Procedure for collecting, storing and transporting urine samples

for uroculture

Definitions and abbreviations

Urinary Tract Infection (ITU) is represented by the presence and multiplication of

bacteria in one or more urinary tract structures followed by consecutive tissue
invasion accompanied by several clinical symptoms depending on the location. This
category includes: chronic pyelonephritis (kidney and pielocaliceal area), cystitis
(urinary bladder), urethritis (urethra), epididymitis (epididym) and prostatitis
(prostate). The infection may extend to adjacent tissues (eg, perinephritis) or may
disseminate through the blood.

Bacteriuria implies that bacteria grow if urine is inoculated, but the patient may or
may not be symptomatic.

Biosecurity considerations

Urine samples must be considered potentially infected and treated as such.

Any sampling maneuvre represents a biological risk for both the patient and the
medical staff involved in sampling, packaging, sample transport and cleaning.
Before and after sampling it is mandatory to wash hands with water and soap or,
preferably, with alcoholic antiseptic solution.
    
General rules

- Perform sampling in dedicated, clean rooms fitted with appropriate furniture

- Disinfect sampling spaces daily
- Use sterile and disposable materials during sampling (eg disposable sterile
containers, sterile gauze pads, sterile physiological saline solution etc.)
- Respect general rules of personal hygiene and work safety (protective equipment,
hand washing, etc.); weare gloves during the collection and handling of
pathological products
- Close tightly containers with pathological products; their exterior has to be clean,
without traces of pathological product
- Use separate packaging of analysis request forms in dedicated envelopes, kept
separately from the collection containers

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Description of the procedure

Sampling

Materials required for sampling

- Sterile, wide-mouth and capped plastic container of 50-100 ml,

- Sealed closure container (typically disposable universal containers)
- Sterile gauze pads of 8 / 8cm size
- Soap and clean water or saline
- Small thin glass slides and microscope slides
- Sterile plastic bags for the collection of urine samples from children and / or other
non-cooperative patients

Best sampling time:

Take the first morning urine or urine eliminated at least 3 hours after previous
micturition.
Sampling is done prior to antibiotic therapy. If this is not possible, urine will be
harvested prior to the next antibiotic dose.

Sampling procedure

 Clean sample caught “in flight” from the urine mid-jet:

Satisfies the requirements of the current cyto-bacterial examination in adults

- Before sampling, wash your hands thoroughly with soap and water; dry them
with paper towel
- Decontaminate the external genital area and the perineum by washing with
soap and water.
- Dry the decontaminated area using 2 sterile gauze wipes by keeping an
unique sense from front to back of the external genital area
- Allow the urine to flow for a few seconds and then place the plastic container
under the jet so that you collect the "middle jet" of urine. This procedure will
reduce the possibility of urine contamination with commensal microorganisms
in the urethra.
- Without interrupting the urine jet, catch the required urine volume into the
container with caution to avoid contact of the inside or the edges of the plastic
container with the skin of the hands, thighs or genital area, to reduce the risk
of contamination with commensal microorganisms on the skin. Required
volume: minimum 20 ml for the quantitative detection of opportunistic micro-
organisms and at least 50 ml for specific pathogens
- Close the lid of the container after sealing

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 - Label the container

Note 1 - In patients loosing vaginal secretions, a nurse will prepare the vulvar
region as described above and finally insert a vaginal sterile pad into the
vagina - the procedure requires the use of the gynecological table

 Sampling from non-cooperative patients (including newborns, infants)

In small children or other non-cooperative patients where harvesting is difficult,

sterile plastic bags for urine collection may be used.

- Decontaminate and dry the external genital area and perineum

- Seal around the vulva or penis the hole of a sterile plastic bag
- Transfer the urine from the sampling bag to the plastic container as soon as
possible after the emission, to avoid contamination with the cutaneous flora
Transfer with a disposable pipette
- Label the container in which the urine was collected

In the absence of sterile plastic bags, the time of the micturition must be
anticipated to capture the sample in a large-mouth conteiner

Wrong practices:
- sampling the urine in a non-sterile container and transferring the sample to a
sterile container for dispatch to the laboratory;
- sampling at home by people untrained on the correct sampling technique

Special sampling:

Suprapubic aspiration

Catheter sampling

These types of sampling are performed exclusively by specialized personnel, in

compliance with the aseptic and antisepsic rules, to avoid contamination of sample,
of the patient and / or of the environment.

STORAGE AND TRANSPORT

• Regardless of the sampling mode, urine specimens should be microbiologically

examined within 2 hours.
• If under exceptional circumstances the interval can not be respected, samples
should be stored at +20 .. + 80 C immediately after sampling. Keeping the cold sample
will diminish the preferential development of the contaminating bacteria
• Transport will be done in special containers, in compliance with the transport
procedure for diagnostic substances or infectious substances

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If samples are not introduced into the microbiological diagnostic procedure in the unit
where the sample was taken, it is recommended that the samples be sorted before
being sent for the cyto-bacteriological examination.

Nonconformities

The sample may be refused by the laboratory in the following cases:

- the absence of the label on the sample to be analyzed
- absence of the analysis request form
- patient identification: absent, incomplete, erroneous or indescipherable
- inadequate conteiner (nonsterile, damaged, unsealed etc.)
- failure to keep the recommended storage and transport conditions