The Effect of Interventions on Adherence to Guidelines for Pediatric Mid-Stream Urine Collection in the Urgent Care Center




Nguyen, Jacqueline
Yen, Kyle


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Purpose: Urinary tract infections (UTIs) are common bacterial infections in the pediatric population. Because diagnosing a UTI is dependent upon accurate urinalysis and urine culture results, proper mid-stream urine (MSU) collection in the toilet-trained child is paramount. Our purpose was to assess the effects of interventions on adherence to guidelines for pediatric MSU in urgent care clinics (UCC). Methods: During 2017-2019, interventions—including staff education and standardized urine collection packets—were implemented in 5 UCCs. A survey developed in 2017 assessed patients' perceptions of staff instruction, materials provided for specimen collection, and patient's comprehension and adherence to UCC MSU collection guidelines. The survey was repeated in 2018 and 2019. Data from 2017 and 2019 were both compared to 2018 using logistic regression. P< 0.05 was considered statistically significant. Results: 60 patients were interviewed from 2017-2019. In 2018 and 2019, the proportion of patients instructed to use and actually using 3 wipes improved. In 2019 but not in 2018, the proportion of patients given and following gender-specific instructions improved, and the proportion of patients given MSU instructions improved. However, patients reporting to follow MSU collection methods did not significantly differ by year. Most respondents (89%) claimed to understand the instructions and they (92%) would not have done anything differently without them. Conclusions: Interventions like staff education and standardizing collection materials can have a positive effect on pediatric MSU collection in UCC. Continued research is needed to identify other variables that could positively affect MSU collection compliance.