URINE COLLECTION MANUAL

2020-2022

PREPARED BY: AMAL HUSSAIN ATEF- SENIOR LAB TECHNOLOGIST

REVIEWED BY : MONA FARAJ – LAB SUPERVISOR
APPROVED BY : DR. ABUL JALALUDDIN BHUIYAN – HEAD OF SECTION
1. PURPOSE:

The purpose of this document is to outline the necessary procedures on proper

collection of urine specimens.

2. PRINCIPLE:

Analysis of urine specimens is useful in monitoring the effectiveness of treatment of

chronic problems, and in screening for asymptomatic conditions. Proper collection and
transport of specimens is critical to the quality of results produced by the laboratory.
The validity of all diagnostic information produced in the lab is contingent on the quality
of the specimen received. Consequences of poorly collected and /or poorly transported
specimens include failure to isolate the causative organism, and recovery of
contaminants or normal flora, which could lead to improper treatment of the patient.

3. DOCUMENTATION:
3.1 Urine Collection Instruction to Male Patients for urine culture test (Appendix A)
3.2 Urine Collection Instruction to Female Patients for urine culture test (Appendix B)
3.3 Collection of 24hrs instructions (Appendix C)

4. PATIENT PREPARATION:

For specimen collection in which the patient is responsible and unsupervised,

verbal and /or written instructions are given to the patient at the time specimen
containers are issued.

5. PROCEDURE:

5.1 Ordering Tests

5.1.1 Laboratory requests shall be signed /stamped by an authorized physician
(as per his/her privileges) on a paper or electronic requisition.
5.1.2 The paper or electronic requisition shall be legible (for paper) and
accurate, clearly mentioning the requested test with adequate clinical
history.
5.1.3 On all request forms, following information is required:
5.1.3.1 Patient name and date of birth
5.1.3.2 Health Card Number
5.1.3.3 Patient’s gender
5.1.3.4 Actual date and time of collection of the specimen
5.1.3.5 Location and telephone number
 5.1.3.6 Test requested
5.1.3.7 Requesting physicians stamp and signature
5.1.3.8 Mention the type of specimen (e.g. catheter, clean catch,
first morning specimen)
5.1.3.9 Mention whether the specimen was refrigerated before transporting.
5.1.3.10 Relevant clinical information pertaining to the investigation.
5.1.4 Ordering on Cerner
5.1.4.1 Select the orderable (test requested)
5.1.4.2 All fields with asterisk (*) and highlighted with yellow color
are mandatory.

5.2 SPECIMEN COLLECTION:

5.2.1 Types of Urine Specimens:

5.2.1.1 Patient Collection

Cooperative patients can collect the following types of urine
specimens after instruction and without direct supervision: random;
first morning; and timed specimen, including 24-hour specimens.

5.2.1.1.1 Random Specimen – may be collected at any time, but

the actual time of collection (voiding) should be recorded
on the specimen container. These specimens are the most
convenient for the patients.
 5.2.1.1.2 First morning specimen – normally collected
immediately on the patient’s arising from a night’s sleep.
This is also known as an “overnight”, “eight hours”, or
early morning specimen. This was retained in the bladder
for approximately 8 hours, it is the most concentrated of
the days urine and it is the most acid, so that the formed
elements such as cells and cats are more stable than in
dilute, less acid urine.
5.2.1.1.3 Timed short-term specimen– collected at a specified
time in the 24-hour period with respect to another activity
such as 2 hours after meal (post prandial) or immediately
after prostatic massage.
5.2.1.1.4 Timed long-term specimen – collected within 12-24
hours. 5.2.1.1.4.1 For 12-24 hours collection, container must be
labeled
with the date and time, the collection has started.
5.2.1.1.4.2 The 24-hour urine specimen - is useful for
quantitative analysis. It is necessary to measure the
total amount of solutes excreted in a 24-hour period, a
strictly timed 24- hour specimen is required, because
many solutes exhibit diurnal variations (e.g.
Catecholamines, 17- hydroxysteroids, and electrolytes
occur in the early morning whereas
highestconcentrations occur in the afternoon). See
Appendix C.

5.2.1.1.4.3 Adult 24-hour urine collection instruction:

5.2.1.1.4.3.1 Discard first the morning specimens on day
one (record time/date).
5.2.1.1.4.3.2 Collect all specimens during the remainder of
the day and evening.
5.2.1.1.4.3.3 Collect the first morning specimen on day
two (must be the same as in day one) then,
stop collection.

