This thesis aims to illustrate the broad concept of the urinary tract infection UTI in children and will suggest to them the best way to collect midstream urine samples. Third chapter is finding, this chapter presents the results of the included studies, what the studies found, and what is the main finding in the studies, and critical evaluation of the studies in the review.
Definition of Urinary Tract Infection
The second chapter is methodology, this chapter will present the methods used to do this review, what is the rationale for using this method, how data was collected, how data was analyzed and what type of critique tools were used to see the quality of the included studies. Chapter four is discussion, this chapter will focus on describing and evaluating what is found in the studies, demonstrating how it relates to the literature review and research questions, and making an argument to support the overall decision.
Used of Urinalysis
Methods Used to Test the Urine
Glucose or urine sugar, if elevated, is an indicator of diabetes, and a follow-up diabetes test is necessary. Bilirubin, a marker for liver function Blood in the urine is an indicator of infections or other diseases (Mayo Clinic, 2021).
Challenges in Urinalysis in Children and Contamination
In a study by Diviney (2021), it is important to use the best method to obtain urine samples from the child to confirm or rule out the diagnosis, and this is a challenge in non-toilet-trained children because it associated with severe morbidity with delayed treatment. The greater susceptibility or chance of having UTI in women is because they have shorter urethra than men and it is located closer to the anus, where stool comes out and makes it easier for an infection to happen.
Incidence and Prevalence of the UTI in Children
Children in the Health Care
It is important to enable children to participate in prevention, promotion, treatment, rehabilitation and palliative care services.
Methods of Urine Collection
The urine bag method requires a sterile plastic bag to be attached to the perineum (the area between the genitals and the anus), with adhesive around the bag opening, and the voided urine to fall into the bag (Diviney, 2020). In a study by Hadjipanayis et al. 2015) it is the preferred collection technique in Europe, 53% chose a urine bag for collection as first choice for infants < 3 months and 59% for children aged 4–36 months).
What is Known on this Review?
The contamination rate with each method is possible due to the collection techniques and the method itself. The groups of participants in Davies et al. 2015) study were similar at the start of the trials. On the other hand, the findings of the four cohort studies by Crombie et al. will be explained here.
The main outcomes of the studies were the contamination rate of the infants' urine sample, the average time taken to collect the urine sample, and the successful urine collection by bladder stimulation. The reported preparation prior to collecting the sample is to clean the patient's genital area. The bladder stimulation was applied by the nurses and the doctor, and they tapped and massaged the infants' lower abdomen.
Another study conducted by Herreros et al. 2015) supported that there is a contamination of the clean catch urine sample in infants.
Gap of the Review
Chapter Summary
Systematic Literature Review
Scope of the Review
The research question for this review is "What is the best clean catch method to collect no contaminated urine sample for children who are not toilet trained?". To collect a CCU sample, it is important to collect it midstream, which means that when the patient will begin to urinate, do not sit the container, let the first drop of urine release and then start collecting (Kirkwood, 2017).
Systematic Search Strategy
All terms that were used in the search were using PIO to make it easy, searchable and also meant that the search could be replicated by another researcher, and thus would be reliable and consistent. Search results were generated using three electronic databases relevant to the review: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and PubMed.
Inclusion and Exclusion Criteria
When selecting the relevant studies from the searches, the first step was to screen the title and abstract of the study and save them in a folder. The second step is to revisit the studies and read the entire articles to decide which studies met the inclusion and exclusion criteria. of the review. The final step is to select the qualified studies based on relevance to the research question, recent publication year, language and sample. PRISMA helps demonstrate the value of the review and assess the strengths and limitations of the study.
Critiquing Articles and Appraisal
The results of the studies were clearly presented, they presented their data in a clear table. The studies of Labrosse et al. 2020) clearly addressed the main issue of the study, the groups of participants being studied and showing how many of the people asked to participate in the study. The results of the study were clearly addressed, the researcher showed the finding of the timing of the collection, the successful rate of the technique and the contamination rate.
Introduction
Assignment of Patients to the Treatments
The method of using sealed, opaque envelopes was suitable in RCT research because it means that participants do not know which treatment will be assigned, they cannot see what is inside the envelopes and they cannot open them. Because the participants in Davies' and Mamta'. studies are children, so the researcher, researcher or parents are the ones who open the envelopes to know what treatment will be given to each child. The numbers were randomly assigned to participants in balanced blocks of 10 using a randomization software program, and the infants were divided into two groups, the experimental group (EG) and the control group (CG).
