COLEGIO SAN AGUSTIN-BACOLOD

College of Health and Allied Professions MLS 112 LABORATORY ACTIVITY SHEET
Medical Technology Program

Laboratory Activity 1
COLLECTING MIDSTREAM CLEAN-CATCH URINE SPECIMEN:
Instructing the Patient

I. Desired Learning Outcomes

The value of examining a patient's urine has been known since ancient times.
Medieval physicians went nowhere without their beakers to collect urine specimens. At
that time, there was only a basic idea of what could be derived from such a study. As
technology has advanced, the humble specimen has yielded more information. Today,
collecting important data from urine is faster, more precise, and easier than ever.

At the end of the activity, the students will be able to:

1. Instruct the patient in the correct procedure for collecting a clean-catch urine
specimen;
2. Describe the proper urine collection and preservation methods;
3. Value the importance of specimen collection on the accuracy of urinalysis results.

II. Materials
Laboratory gown
Disposable latex gloves
Paper towels and tissue papers
Hand disinfectant
Towelette
Tampon (for female patients, only if necessary)
Disposable, clean, dry, and leakproof urine containers with lids
Labeling materials (masking tape and pens)

III. Procedure
1. Put on a protective lab gown; wash your hands with disinfectant, dry them, and
wear gloves.
2. Collect and prepare the appropriate equipment.
3. Verify the identification of the patient and direct the patient to the toilet facility.
4. Explain the collection procedure to the patient.
5. If the patient is a male, explain the collection procedure as follows:
a. Wash and dry your hands before starting.
b. If uncircumcised, retract the foreskin with a towelette.
c. Clean the urethral opening three times, using a fresh towelette each time
in a single wipe toward the glans.
d. Start urinating into the toilet with your foreskin still retracted.
e. Collect a midstream specimen of about 20 mL in the collection container.
f. Void the rest of the urine into the toilet.
g. Cap the container and take it into the laboratory.
6. If the patient is a female, explain the collection procedure as follows:
a. Wash and dry your hands before starting.
b. Sit on the toilet seat with your legs spread apart as far as comfortable.
c. If you are menstruating or have a heavy vaginal discharge from a yeast
infection, insert a tampon.
 COLEGIO SAN AGUSTIN-BACOLOD
College of Health and Allied Professions MLS 112 LABORATORY ACTIVITY SHEET
Medical Technology Program

d. Spread the outer labia with your left hand (right hand if you are left-
handed).
e. Clean the inner labia and the urethral opening, using a fresh towelette
each time to wipe front to back in a single stroke.
f. Start urinating into the toilet with the outer labia still spread.
g. Collect a midstream specimen of about 20 mL in the collection container.
Do not touch the inside of the container or its lid.
h. Void the rest of the urine into the toilet.
i. Cap the container and take it to the laboratory.
7. Receive the urine specimen from the patient and tell the patient to return to the
examination room.
8. Wipe the outside of the container with a tissue soaked in disinfectant and place
the container on the counter.
9. Fill in the label with the patient’s name, chart number, the physician’s name, the
date, and time of collection.
10. Attach the label to the urine container, not the lid.
11. Store the urine specimen in the refrigerator if you do not process it immediately.
12. Discard the disposable equipment.
13. Disinfect other equipment and return it to storage.
14. Clean the work area following the Universal Precaution guidelines.
15. Remove your laboratory gown and gloves; wash your hands with disinfectant
and dry them.

IV. Guide Questions

1. Why are elaborate instructions given to patients for a midstream, clean-catch

specimen?
2. How is urine collected from infants?
3. Why should urine specimens be protected from light?
 COLEGIO SAN AGUSTIN-BACOLOD
College of Health and Allied Professions MLS 112 LABORATORY ACTIVITY SHEET
Medical Technology Program

NAME OF STUDENT: 000000000

Lab Act 1: COLLECTING MIDSTREAM CLEAN-CATCH
URINE SPECIMEN: Instructing the Patient
TITLE OF LABORATORY ACTIVITY:_______________ DATE SUBMITTED: 0000

I. Observation/Results

Figure 1. Urine collected using midstream, clean-catch technique

Urinalysis, a crucial medical diagnostic procedure, involves looking at someone's urine to learn
more about their health towards disease diagnosis, treatment, and maintenance (Simerville et al., 2005).
The midstream clean catch is a crucial method in urinalysis. To ensure a more accurate depiction of the
body's internal state—and prevent contaminants like bacteria from the genitalia’s skin from interfering
—this procedure calls for taking a urine sample in the midst of the stream, following the first flow (North
Oaks Health System, 2007). Specifically, these are instructed well to the patient and are done as follows:

