Browsing by Author "Henson, Robin"
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Item Contamination Rates in Urine Collection at Cook Children’s Pediatric Urgent Care Centers(2018-03-14) Fulton, Audra; Hamby, Tyler; Akkad, Rana; Coplin, Bradley; Martin, Parul; Henson, RobinBackground: Over $180 million in health care costs are spent annually on pediatric urinary tract infections (UTIs). Pediatric UTI symptoms are often non-specific causing physicians to rely on the results of a urine dip stick to assess appropriate follow up and treatment. Improper urine collections can result in bacterial contaminations and can mask true urinary tract infections. This would lead to inaccurate diagnosis, unnecessary treatment, and/or obtaining additional specimens, all adding to the burden of increased costs and patient/parental anxiety. Hypothesis: Cook Children’s Urgent Care Clinics (UCCs) have significant contamination rates from patients who gave mid-stream urine. Methods: Data collection consisted of a six-week retrospective chart review on patients with suspected UTI at each UCC location. Included in this study were patients five years and older and able to collect a mid-stream urine. Data was placed into Red Cap database. Contamination was defined as culture results= 12 yrs) on the assumption that adult supervision was needed in the former group. Contamination rates were then calculated for age, gender, and UCC location. Results: Of the 258 charts reviewed, 202 met the criteria for this study. The sample size was significantly smaller for males (13%) than females (87%). Total contamination rate was 30% (p=). Based on age, contamination rates showed 54% for 5-11 yrs and 46% for 12 yrs and older (p=0.0069). Females were more likely than males to have contamination, 33% vs 11.5%, respectively (p=0.026). There was no significant relationship between UCC location and contamination (p=0.52). Small, moderate, and large amounts of leukocyte esterase were associated with infection (p= 0.0006), however, trace results were not. Conclusions: The results from this preliminary study reinforce significant urine collection contamination rates. Chart reviews will be completed to provide a more robust sample size, but steps need to be taken to determine what is causing this high rate. To elucidate these variable(s), surveys (patient/family and provider) will be obtained to assess collection methods: how the urine is collected (parent/patient perspective), how it is thought to be collected in the clinic (provider perspective), and financial burdens to the family and institution (administrative perspective).Item Patient Surveys Referring to Urine Sample Collection Methods: A Quality Improvement Study at Cook Children’s Urgent Care Centers(2018-03-14) Akkad, Rana; Henson, Robin; Fulton, Audra; Hamby, Tyler; Martin, Parul; Coplin, BradleyBackground:Urinary Tract Infections (UTIs) are a common problem amongst Pediatric Urgent Care Centers (UCCs) and are usually the result of various bacterial species. While many factors are considered when diagnosing a UTI, the urinalysis remains the most important screening tool and a urine culture gives diagnostic confirmation. The sensitivity and reliability of a urinalysis is affected by many factors including the urine collection method. A previous retrospective study found that Cook Children’s UCCs had high rates of urine contamination (defined as Hypothesis: We hypothesize that Cook Children’s midstream urine collection policy is not being followed/enforced. Methods: A quality improvement (QI) study was designed and conducted at Cook Children’s Pediatric UCC in Fort Worth. The Fort Worth site was chosen because of its historically high patient volume. A survey was developed with questions that modeled Cook Children’s midstream urine collection policy. Surveys were given verbally to patients who gave a urine sample and met the inclusion criteria: potty trained. Families could follow along with a provided copy of the survey. The data were collected over a four-week period, placed into REDCap, and analyzed according to survey questions. Results: Of those surveyed (n=24) less than 10% received gloves; 35% of female patients and 66% of uncircumcised male patients were properly instructed to clean their genitalia. Midstream urine collection instructions were given to 26% of patients, and more than 50% of patients claimed to not collect urine midstream. Conclusions: The results from this preliminary study demonstrate that Cook Children’s midstream urine collection policy is not properly followed by the UCC staff. There is evidence that rates of urine contamination and improper UTI diagnosis are high. As such, future interventions will focus on educating the UCC staff on Cook Children’s policy and employing a check off to make sure all members of the staff are properly trained on giving patient instructions for midstream urine collection.Item Pediatric Midstream Urine Collection Methods in the UCC: Post-Intervention Surveys(2019-03-05) Henson, Robin; Collins, Audra; Hamby, Tyler; Zia, SamadPurpose Urinary tract infections (UTIs) are one of the most common bacterial infections in the pediatric population. Diagnosing UTIs requires a urinalysis and often a urine culture. Diagnosing a UTI in the toilet trained child requires consistent staff education and materials for specimen collection to avoid risk of contamination. Contamination of a urine sample can be reduced with a policy which includes consistent instructions to patients and provision of the correct materials. A quality improvement (QI) project conducted in June 2017 at Cook Children’s Pediatric Urgent Care Center (UCC) in Fort Worth surveyed patients and parents regarding midstream urine collection (MSUC), and it showed that the MSUC policy was not consistently followed by the UCC staff. Online education and training were then provided to clinical staff to reinforce this policy. The objective of this QI project is to conduct the same patient/parent survey to determine if the staff education improved adherence to the MSUC policy. Methods The patient/parent survey, which was used in June 2017, was again administered to patients in June 2018. The survey included questions concerning Cook Children’s MSUC policy. Patients (ages 4-18) who presented with signs of UTI were given the survey after staff instruction was given and urine was collected. The surveys were conducted at Cook Children’s Pediatric UCC in Fort Worth, Texas. Results A total of 20 (2017) and 19 (2018) patients were surveyed. Patients in 2018 were significantly more likely to receive instructions to use 3 wipes, receive 3 or more wipes, and actually use 3 wipes. There was no significant difference in the likelihood of receiving gender-specific instructions, receiving MSUC instructions, following gender-specific instructions, or following MSUC instructions. Conclusions The distribution of pre-assembled packets of materials enabled all patients to receive the proper number or wipes. However, staff should be encouraged to provide pre-assembled packets as well as verbal instructions to each patient. Educational interventions for UCC staff should be re-evaluated and repeated throughout the year. Further educational interventions for the UCC staff may result in a greater adherence to the Cook Children’s MSUC policy and a decrease in midstream urine contamination rates.