Urine Specimen Collection For Diagnosing a Urinary Tract Infection-Patient Experience and Preference For Urine Specimen Collection: A Qualitative Study

Background A urinary tract infection (UTI) is very common and patients frequently present to their General Practitioner and emergency department with symptoms. Diagnosis of the infection is made by examining fresh urine with microscopy, to detect white cells and epithelial cells shed from the bladder or by submitting the urine for microbial culture. Patients are often requested to provide a urine specimen, but very little is known about the patient experiences of carrying out the task or their preference of specimen collection method. The aim of this study was to explore patient experiences and preferences between four different urine specimen collection methods for diagnosing the presence of a UTI.Materials Semi-structured interviews were conducted and explored patient experiences of four different urine specimen collection methods (midstream urine specimen (MSU), catheter specimen (CSU), Peezy MSU™ and Natural void). The interviews consisted of four open-ended questions and all data were collated and organised using NVivo to establish themes that emerged from the data.Results The natural void without technique was repeatedly referred to and was regarded as being the most straightforward of all of the sampling methods. Pain symptoms were described only in the catheter method and not in the MSU, Peezy MSU™ or natural void method. The catheter was regarded as the urine collection method that produced the best specimen for diagnostic testing by the patients’. Conclusion A majority of the participants expressed the desire for straightforward urine sampling methods and preferred the natural void as a standard method in clinical practice.

Contaminated fingers: a potential cause of Chlamydia trachomatis-positive urine specimens

ObjectivesThe detection of an STI agent in a urogenital tract (UGT) specimen from a young child is regarded as being indicative of sexual abuse. However, the probabilities of contamination events that could conceivably lead to STI positive specimens in the absence of sexual contact are unclear. The objective was to estimate the potential for fingers that have come in contact with Chlamydia trachomatis-positive urine to detectably contaminate C. trachomatis-negative urine.MethodsThe study design was based on self-experimentation. Dilutions of C. trachomatis elementary bodies (EBs) were prepared. A participant contacted an EB dilution then a urine surrogate specimen. The experiment was performed by three participants using three C. trachomatis isolates, of genotype E, F and B. Two surrogate urine contact methods were used to mimic contamination of a carer assisting with a child’s urine collection. All EB dilutions and urine surrogate specimens were subjected to C. trachomatis assay and quantification in a real-time PCR-based diagnostic system.ResultsThe amplimer crossing point (Cq) for EB dilutions was 10.0±1.6 less than for corresponding finger contacted urine specimens, which corresponds to ~10 µL of EB suspension transferred. This was largely independent of participant identity, C. trachomatis strain or EB dilution. Hand decontamination led to large reductions in EBs transferred, but transfer remained consistently detectable. Recent Cq data from C. trachomatis-positive clinical urine specimens were collated, and 20% clearly contained sufficient C. trachomatis to detectably contaminate another specimen by finger-mediated transfer, as in this experiment.ConclusionsThis study directly demonstrated the potential for urine contaminated fingers to convert a C. trachomatis-negative urine specimen to C. trachomatis positive as a result of contact. Accordingly, procedures for urine specimen collection, particularly from children, need to be designed to prevent contamination.