FEMALE PATIENTS:
1. Tell the patient to expand her labia (vaginal lips).
2. Wipe front to back three times with the provided wipes. Each time, discard the wipe. (NEVER REUSE.)
3. Start urinating while keeping the labia open. The first piece of the pee will come out of the urethra
and contain debris.
4. Pour some pee into the sterile cup, ensuring the bladder is in good shape by catching some urine mid-
stream. The container should not touch the genitalia.
5. Complete the bedpan or toilet.
6. Soon, label, secure, and send the specimen to the laboratory.

POTTY-TRAINED CHILDREN:
1. Depending on their level of comprehension, children may need assistance from their female guardian,
parent, or phlebotomist.
2. Give female caretakers instructions.
3. When possible, instruct male caregivers to take care of men.
4. If necessary, help with collection.
5. Both males and females must follow the same procedure as adults.

MALE PATIENTS:
1. If the animal is not circumcised, the foreskin must be retracted before washing, and the area should
be wiped with the wipes provided’ After each usage, discard.
2. Tell the man to start urinating in the urinal or toilet.
3. Fill a sterile specimen container with urine.
4. Complete peeing in the urinal or toilet.
 COLEGIO SAN AGUSTIN-BACOLOD
College of Health and Allied Professions MLS 112 LABORATORY ACTIVITY SHEET
Medical Technology Program

II. Discussion

A diagnostic procedure called urinalysis looks for any urine composition irregularities that can
point to an illness or infection (Simerville et al., 2005). One of the methods for collecting a clean urine
specimen is the midstream clean-catch procedure. To guide patients in accurately collecting a clean-
catch midstream urine specimen (CCMS), the North Oaks Health System (2007) suggests providing or
preparing a sterile Clean Catch Kit comprising a specimen container, wipes, and two sterile tubes. The
technique for female patients entails widening the labia, cleaning the front and rear three times with
wipes, and then collecting midstream pee in the sterile container without contacting the genitalia.
Gender-specific caregivers are instructed to offer assistance as needed for potty-trained kids in the same
way that adults would. Male patients who are not circumcised must retract their foreskin and clean
themselves with the offered wipes before collecting urine in the container. Finally, the gathered
specimen needs to be marked, kept safe, and transported to the lab without delay (Mcgoldrick, 2015).

Bhutta et al. (2023) discussed various preservation methods for urine that can be done to
preserve the sample’s integrity. Refrigeration at particular temperatures is advised if testing is delayed.
Freezing is an option, particularly if the examination must wait more than two hours after collection. The
advantages of refrigeration include preventing bacterial development and not influencing urine chemical
testing; nevertheless, the disadvantages include an increased specific gravity and the potential for the
precipitation of amorphous phosphates and urates. Adding hydrochloric acid can preserve aldosterone,
calcium, and creatinine. Boric acid aids in preserving protein and formed components, interfering only a
little with normal tests other than pH readings. However, it can also impact medications and hormones
and may precipitate crystals in high concentrations. Despite its interference with several chemical tests,
formaldehyde is excellent for preserving sediment. Although sodium fluoride can obstruct the results of
tests for blood sugar, white blood cells, and red blood cells, it is useful for avoiding glycolysis and
protecting drugs. Options like phenol, thymol, and toluene do not significantly interfere with normal
tests. When refrigeration is not an option, commercial preservative tablets with these ingredients plus
sodium fluoride provide a simple alternative; however, evaluating their effects on particular tests is
advisable. However, for culture, Baer (2002) claims that the basic rule is to avoid chemical preservatives;
the ideal urinalysis completion time is between 6 and 8 hours, and culture does best when refrigerated.

