Patient Surveys Referring to Urine Sample Collection Methods: A Quality Improvement Study at Cook Children’s Urgent Care Centers

Background: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.