Contamination Rates in Urine Collection at Cook Children’s Pediatric Urgent Care Centers

Background: 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).