Mid-stream clean catch urine collection in newborns: a non-invasive and safe technique

Background: The aim of this study is to determine the success rate and safety of a non-invasive technique to obtain clean-catch midstream urine samples in newborns.Methods: Prospective bedside clinical study. After obtaining written informed consent,120 consecutive newborns admitted in NICU with no dehydration, poor feeding, need for immediate urine sample by invasive method' for whom urine collection was advised for various reasons who met the inclusion criteria were included in the study with consent being taken from the parents. After adequate milk intake supra pubic and lumbar para vertebral areas were stimulated in repeated cycles of 30 s until micturition began.Results: Success rate in obtaining a midstream urine sample within 5 min. The success rate was 90%. The mean time taken to collect urine was 64.24s, for males it was 62.55s and for females 65.93s.Conclusions: The technique has been demonstrated to be safe, quick and effective. The discomfort and time consumption usually associated with bag collection methods as well as invasive techniques can be avoided.

Low Contamination Rates in Bag Urine Samples Can Be Achieved.

Aims: Although international guidelines consider bag urine sample (BUS) as an unreliable way to collect urine in non-cooperative children suspected to have urinary tract infection (UTI), BUS is a commonly used method both in hospital and at home. Contamination of urine samples is believed to be a major problem of this technique. To assess the contamination rate of BUS in our clinical practice we reviewed our microbiological data of the last three years in young children investigated for UTI. Study Design: Retrospective study. Place and Duration of Study: Department of Pediatrics, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy (2010-2012). Methodology: Microbiological records of BUS and clean catch urine (CCU), in infants younger than 36 months of age, were retrospectively reviewed. Trained nurses collected BUS according to a standardized procedure. We also reviewed the three-year microbiological records of CCU in children older than 36 months of age. Contamination of a urine sample was defined as the growth of multiple pathogens irrespective to CFU counts. Results: A total of 583 microbiological records were reviewed, 71% were BUS, 7% and 22% were CCU in children younger and older than 36 months of age respectively. In children younger than 36 months of age, contamination rates were comparable (P=.90) when urine was collected with BUS (16%) or with CCU (14%). In patients older than 36 months of age, contamination rates were significantly reduced (2.4%; P<.001) in CCU compared with both BUS and CCU in younger children. Conclusion: A good adherence to a standardized nursing procedure for bag urine collection could limit the risk of contamination of urine samples.

Which Urine Sampling Method is Suitable for Women Visiting the Emergency Department?

BACKGROUND: Urinalysis is a useful laboratory test in the diagnosis of various diseases. In sampling for the urinalysis, there is much concern about contamination that can lead to misdiagnosis in the mid-stream urine sampling method. We conducted this study to determine, in terms of concordance of results and contamination in culture, whether there was any superiority in mid-stream sampling methods with or without disinfection measures compared to the catheterization method. MATERIALS AND EMTHODS: We used three kinds of urine sampling methods sequentially, mid-stream non-clean catch, mid-stream clean catch, and catheterization, for ambulatory, non-pregnant, non-menstruating female patients who visited NHIC Ilsan Hospital emergency department during a one-week period in September 2001. Each sample was electrophotometrically analyzed for leukocyte esterase, nitrite, and blood by using a reagent strip and was cultured immediately or after overnight refrigeration. RESULTS: Of the 41 patients, 9 had culture-proven urinary tract infections. The concordance rates(kappa) for nitrite, blood, and leukocyte esterase were 0.875, 0.403, and 0.406 between non-clean catch and catheterized samples and 0.875, 0.481, and 0.560 between clean catch and catheterized samples, respectively. The contamination rate of the non-clean catch, the clean catch, and the catheterized samples were statistically different: 51.2%, 29.3% and 0%, respectively. CONCLUSION: We found that cleaning with disinfectant was effective for reducing the contamination rate, even though the best urine sampling method for zero contamination was catheterization. We recommend considering cost, patients' comfort, an acceptable threshold for contamination, and the necessity for a culture before choosing a urine sampling method for women who visit the emergency department.

Comparison of the Bacterial Contamination Rates according to the Urine Collection Methods in Women / 기본간호학회지

BACKGROUND: The purpose of this study was to determine whether cleansing the perineum and urethral meatus and using midstream urine affect the rate of bacterial contamination of urine specimens, and to determine the optimum urine collection method. We studied 41 asymptomatic healthy nursing school students. Women who were menstruating were not excluded from this study. METHOD: The first and midstream urinesamples were collected during consecutive urinationsby each woman. The first sample was not a clean-catch specimen, and the second one was a clean-catch specimen. Both specimens were studied by urinalysis and bacterial culture with standard methods. RESULTS: 41 women met the study criteria and 39 successfully completed the study. None of the urine cultures were positive. 68.3% of the non clean-catch first urine cultures, 53.7% of the non clean-catch midstream cultures, 33.3% of the first clean-catch urine culteres and 30.8% of the midstream clean-catch urine were found to be contaminated. There was a significant difference in the bacterial contamination rates between the first and midstream urine, and the clean-catch and non clean-catch urine(p=0.035, p=0.001 respectively). On urinalysis, 7.3% of the non clean-catch first urine, 7.3% of the non clean-catch midstream urine, 2.6% of the clean-catch first urine and 2.6% of clean-catch midstream urine were found to be above grade 2. CONCLUSIONS: According to our results, the bacterial contamination rate was the lowest in midstream and clean catch urine specimens. Threrfore it is recommended that the midstream clean-catch technique is the standard practice for collecting urine specimens for bacterial culture in women.