5.2.1.2 Supervised Collection

Collecting the following type of specimens may require
supervision or participation of trained laboratory or healthcare
personnel: midstream clean catch specimen; and
microbiological culture.

5.2.1.2.1.1 Urine collection guide –Male

5.2.1.2.1.1.1 Wash hands with soap and water.
5.2.1.2.1.1.2 If uncircumcised, retract the
foreskin.
5.2.1.2.1.1.3 Wipe the end of penis with tissue. As you start
 to urinate, allow small amount urine to pass in
to the toilet bowl to clear urethral
contamination.
5.2.1.2.1.1.4 After the urine stream is well established, urine
should be passed into a sterile, screw-cap
plastic cup. The Cup should be half-full
(approximately 50 ml).
5.2.1.2.1.1.5 Pass the remaining urine into toilet.
5.2.1.2.1.1.6 Screw the lid on the cup tightly.

5.2.1.2.1.1.7 Transport the specimen immediately to

the
laboratory. If delay of >2 hrs. in urine
transport is anticipated, use boric acid
container (max volume is 20 ml).
5.2.1.2.1.1.8 Refrigerate (up to 2 hrs.) if transport is
delayed.
5.2.1.2.1.1.9 For more information please refer to Clinical
Microbiology Specimen Collection guide (lab guide/HMC i-
Tawasol).
5.2.1.2.1.2 Urine collection guide –Female

5.2.1.2.1.2.1 Wash hands with soap and water.

5.2.1.2.1.2.2 With one hand the, spread the folds of
skin
(labia) apart until the urine is voided into a
sterile screw-cap container.
5.2.1.2.1.2.3 Wipe the urethral meatus from front to
back. 5.2.1.2.1.2.4 After the urine stream is well
established, allow
the first portion of the urine to pass, specimen
should be caught in the sterile container
without stopping the stream. The sterile
container should be held in such a way that
contact with the legs, or clothing is avoided.
The container should be half-full
(approximately 50 ml).
5.2.1.2.1.2.5 Refrigerate (up to 2 hrs.) if transport is delayed > 2 hrs.
5.2.1.2.1.2.6 For more information please refer to Clinical
Microbiology Specimen Collection guide (lab
guide/HMC i-Tawasol).

5.2.1.2.2 Microbiological Cultures – any of the specimens

such as clean catch, catheter specimens or suprapubic
specimens maybe used for culture if special
precautions are taken. Providing instructions to patients
 on proper specimen collection may reduce the
incidence of urine culture contamination.
5.2.1.2.3 Help if patient is unable to carry out the recommended
procedure. The assistant should wear sterile gloves.

5.2.1.2.4 Midstream clean catch specimen – the patient first

cleans the urethral meatus (female) or glans penis
(male) and surrounding areas, then voids while
preventing tissues surrounding the urethral orifice from
contact with the urine to avoid contamination to have
accurate results. See Appendix A and B

5.2.1.3 Assisted Collection

Collecting the following types of specimens require the active
participation of trained personnel: catheter specimens;
suprapubic aspiration specimens; and collections from infants.
5.2.1.3.1 Catheter specimen – collected after inserting a catheter
into the bladder
through the urethra, using sterile technique. Urine
maybe collected as
a single specimen from the catheter outflow.
5.2.1.3.1.1 Do not collect urine from the drainage bag
because growth of
bacteria outside the catheter may have occurred at
this site.
5.2.1.3.1.2 Clean the catheter with an alcohol pad.
5.2.1.3.1.3 Use a sterile needle and syringe to puncture the tubing.
Aspirate the urine directly from the tubing.
5.2.1.3.1.4 Transfer the urine to a sterile specimen container
or appropriate transport media.
5.2.1.3.1.5 Urine catheter tip cultures are not acceptable.

5.2.1.3.2 Suprapubic aspiration specimen- collected by

aspirating urine from the
distended bladder through the abdominal wall, using
sterile technique.

