Illustrations reduce contamination of midstream urine samples in the emergency department

Eley, Robert, Judge, Chantelle, Knight, Lisette, Dimeski, Goce and Sinnott, Michael (2016) Illustrations reduce contamination of midstream urine samples in the emergency department. Journal of Clinical Pathology, . doi:10.1136/jclinpath-2015-203504


Author Eley, Robert
Judge, Chantelle
Knight, Lisette
Dimeski, Goce
Sinnott, Michael
Title Illustrations reduce contamination of midstream urine samples in the emergency department
Journal name Journal of Clinical Pathology   Check publisher's open access policy
ISSN 1472-4146
0021-9746
Publication date 2016-02-18
Year available 2016
Sub-type Article (original research)
DOI 10.1136/jclinpath-2015-203504
Open Access Status Not Open Access
Total pages 5
Place of publication London, United Kingdom
Publisher BMJ Group
Collection year 2017
Language eng
Formatted abstract
Aims: Urinalysis provides direction in diagnosis and treatment of patients in the emergency department (ED). Midstream urine (MSU) collection from female patients has a high contamination rate. Verbal instruction by nurses to patients reduces contamination but is inconsistent owing to lack of time and professional knowledge. This study aimed to determine if an alternative mode of instruction requiring minimal staff input may be effective.

Methods: A pseudorandomised controlled trial was undertaken with 240 female patients for whom urinalysis was clinically required. No change was made to normal practice with regards to verbal instruction. Prior to collecting their sample the intervention cohort received illustrated instruction on how to collect a clean uncontaminated MSU sample. The control cohort received no illustrated instruction. Compared outcomes were rate of contamination on urinalysis, defined as 10 or more epithelial cells per high power field, and answers to a structured patient questionnaire.

Results: Contamination rate was reduced from 40% to 25% by the intervention. According to patient survey responses, verbal collection instructions were seldom given and the actions of hand washing, cleaning with a towelette, and voiding then stopping were significantly higher in the intervention group. The illustrations were well received by over 95% of patients and were considered to be clear and effective especially for patients with reading difficulties and/or from a non- English speaking background.

Conclusions: Illustrated urine collection instructions were well accepted by female ED patients, improved the rate of proper MSU collection and reduced the rate of urinalysis contamination in the ED.
Keyword Urinary tract infections
Contamination
MSU sample
Urinalysis contamination
Proper MSU collection
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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