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Use of a midstream clean catch mobile application did not lower urine contamination rates in an ED.
Am J Emerg Med. 2018 Jan; 36(1):61-65.AJ

Abstract

OBJECTIVES

Urine microscopy is a common test performed in emergency departments (EDs). Urine specimens can easily become contaminated by different factors, including the collection method. The midstream clean-catch (MSCC) collection technique is commonly used to reduce urine contamination. The urine culture contamination rate from specimens collected in our ED is 30%. We developed an instructional application (app) to show ED patients how to provide a MSCC urine sample. We hypothesized that ED patients who viewed our instructional app would have significantly lower urine contamination rates compared to patients who did not.

METHODS

We prospectively enrolled 257 subjects with a urinalysis and/or urine culture test ordered in the ED and asked them to watch our MSCC instructional app. After prospective enrollment was complete, we retrospectively matched each enrolled subject to an ED patient who did not watch the instructional app. Controls were matched to cases based on gender, type of urine specimen provided, ED visit date and shift. Urinalysis and urine culture contamination results were compared between the matched pairs using McNemar's test.

RESULTS

The overall urine culture contamination rate of the 514 subjects was 38%. The majority of the matched pairs had a urinalysis (63%) or urinalysis plus urine culture (35%) test done. There were no significant differences in our urine contamination rates between the matched pairs overall or when stratified by gender, by prior knowledge of the clean catch process or by type of urine specimen.

CONCLUSION

We did not see a lower contamination rate for patients who viewed our instructional app compared to patients who did not. It is possible that MSCC is not effective for decreasing urine specimen contamination.

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Authors+Show Affiliations

Jacob MS
Washington Adventist Hospital, Emergency Department, United States.
Kulie P
George Washington Medical Faculty Associates, Department of Emergency Medicine, United States.
Benedict C
George Washington Medical Faculty Associates, Department of Emergency Medicine, United States.
Ordoobadi AJ
George Washington Medical Faculty Associates, Department of Emergency Medicine, United States.
Sikka N
George Washington Medical Faculty Associates, Department of Emergency Medicine, United States.
Steinmetz E
George Washington University Milken Institute School of Public Health, Department of Health Policy and Management, United States.
McCarthy ML
George Washington University Milken Institute School of Public Health, Department of Health Policy and Management, United States. Electronic address: melmccar@gwu.edu.

MeSH

AdolescentAdultAgedEmergency Service, HospitalFemaleHumansMaleMiddle AgedMobile ApplicationsPatient Education as TopicProspective StudiesUnited StatesUrinalysisUrinary BladderUrinary Tract InfectionsUrine Specimen CollectionYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28711277

Citation

Jacob, Mary S., et al. "Use of a Midstream Clean Catch Mobile Application Did Not Lower Urine Contamination Rates in an ED." The American Journal of Emergency Medicine, vol. 36, no. 1, 2018, pp. 61-65.
Jacob MS, Kulie P, Benedict C, et al. Use of a midstream clean catch mobile application did not lower urine contamination rates in an ED. Am J Emerg Med. 2018;36(1):61-65.
Jacob, M. S., Kulie, P., Benedict, C., Ordoobadi, A. J., Sikka, N., Steinmetz, E., & McCarthy, M. L. (2018). Use of a midstream clean catch mobile application did not lower urine contamination rates in an ED. The American Journal of Emergency Medicine, 36(1), 61-65. https://doi.org/10.1016/j.ajem.2017.07.016
Jacob MS, et al. Use of a Midstream Clean Catch Mobile Application Did Not Lower Urine Contamination Rates in an ED. Am J Emerg Med. 2018;36(1):61-65. PubMed PMID: 28711277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of a midstream clean catch mobile application did not lower urine contamination rates in an ED. AU - Jacob,Mary S, AU - Kulie,Paige, AU - Benedict,Cameron, AU - Ordoobadi,Alexander J, AU - Sikka,Neal, AU - Steinmetz,Erika, AU - McCarthy,Melissa L, Y1 - 2017/07/08/ PY - 2016/12/21/received PY - 2017/07/04/revised PY - 2017/07/04/accepted PY - 2017/7/18/pubmed PY - 2017/12/27/medline PY - 2017/7/17/entrez KW - Diagnostic testing SP - 61 EP - 65 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 36 IS - 1 N2 - OBJECTIVES: Urine microscopy is a common test performed in emergency departments (EDs). Urine specimens can easily become contaminated by different factors, including the collection method. The midstream clean-catch (MSCC) collection technique is commonly used to reduce urine contamination. The urine culture contamination rate from specimens collected in our ED is 30%. We developed an instructional application (app) to show ED patients how to provide a MSCC urine sample. We hypothesized that ED patients who viewed our instructional app would have significantly lower urine contamination rates compared to patients who did not. METHODS: We prospectively enrolled 257 subjects with a urinalysis and/or urine culture test ordered in the ED and asked them to watch our MSCC instructional app. After prospective enrollment was complete, we retrospectively matched each enrolled subject to an ED patient who did not watch the instructional app. Controls were matched to cases based on gender, type of urine specimen provided, ED visit date and shift. Urinalysis and urine culture contamination results were compared between the matched pairs using McNemar's test. RESULTS: The overall urine culture contamination rate of the 514 subjects was 38%. The majority of the matched pairs had a urinalysis (63%) or urinalysis plus urine culture (35%) test done. There were no significant differences in our urine contamination rates between the matched pairs overall or when stratified by gender, by prior knowledge of the clean catch process or by type of urine specimen. CONCLUSION: We did not see a lower contamination rate for patients who viewed our instructional app compared to patients who did not. It is possible that MSCC is not effective for decreasing urine specimen contamination. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/28711277/Use_of_a_midstream_clean_catch_mobile_application_did_not_lower_urine_contamination_rates_in_an_ED_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(17)30544-2 DB - PRIME DP - Unbound Medicine ER -