Screening midstream urine (MSU) is a fundamental, routine process of prenatal care, recommended by all maternity guidelines. The problem for both midwife and woman is the lack of methodology around MSU collection, exacerbated by the increasing size of pregnant abdomen from the second trimester. A messy and failed MSU can sabotage the infection control and patient safety measures so important at point of care testing, and with at least seven urine dips during pregnancy, this process is an integral and important part of routine prenatal screening.

Urine specimen contamination rates are higher in pregnant women, mainly because there is more going on in the urinary tract and genital area primarily due to anatomical and physiological changes that make providing a “clean-catch” midstream sample more difficult, alongside increased vaginal discharge and higher rates of skin flora. Contamination can lead to empirical prescribing of a broad-spectrum antibiotic, which if unnecessary, can have detrimental impact on both woman and baby.

A paper on Antibiotic use during pregnancy recommends targeting antibiotics during pregnancy:

“Antibiotic treatment during pregnancy is widespread in Western countries, and accounts for 80% of prescribed medications in pregnancy. However, antibiotic treatment, while at times lifesaving, can also have detrimental consequences. A single course of antibiotics perturbs bacterial communities, with evidence that the microbial ecosystem does not return completely to baseline following treatment. Antibiotics in pregnancy should be used only when indicated, choosing those with the narrowest range possible.”

Targeted prescribing requires a reliable, contamination-free urine specimen both in and outside of pregnancy.

This US clinical trial around urine collection in women reveals that:

“55% of urine cultures collected in primary care clinics were contaminated, revealing a major opportunity for nurse-driven diagnostic stewardship interventions. Urine culture contamination occurred frequently in our clinics, and obesity, female sex and pregnancy were independent risk factors for contamination. The association of pregnancy and contamination is particularly concerning as pregnant females are routinely screened and treated for asymptomatic bacteriuria [in the US]. Culture contamination may obscure underlying uropathogens, leading to pyelonephritis or potential neonatal infection if untreated. Conversely, overtreatment of false positive bacteriuria could lead to adverse effects from antibiotics and increased risk for antibiotic resistance. As nurses play a prominent role in patient education, diagnostic stewardships interventions may want to utilize nurses’ education capabilities to improve urine culture collection.”

And what is the standard urine culture collection method?

1. Start to pee
2. Stop peeing
3. Position the given vessel under your perineum
4. Start to pee
5. Remove the vessel when urine is collected
6. If provided with the 22mm wide universal container, replace lid and wash soiled tube
7. If provided with a basic vessel, prop onto loo cistern
8. Wipe loo seat and possibly floor with loo paper
9. Wash hands
10. Give damp tube or vessel to midwife to dip and hope the specimen is not contaminated with bacteria/debris/flora from the skin or hands

With the advent of greater focus on women’s health with precision and prevention, comes the solution to this sorry and most unreliable of processes.

Peezy Midstream was designed by an NHS GP to eliminate risk of doubt around the collection, analysis, diagnosis and treatment of urine for women, a device that comes into its own during prenatal screening:

• The woman can feel it is in place without having to struggle to look under her body
• Midstream urine collection is fully automated without any patient intervention
• Hands, body and toilet environment are left clean and dry
• Specimen collects into a lab-compatible primary tube eliminating need to decant
• Implicit hygiene and dignity

Finally, let’s look at savings. Dramatically reduced retesting at £15 produces savings that run into millions of pounds for the NHS; add the saving on repeat appointments, resources, staff time and those savings balloon into the hundreds of millions, as demonstrated by our detailed cost-benefit model. But don’t take our word for it; after evaluations and trials, this is what clinicians have concluded:

Una Health and Forte Medical are proud to be improving life for midwives and their service users.

For more information, contact Una Health. Peezy Midstream is now available from NHS Supply Chain.

© Giovanna Forte

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