Loss of Participants During the Study
Nurses and doctors were needed to perform the technique in EG. 2015) participants were properly counted in the final study and the researcher explained the excluded patients with a reason. Participants in the Altuntas et al. 2015) study, one hundred and forty newborns (140) in the hospital between August 2013 and December 2013 were assessed as eligible for the study. The researcher mentioned that six neonates were excluded due to dehydration (n=3) or low oral intake (n=3), and seven mothers refused to participate in the study.
Were patients, health workers and study personnel ‘blind’ to treatment
2015) participants were properly accounted for in the final study and the researcher explained the excluded patients with a reason. This does not really apply to babies in this review because they are not aware of the study and the treatment. The researchers did not mention whether they themselves were blinded to the treatment or whether the staff and parents who did the stimulation for the babies' studies were also blinded.
Factors Might Affect the Outcome of the Group
Intervention of the Groups
Effectiveness of the Length of Time Taken to Produce a Urine Sample
Clinically Important Outcomes
Cohort Studies’ Findings
Inclusion and Exclusion
Bias in the Studies
- Design bias
- Selection/Participants bias
- Publication Bias
- Procedural bias
- Interviewer Bias
According to Smith and Noble's (2014) study, selection or participant bias pertains to each method of recruiting members and examining study inclusion criteria. Insufficient time to answer the survey can lead to larger amounts of missing question data, reduced variability in question responses, shorter responses to open-ended questions, and shorter response times. None of the studies lose their participants or the participants refuse to participate in the study, the researchers already know the inclusion and exclusion criteria before starting the study, they also give the participants enough time to complete the questions.
Confounding Factors in the Studies
This can lead to treatment bias because a child who has received effective tapping and massage may urinate while another child who also receives tapping and massage will not urinate.
Data Analysis of RCT and Cohort Studies
The Successful Rate of the Bladder Stimulation in Cohort Studies
According to Fernández et al. 2020), the intervention appeared to have no benefits for the infants, as there was no significant difference in technique between the infant groups. The findings of Labrosse et al. are applicable to practice because the finding in Labrosse et al. 2019) showed that the success rate was found to be statistically significant in 90% of the infants, meaning that the stimulation mauver is successful for the infants .
Timing of the Bladder Stimulation
Introduction
Best Practice To collect Urine Sample in Children
It is important in urine collection to clean the genital area before taking the sample because of the possibility of contaminating the urine with bacteria from the surrounding skin during collection. Another study evaluated the effectiveness of cleaning the genital area before urine sample collection by Shrestha et al. 2013), the researchers divided the patients into three groups. According to the above studies, the best ways to clean the genital area for patients before taking the urine sample were hand hygiene, using chlorhexidine wipes and paper soap.
Contamination Rate in the Urine Sample Collection
Crombie, Labrosse, Mamta and Altuntas' studies reported contamination in the urine sample collection during the study conducted. Other reason for the fact that a low percentage was found in contamination sample due to the cleaning resources used in the study for sterilization, the investigator used soap. Contamination rate was 9 of 57 in the clean capture group compared to 4 of 62 in the invasive method group.
The Successful Rate for Bladder Stimulation Technique in Urine Collection in Infants
Fernández et al, (2013) study because the researchers planned a stimulation technique and conducted a study after nurses and doctors had been trained. Further evidence is that the method includes a mixture of fluid intake, breastfeeding or formula feeding and non-invasive bladder stimulation maneuvers which induce the baby to urinate. It's the techniques they did in the study that enable them to have this high success rate in collecting urine samples from infants, and it's the best practice in urine collection.
The Length Time of the Procedure
Child Rights When Participate in the Research Study
Clarke (2015) mentioned that researchers must be aware of the full humanity of the child with honesty and personality and the ability to participate freely in the research. To have accurate diagnosis of UTI is by obtaining a sample of urine for culture with minimal contamination before starting the treatment. A foundation for research on high quality medical education'. 2010) 'Needs, rights and the human family: The practical application of the Convention on the Rights of the Child'. 2019) 'Contamination in adult midstream clean-catch urine cultures in the emergency department: a randomized controlled trial'. 2018) 'Urine collection methods in children: which is best'. 2019) Qualitative vs Quantitative Research | Pure psychology. lt;https://www.simplypsychology.org/qualitative-quantitative.html> [Accessed: 13 August 2021].
2011) "Urinary tract infection: clinical practice guidelines for the diagnosis and management of incipient UTI in febrile infants and children aged 2 to 24 months". A general comment on the child's right to have his or her best interests considered as a primary concern.
