamination rates in pediatric midstream clean catch urine cultures.
• To assess the impact of the intervention on repeat urine cultures and catheterization rates.
• To evaluate the sustainability of the intervention's effects over time.

Main Methods:

• A bundled intervention was implemented across emergency, inpatient, and outpatient settings.
• Contamination rates were assessed pre-intervention (April 2016-September 2017), post-intervention (April 2018-September 2018), and during a sustainability period (October 2018-September 2020).
• Balancing measures included repeat urine cultures and contaminated catheterization cultures.

Main Results:

• Midstream clean catch urine culture contamination decreased from 45.3% to 30.9% post-intervention, a 14.7% absolute reduction.
• Repeat urine culture rates significantly decreased from 4.9% to 0.9% six months post-intervention.
• The intervention's impact waned over time, with contamination rates rising to 38.4% and repeat urine culture rates at 3.2% over 30 months post-intervention.

Conclusions:

• A resident-led bundled intervention effectively reduced pediatric midstream clean catch urine culture contamination.
• The positive effects of the intervention, including reduced contamination and repeat cultures, diminished over a 2-year period.
• Sustaining improvements in urine culture collection techniques requires ongoing monitoring and reinforcement.