5.2.1.3.3 Specimens from infants and small children – use

pediatric and newborn urine specimen collection bags
with hypoallergenic skin adhesives attached over the
labia in girls or penis in boys to collect specimens.
5.2.1.3.3.1 To collect random specimens from children,
clinical personnel should do the following:
5.2.1.3.3.1.1 Separate the child’s legs.
5.2.1.3.3.1.2 Be sure pubic and perineal areas are clean,
dry, and free of mucus. Do not apply
 powders, oils, or lotions to the skin.
5.2.1.3.3.1.3 Using a pediatric urine collection device,
remove the protective paper, exposing the
hypoallergenic skin adhesive attached to the
bag.
5.2.1.3.3.1.4 For girls, stretch the perineum to remove
skin folds. Press the adhesive firmly to the
skin all around the external genitals. Avoid
contamination from the anal area.
5.2.1.3.3.1.5 For boys, fit the bag over the penis and press
the flaps firmly to the perineum.
5.2.1.3.3.1.6 Make sure the entire adhesive coating is firmly
attached to the skin with no puckering of the
adhesive.
5.2.1.3.3.1.7 Check the container periodically (e.g. every
15 minutes).
5.2.1.3.3.1.8 Retrieve the collected specimen from the
patient and label it.
5.2.1.3.3.1.9 Without further contamination, transfer the
specimen into a collection cup. Label the
cup and transport it.
6. COLLECTION CONTAINERS:

6.1 Urine specimen container should be clean, leak proof, particle-free, and
preferably made of a clear, disposable material that is inert about urinary
constituents. The container and closure should be free of interfering
substances (e.g. detergents or trace elements).
6.2 Urine specimens for routine urinalysis (UA) are collected in clear,
dry, chemically-clean containers with tight-fitting lids.
6.3 Sterile urine containers with secure closures are used for microbiological testing.

6.4 The specimen containers should not be re-used.

6.5 Container Labels

6.5.1 The container should be designed to accept a label that will adhere
during refrigeration or freezing.
6.5.2 The primary container label should be positively identified with at least
two main identifiers which are patient’s full name and HC number in
accordance to HMC policy CL7026Ptaient Identification. Urine
container labels should also include date and time of specimen
collection; barcode; accession number; source of specimen; and the
name of the preservative in the container, if applicable.
6.5.3 If necessary, to aliquot the specimen, the same identifiers must be
carried over to the secondary container.
6.5.4 To ensure proper specimen identification, place labels on the
container, not on the closure.

6.6 Preservatives

6.6.1 For specimens not analyzed within two hours of collection, the urine
specimen is preserved by refrigeration or freezing (not suitable for
microscopy). Refrigeration for periods longer than 24-hours may
compromise the stability of some analytes. Therefore, it is best to
deliver urine specimens to the testing area as soon as they are
received.
6.6.2 Urine specimens for culture are often placed in a urine culture
preservative tube (e.g. boric acid). Once the urine is placed in a
preservative tube intended for culture, the specimen cannot be
used for routine urinalysis testing.
6.6.3 For other urine tests which require special preservatives, check
specimen requirements for specific test in the HMC Intranet Lab
Guide.
6.7 Types of urine containers

A. plain urine Collection Container B. Plain Urine Collection Container C. Urine Container with Boric Acid D. 24 Hour Urine Collection Container

7. SPECIMEN TRANSPORT AND STORAGE:

7.1 Patient test results are directly related to the quality of the specimen
collected and the ability to maintain specimen integrity to the laboratory.
Therefore, proper handling and timely processing of specimens is necessary
for accurate testing.

7.2 Rapidly transport urine specimens to the laboratory for prompt

examination. If the specimen cannot be transported and analyzed
immediately, it should be stored in 2 OC to 8OC after collection.
Refrigeration is associated with significantly lower contamination rates for
urine cultures.
7.3 The specimen container should have a secure closure to prevent leakage
of the contents and possible spills.

8. EVENTUAL SAFETY ISSUES

8.1 Precautions should be taken when handling and transporting of

specimens. Contamination should be minimized when handling specimens
by using PPE. (Personal Protective equipment).
8.2 Specimen handling shall be in accordance with the Infection Control
 Standards of Practice, with special reference to Category of Isolation
Precautions as specified in CL7233.

9. REFERENCES
9.1 Clinical and Laboratory Standards Institute (CLSI). Urinalysis;
Approved Guideline-Third Edition. CLSI document GP16-A3 Vol.29
Number 4
9.2 College of American Pathologist (CAP) 2017 Pro Course: Common
Pitfalls in Specimen Processing
9.3 HMC Intranet Clinical Services Lab Guide-Microbiology
9.4 HMC Policy CL 7067 Management of Laboratory Specimens
9.5 HMC Policy CL 7026 Patient Identification
9.6 HMC Policy CL 7233 Category of Isolation Precautions
9.7 CLINICAL MICROBIOLOGY SPECIMEN COLLECTION GUIDE 2018.

10. ATTACHMENTS / APPENDIXES:

10.1 Urine Collection Instruction to Male Patients.

10.2Urine Collection Instruction to Female
Patients. 10.3Urine 24hrs Collection Instruction
Urine Collection Instruction to Male Patients for urine culture test (Appendix A)

1. Wash hands with soap and water.

2. If uncircumcised, retract the foreskin.
3. Wipe the end of penis with tissue. As you start to urinate, allow small amount urine to pass in
to the toilet bowl to clear urethral contamination.
4. After the urine stream is well established, urine should be passed into a sterile, screw-cap plastic
container. The container should be half-full (approximately 20 ml).
5. Pass the remaining urine into toilet.
6. Screw the lid on the container tightly.

7. Transport the specimen immediately to the laboratory.

.‫ غسل اليدين جيدا بالماء والصابون‬.1

.‫ تنظيف وغسل المنطقة وتجفيفها جيدا‬.2
.‫ يترك أول كمية صغيرة من البول وال يتم جمعها في علبة الفحص‬.3
.‫ ثم يتم جمع البول في علبة الفحص بدون مالمسة العلبة من الداخل‬.4
.)‫ يتم ملىء علبة الفحص بالكمية المطلوبة (يجب اال تكون اقل من نصف العلبة‬.5
.‫ افراغ ماتبقى من البول في المرحاض‬.6

.‫ أغالق علبة البول جيدا دون مالمستها من الداخل‬.7

.‫ تسليمها للمختبر مباشرة‬.8
Urine Collection Instruction to Female Patients for urine culture test (Appendix B)

1. Wash hands with soap and water.

2. With one hand the, spread the folds of skin (labia) apart until the urine is voided
into a sterile screw-cap container.
3. Wipe the urethral meatus from front to back.
4. After the urine stream is well established, allow the first portion of the urine to pass,
specimen should be caught in the sterile container without stopping the stream. The
sterile container should be held in such a way that contact with the legs, or clothing is
avoided. The container should be half-full (approximately 20 ml).
5. Pass the remaining urine into toilet.
6. Screw the lid of the container tightly.

7. Transport the specimen immediately to the laboratory.

.‫ غسل اليدين جيدا بالماء والصابون‬.1

.‫ تنظيف وغسل المنطقة وتجفيفها جيدا‬.2
.‫ يترك أول كمية صغيرة من البول وال يتم جمعها في علبة الفحص‬.3
.‫ ثم يتم جمع البول في علبة الفحص بدون مالمسة العلبة من الداخل‬.4
.)‫ يتم ملىء علبة الفحص بالكمية المطلوبة (يجب اال تكون اقل من نصف العلبة‬.5
.‫ افراغ ماتبقى من البول في المرحاض‬.6

.‫ أغالق علبة البول جيدا دون مالمستها من الداخل‬.7

.‫ تسليمها للمختبر مباشرة‬.8
Collection of 24hrs instructions (Appendix C)

Purpose: to provide instruction in how to properly collect a 24-hour urine

specimen

Equipment: Requisition (paper/electronic), specimen label, 24-hour urine

container, preservative (if applicable), disposable ice chest (if required), copy
of written instructions.

Please follow below steps: : ‫الرجاء اتباع االرشادات التالية‬

1. Void into toilet as usual upon awakening. .‫ افراغ البول في المرحاض كالمعتاد عند االستيقاظ‬.1
2. Note the time and date of begin the
.‫ تنبه الى الوقت والتاريخ لبدء وقت جمع العينة‬.2
collection timing.
3. Collect all urine voided for the next 24 .‫ ساعة القادمة‬24 ‫ اجمع كل البول لمدة‬.3
hours. .‫ قم بتبريد العينة طوال فترة الجمع اذا لزم االمر‬.4
4. Refrigerate the specimen
throughout the collection period if ‫ عندما تكون حركة االمعاء متوقعة قم بجمع‬.5
required. .‫ وليس بعد‬،‫عينة البول من قبل‬
5. When a bowel movement is anticipated, ‫ شرب كمية عادية من السوائل مالم يأمر من‬.6
collect the urine specimen before, not
after it. .‫الطبيب عكس ذلك‬
6. Drink a normal amount of fluid unless .‫ ساعة‬24 ‫ تفريغ اخر مرة في نهاية ال‬.7
instructed to do otherwise.
‫ ضعها في جهاز التبريد المتنقل‬،‫ اغلق العلبة‬.8
7. Void one last time at the end of the 24
hours. .‫وقم بنقله الى المختبر في أسرع وقت ممكن‬
8. Seal the container, place it in a portable
cooler, and transport it to the laboratory
ASAP.