Video Instruction in the Collection of Clean Catch Urine in Pregnant Women Undergoing Testing for Urine Culture
Video Instruction in the Collection of Clean Catch Urine in Pregnant Women Undergoing Testing for Urine Culture
The prevalence of asymptomatic bacteriuria in pregnancy has been reported in the range of
 2-15%[3]. Due to the severity of the complications related to asymptomatic bacteriuria in
 this patient population, the American College of OBGYN recommends routine screening of all
 pregnant women. Asymptomatic bacteriuria in a pregnant woman should be screened only using a
 clean-catch non contaminated urine sample. Screening for ABU using urine chemistries is not
 recommended due to the lack of sensitivity and specificity of these tests . If ABU is
 present, appropriate antibiotic is given and post treatment urine culture is performed.
 However, a controversy does exist as to the value of treatment of ABU in the prevention of
 above noted complications [7].

 Interestingly, we have noted a contaminated urine cultures in up to 15 to 20% of our prenatal
 patients. This can be frustrating to both the patient and her physician. Repeat testing,
 delay in the diagnosis, and additional cost are just some of the problems associated with
 these contaminated urine cultures.

 We hypothesis by improving the instructions given to patients on how to perform a clean catch
 urine, that we will decease our contaminated urine cultures.
Introduction Asymptomatic bacteriuria (ABU) is defined as the presence of bacteria ( ≥105 per
 ml) in a non- contaminated urine sample collected from a patient without signs or symptoms
 related to UTI[1]. Although this is a benign condition that does not require treatment in
 most adults, ABU in pregnant women has been linked to several complications. The pregnancy
 state, with its increase in urine stasis and altered immune, can result in increased rates of
 pyelonephritis and preterm labor[2].

 The prevalence of asymptomatic bacteriuria in pregnancy has been reported in the range of
 2-15%[3]. Due to the severity of the complications related to asymptomatic bacteriuria in
 this patient population, the American College of OBGYN recommends routine screening of all
 pregnant women[4]. Asymptomatic bacteriuria in a pregnant woman should be screened only using
 a clean-catch non contaminated urine sample. Screening for ABU using urine chemistries is not
 recommended due to the lack of sensitivity and specificity of these tests[5, 6]. If ABU is
 present, appropriate antibiotic is given and post treatment urine culture is performed.
 However, a controversy does exist as to the value of treatment of ABU in the prevention of
 above noted complications [7].

 Interestingly, we have noted a contaminated urine cultures in up to 15 to 20% of our prenatal
 patients. This can be frustrating to both the patient and her physician. Repeat testing,
 delay in the diagnosis, and additional cost are just some of the problems associated with
 these contaminated urine cultures.

 Hypothesis/Clinical Question We hypothesis by improving the instructions given to patients on
 how to perform a clean catch urine, that we will decease our contaminated urine cultures.

 Material and Methods:

 All patients (16 years and older) presenting for initial routine prenatal care at one of the
 St Luke University Hospital perinatal clinics will be eligible. Patients with known urinary
 infection, symptoms of UTI, and other renal disease will be excluded. Consented patients will
 be randomized (1:1) using previously prepared sealed envelopes to either the current standard
 of verbal explanation of the clean-catch urine technique or to view the instructional video
 on the collection technique. A Spanish version video tape will also be available. These
 sample results as well as basic patient demographics will be collected (Age, Gestational age,
 BMI, gravidity, parity) will be compared.

 We will recruit 200 patients based on an improvement from 15% contaminated rate to a 5%
 contaminated rate (power 0.80; p=0.05). We will compare proportion of contaminated urine
 specimens using chi square test to those patients that watch the video to those that did not.
 In addition, we will compare demographics to determine if any difference exists between the
 groups. We will employ t-test, chi-squared and Mann-Whitney-U test as appropriate.

 Risk and cost to patients This study does not incur any additional risk to the patient. No
 additional cost will be charged to the patients since all pregnant patients receive a urine
 culture screen as part of their standard of care.

 1. Trautner, B.W., Asymptomatic bacteriuria: when the treatment is worse than the disease.
 Nat Rev Urol, 2011. 9(2): p. 85-93.

 2. Glaser, A.P. and A.J. Schaeffer, Urinary Tract Infection and Bacteriuria in Pregnancy.
 Urol Clin North Am, 2015. 42(4): p. 547-60.

 3. Schneeberger, C., B.M. Kazemier, and S.E. Geerlings, Asymptomatic bacteriuria and
 urinary tract infections in special patient groups: women with diabetes mellitus and
 pregnant women. Curr Opin Infect Dis, 2014. 27(1): p. 108-14.

 4. Patterson, T.F. and V.T. Andriole, Bacteriuria in pregnancy. Infect Dis Clin North Am,
 1987. 1(4): p. 807-22.

 5. Rogozinska, E., et al., Accuracy of Onsite Tests to Detect Asymptomatic Bacteriuria in
 Pregnancy: A Systematic Review and Meta-analysis. Obstet Gynecol, 2016. 128(3): p.
 495-503.

 6. Awonuga, D.O., et al., Asymptomatic bacteriuria in pregnancy: evaluation of reagent
 strips in comparison to microbiological culture. Afr J Med Med Sci, 2011. 40(4): p.
 377-83.

 7. Angelescu, K., et al., Benefits and harms of screening for and treatment of asymptomatic
 bacteriuria in pregnancy: a systematic review. BMC Pregnancy Childbirth, 2016. 16(1): p.
 336.
Inclusion Criteria:

 -  women that are pregnan and requiring a urine sample for asymptomatic bacteriuria
 testing

 Exclusion Criteria:

 -  any urinary renal disease, including urinary tract infection, proteinuria, hematuria.