AppHealthCare Appalachian District Health Department Policy and Procedure
Policy Name: Section 1100 Approved Date: Laboratory Procedure 1‐21‐14 Policy Topic: Chapter 1126 Revision Date: Urine Collection
PURPOSE Urine tests detect a wide range of conditions which include screening the asymptomatic individual, diagnosing the symptomatic patient and monitoring the diagnosed patient. Proper collection and handling of the specimen is critical to produce accurate, reliable results. Urine tests include: • physiochemical (e.g. specific gravity, pH, dipstick, chemical) • microscopic • culture It is recommended that a clean‐catch midstream specimen be collected when a culture may be indicated. Frequently a culture is requested based on the results of a dipstick test and/or microscopic examination. If the original specimen is collected using clean‐catch midstream technique, then the need to collect a second specimen for the culture is eliminated. To use the specimen for a dipstick test or microscopic examination, pour a well‐mixed portion of the specimen into a separate cup or tube, being sure not to contaminate your "sterile" specimen.
COLLECTION Container The container for urine specimen is a sterile, free standing, wide‐mouthed container (50‐100 milliliters) with a tight‐fitting lid. Sterile disposable containers with a label or an identification area on the containers are available from distributors. If specimens must be stored refrigerated, be sure the label will adhere under refrigeration. Timing First Morning Specimen: First morning voiding is the first specimen collected after rising. This is the most desirable specimen for urinalysis and urine hCG testing since it is usually the most concentrated urine. NOTE: it is the policy of the Appalachian District Health Department to use only specimens collected on site. The only exception is with the orders of a clinician. 1 Urine Collection
Random Specimen: A random specimen is the most common and convenient specimen because it is collected any time. The method involves collecting a portion of urine in a clean container. Because of variations in water intake, diet, time of collection and personal hygiene, results must be interpreted with these factors in mind.
Method Clean‐catch Midstream Specimen: The object of clean‐catch midstream urine collection is to obtain about 50‐60 ml of urine from a person's bladder and to minimize contamination by bacteria and cells normally found in the surrounding area. A sterile container is used when a culture is requested. The patient needs to realize the importance of the collection procedure. If the patient understands that a carelessly collected urine specimen can give unsatisfactory or inaccurate results necessitating a repeat specimen or delaying treatment, then the patient may be more likely to follow good collection directions. The cleansing procedure needs to remove the contaminating organisms which come from these sources: • Bacteria from the hands, skin or clothing may enter the collection container. • Bacteria from vaginal secretions or distal urethra in females may contaminate the urine stream. Instructions for patients should be both verbal and written. These instructions should be clear, detailed, given by a trained individual and given during each visit that a specimen is collected.
Handling Specimen Handling Be sure the specimen container is properly labeled with patient name or other appropriate identifier. Urine should be analyzed immediately after collection. If immediate analysis is not possible, the specimen should be analyzed for microscopic and chemical elements within one hour of collection. If unable to test specimen within one hour, specimen can be refrigerated for 24 hours. FOLLOW APPROPRIATE PROCEDURES FOR COLLECTION AND TRANSPORT OF SPECIMENS SENT TO REFERENCE LABORATORY. If a first morning specimen must be transported, instruct the patient to refrigerate the specimen until coming to the health department. 2 Urine Collection
NOTE: A second (or repeat) urine specimen collected during a patient's visit is not recommended because: • The specimen has not incubated in the bladder long enough. • The specimen is too dilute. • The patient may be unable to void. • The results may not be comparable with the initial specimen results. Be sure the specimen label matches the patient file or requisition form before testing the specimen and recording the results.
Collection of a Clean‐catch Midstream Urine Specimen
Female Patients Supplies • Cleansing wipes • Wide‐mouthed, sterile container with tight‐fitting lid Instructions 1. Wash hands with soap and water, rinse and dry. 2. Remove lid from sterile container and put aside, with inside of lid up. Never touch the rim of the specimen container. Try to keep the container from contact with the legs, external genitalia or clothing. 3. With one hand "spread yourself" and continue to hold yourself spread during cleansing and collection of the urine specimen. 4. Wash the area where you pass urine. Using one soap pad, wipe one side of the labia from front to back once. Discard the pad. Using a second pad, wipe the other side of the labia, front to back once. Discard the pad. Using the third pad, wipe down the middle once. Discard the pad. Note: If gauze, cotton balls or other non‐biodegradable product is used, be sure to dispose it in a trash receptacle ‐‐ Not In The Toilet. 5. Void a small amount of urine into the toilet, then collect the middle portion of urine in the sterile container until it is about half full. Finish voiding in the toilet. 6. Carefully close the container, redress, wash hands and give the specimen to appropriate personnel.
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Collection of a Clean‐catch Midstream Urine Specimen Male Patients Supplies • Cleansing wipes • Wide‐mouthed, sterile container with tight‐fitting lid Instructions 1. Wash hands with soap and water, rinse and dry. 2. Remove lid from sterile container and put aside, with inside of lid up. Never touch the rim of the specimen container. 3. Expose penis, retract foreskin (if uncircumcised), and wash with soap pad. 4. Void a small amount of urine into the toilet, then collect the middle portion of the urine in the sterile container until it is about half full. Finish voiding in the toilet. 5. Carefully close the container, redress, wash hands and give the specimen to appropriate personnel. References 1.Bradley, M and GB Schumann. Examination of urine, pp. 380‐458. In Henry, JB (ed.), Clinical diagnosis and management by laboratory methods, 17th ed. Sanders Company, Philadelphia. 1984. 2.Clarridge, JE, MT Pezzlo, and KL Vosti. Laboratory diagnosis of urinary tract infections, Cumitech 2A. Coordinating ed., AS Weissfeld. American Society for Microbiology, Washington, DC. 1987. 3.Garga, D. Urine collection and preservation, pp 57‐66. In Ross, DL, and AE Neely (eds.), Textbook of urinalysis and body fluids. Appleton‐Century‐Crofts, Norwalk, CN. 1983 4.National Committee for Clinical Laboratory Standards. Collection and transportation of single‐collection urines specimens. Proposed guideline GP 8‐P NCCLS, Villanova, PA. 1984. 5.Nickander, KK, CJ Shanholtzer, and LR Peterson. Urine culture transport tubes: Effects of sample volume on bacterial toxicity of the preservative. J Clin Microbiol. 15:593‐595. 1982. 6.Schumann, GB. Examination of urine, pp 996‐1032. In Kaplan, LA and AJ Pesce (eds.), Clinical 4 Urine Collection
chemistry. The C.U. Mosby Co., St. Louis. 1984. 7.Simindinger, J, FK Mansour, and JM Slockbower. Specimens for urinalysis, pp 103‐113. In Slockbower, JM, and TA Blumenfeld (eds.), Collection and handling of laboratory specimens. J.B. Lippincott Co., Philadelphia. 1983.
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