Is it bad that I accidently contaminated pt. urine?

[Spring235]

I contaminated my pt.'s urine specimen. I'm a student, I didn't think about it until AFTER clinical. I thought I was being helpful because pt. stated they had burning while urinating along with frequency. So, I alerted the nurse and I obtained a urine specimen. The patient urinated in a bedside pan but also had a small BM on the toilet paper...I don't know what I was thinking but I collected that urine that was in the bedside pan with the toilet paper in it. I was driving home and I thought OMG why the heck did I collect that urine?! It was completely contaminated. Will it be obvious that a urine specimen was contaminated? I remember looking at the results at the end of the day and it showed >150 WBC, >150 RBC, and +2 bacteria, etc. Could I cause harm to my pt. if the doctor prescribed a med that was un-needed? I feel so awful......What do you all think about this scenario?

[sbostonRN]

Usually when a sample is contaminated it's very obvious from the number and types of bacteria that it is contaminated rather than infected. The lab generally suggests to re-submit a cath specimen.

[KelRN215, BSN, RN]

What was sent? Just a U/A or a U/A and culture? A culture needs to be done sterilely so the patient either needs to clean himself off beforehand and urinate directly into the specimen cup or be straight cath'd.

If it was just a U/A and not a clean catch, my guess is they'd repeat it and do a U/A and culture before starting any meds. At least that's what we'd do.

[Spring235]

It was sent for a U/A and culture. This is what the results were...what do you think when looking at it?

RBC >50

WBC >50

Epithelial cells 3-5

Bacteria +2

Color: yellow

Urine Clarity: Turbid

Urine pH: 6.5

Leukocytes: Moderate

Nitrate: Negative

Bacteria: +2

Ketones: Neg

Urine Bili: Neg

Urine glucose: Normal

Urine occult blood: Large

Total Urine Protein: 150

I know i'm missing some info but that is what I wrote down...

[dishes, BSN, RN]

The ordering physician and the lab should be notified that the specimen was contaminated and sterile specimen should be sent. Waiting for results from a contaminated specimen is a waste of time and it is not fair to the patient to delay treatment.

[mazy]

Two issues here. First of all, sometimes specimens are dirty and have to be done again. It's not the end of the world, it happens.

Second issue is that you contaminated the specimen which is also not the end of the world. It happens. Next time you will remember not to do that, and if the issue comes up again, you will know to say, "oh I think that specimen is contaminated, let's do another."

The doctor isn't going to prescribe a med based on a contaminated specimen. No one is going to backtrack and say "what happened to this specimen that it's contaminated! Who did that!" They'll just do it again. Because it happens.

Especially when you're doing a clean catch, sometimes fecal matter or other stuff (i.e. menstrual blood) gets into the sample.

So stop beating yourself up.

The only time it's a big deal is if you have broken your sterile field cathing a patient. Then you've got some problems.

[Spring235]

I always beat myself up over things from clinical. It's so stressful to me. All I think is obtaining a contaminated urine specimen will lead to a million problems and ultimately lead to my patient's death. I'm sooooooooo afraid of killing a patient. I am starting to wonder if nursing is for me or not, bc I'm freaking out about a urine specimen. ughhh . Or am I just crazy?

[Miller86]

Relax! it will indicate if it has been contaminated and will ask for it to be re-submitted. Just let your preceptor know and everything will be just fine!

[Spring235]

Thanks for the replies. I did let my instructor know. The pt was already discharged though...she told me I could have called the unit after clinical to let them know but I didn't know that I was allowed to do that til it was to late, pt was already discharged.

[AnonRNC]

Given the RBC, WBC and occult blood your patient probably does have a UTI - or a GI bleed. There's more to a UA than just the bacteria count and culture.

[Guttercat, ASN, RN]

Bet you won't do that again. :)

Relax! You're learning, and, it's a valuable lesson in the "stop and think" department.

Even we veterans have to smack ourselves upside the head from time to time.

[Double-Helix, BSN, RN]

My biggest concern would be the culture, not the UA. Ecoli is a bacteria that is prevalent, and necessary in the GI tract and present in stool. However, the presence of Ecoli in the urine would indicate an infection. So if they urine was contaminated with stool the culture could grow positive for Ecoli, when it's really not. That could result in an improper antibiotic being given to the patient. As for the UA, the occult blood and bacteria could have come from stool, or a dirty bedpan as well.

OP, as others have said, contact someone to explain that the sample was contaminated. They will do another one to double check, and no harm will be done.