title: Illustrations reduce contamination of midstream urine samples in the emergency department.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Eley
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Chantelle
authors.initials: C
authors.lastname: Judge
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Lisette
authors.initials: L
authors.lastname: Knight
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia Department of Chemical Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Goce
authors.initials: G
authors.lastname: Dimeski
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Sinnott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008488:Medical Illustration; D008875:Middle Aged; D013048:Specimen Handling / Q000379:methods / Q000592:standards; D011795:Surveys and Questionnaires; D016482:Urinalysis / Q000379:methods* / Q000592:standards; D059349:Urine Specimen Collection / Q000379:methods* / Q000592:standards; D055815:Young Adult
keywords: GENITOURINARY PATHOLOGY; METHODOLOGY; URINE