EPIC: Effect of Povidone Iodine Periurethral Cleansing on Level of Contamination With Clean Catch
Condition: Urine Contamination
Study type: Interventional

Summary: 
      The primary aim of this study is to see if the use of an antiseptic preparation (povidone
      iodine) versus cold normal saline, will decrease rates of urine contamination during the
      non-invasive Quick Wee (QW) collection of pediatric urine.
    

Detailed description: 
      Urinary tract infections (UTI) are common acute illnesses among pediatric patients,
      accounting for 5-7% of emergency department visits in the under two-year-old population.
      However, obtaining urine samples from the precontinent patient can be difficult. There is an
      ongoing debate regarding which noninvasive method for urine specimen collection is best for
      this population. The main argument against clean catch is the high rate of contamination
      compared to invasive collection and reliability.

      There are many methods of noninvasive urine collection. These methods are preferred as they
      are fairly well tolerated by patients, less distressing to parents, cost effective, and
      require less technical expertise. In the past; these methods have been dismissed due to their
      high rates of contamination, time to void and also effectiveness. The National Institute of
      Health and Clinical Excellence (NICE, UK) recommends a clean-catch urine (CCU) be the first
      attempt at obtaining a urine specimen from children suspected of having UTI. This means
      placing the urine specimen collection container into the urine mid-stream once the child has
      begun to void to avoid contamination. Conversely, the American Academy of Pediatrics
      recommends clean catch urine for screening and a catheter specimen urine collection or
      suprapubic aspiration for definitive diagnosis. Both of these invasive techniques produce
      quick urine samples with low rates of contamination; however they can be painful and
      distressing to both the patient and parent.

      The Quick-Wee method for noninvasive urine collection has been evaluated in a one randomized
      controlled trial and has been shown to significantly increase the five minute voiding success
      rate for CC urine collection; 31%, n= 174. However a past study demonstrated contamination
      rate of 27%, n=174. No study has directly evaluated the use of antiseptic solution in the
      evaluation of the QW rate of contamination in pediatric patients. The purpose of this study
      is to see whether the use of povidone iodine swabs prior to the QW method will decrease the
      rate of contamination. A decrease of the rate of contamination would strengthen the validity
      of this simple CCU method. Also using the this method for the collection method in both the
      experimental and control groups will further evaluated the five min void success rate.

      The investigators chose to use iodine as the prepping agent because it is currently the
      standard cleaning solution used for adult and pediatric patients. It is readily available,
      inexpensive and has been shown to be less caustic then other prepping agents.
    

Intervention name(s): Iodine swabs.; Saline flush.
Intervention type(s): Other; Other
Intervention description(s): Children will then have their periurethral region gently cleansed for ten seconds with iodine swabs.; Children will then have their periurethral region gently cleansed for ten seconds with saline flush.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention