Pediatric Midstream Urine Collection Methods in the UCC: Post-Intervention Surveys

Purpose 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.