Thus, Chandra (2022) reminds that it is important to have appropriate specimen collection and
preservation to make urinalysis accurate and reliable. Errors in collection methods, like improper
handling, delays, or contamination, can lead to skewed results that misrepresent the patient's condition.
Delays in delivering the specimen collected may alter the chemical composition, bacterial growth, and
cellular morphology, affecting parameters such as pH, specific gravity, and sediment analysis.
Maintaining uncompromised results requires using the right transport materials in acceptable, leak-
proof containers while maintaining the right temperature conditions. Precision is required in patient
identification, matching samples to unique patient data. It is essential to have sufficient specimens to
allow for thorough testing. Notably, poor specimen quality is the most frequent cause of laboratory
errors, which can negatively affect patient comfort and the timing of test results.
 COLEGIO SAN AGUSTIN-BACOLOD
College of Health and Allied Professions MLS 112 LABORATORY ACTIVITY SHEET
Medical Technology Program

III. Guide Questions

1. Why are elaborate instructions given to patients for a midstream, clean-catch specimen?

Elaborate instructions for collecting a clean-catch midstream urine specimen (CCMS) are required
to avoid contaminating the urine sample and guarantee reliable test findings (Kirkwood, 2017). The
clean-catch technique is intended to keep microorganisms from the penis or vaginal skin from
contaminating the urine sample. Furthermore, catching the stream of urine midway through and then
removing it before finishing helps flush out any contaminants present at the beginning or end of the
urinary stream.

2. How is urine collected from infants?

Urine collection from infants for testing involves careful hygiene and specialized equipment, and
most of the time, it is done in the medical professional’s office rather than at home (McPherson &
Pincus, 2021). The process entails cleansing the genital area, placing a specially designed plastic bag with
a sticky grip at the end over the baby's genitals, and securing it with adhesive. A diaper is placed on the
baby just over the bag and is being checked frequently if the infant is active. After the baby urinates, the
sample is promptly transferred from the bag to a container the healthcare provider provides. However,
the container can be placed in the refrigerator at home. A catheter may collect a sample directly from
the bladder if sterility is required. This involves cleaning the urethral area, inserting a small catheter, and
removing it after urine collection.

3. Why should urine specimens be protected from light?

Urine specimens must be shielded from light due to the risk of photochemical degradation
affecting specific analytes (MLabs, 2020). UV and visible light, known to initiate reactions, can cause
changes in constituents like bilirubin, urobilinogen, and medications—leading to skewed results and
impacting the reliability of diagnoses for the worse. Therefore, employing light-protective containers—
such as aluminum foil or paper towel—during storage helps maintain specimen integrity and ensures
reliable analysis.

IV. Conclusion

During the laboratory activity, I learned about the proper instruction and collection of urine
needed for urinalysis using the midstream clean-catch method. The objectives were sufficiently achieved
because I have valued the critical importance of meticulous specimen collection and preservation
methods to ensure accurate and reliable diagnostic results. Elaborate instructions are provided to
patients for a midstream, clean-catch specimen to prevent contamination and guarantee the credibility
of test findings. The technique involves catching the urine stream midway through, with men retracting
their foreskin while a female must hold their labia. After that, various urine preservation methods, such
as refrigeration, can be done to preserve the specimen’s integrity. Any preanalytical errors, such as in
the collection, can harm the delivery of health. For infants, urine collection entails specialized
equipment and hygiene measures involving either a plastic bag method or a catheter insertion.
Employing light-protective containers during storage mitigates the risk of analyte photodegradation and
upholds the specimen’s integrity for accurate analysis. Thus, adhering to proper procedures for
instructing, collecting, transporting, and storing this gold liquid is paramount to unlocking valuable
insights about our health—underscoring the pivotal role of meticulous methodology in the realm of
urinalysis.
 COLEGIO SAN AGUSTIN-BACOLOD
College of Health and Allied Professions MLS 112 LABORATORY ACTIVITY SHEET
Medical Technology Program

V. References

Baer, D. (2002). Preserving routine urine specimens, documentation of normal flora, and ... Medical
Laboratory Observer. https://www.mlo-online.com/home/article/13002270/preserving-routine-
urine-specimens-documentation-of-normal-flora-and-quantitative-body-fluid-counts

Bhutta, R. A., Syed, N. A., Ahmad, & Khan, S. (2023). Urine Formation, types of urine, and urine
preservatives. Labpedia.net. https://labpedia.net/urine-formation-types-and-preservatives/

Chandra, R. (2022). Specimen collection and handling best practices and pitfalls. Medical Laboratory
Observer. https://www.mlo-online.com/diagnostics/specimencollection/article/21280897/
specimen-collection-and-handling-best-practices-and-pitfalls

Kirkwood, J. (2017). Clean catch urine sample and culture. Healthline.

https://www.healthline.com/health/urine-culture-clean-catch

Mcgoldrick, M. (2015). Urine specimen collection and transport. Home healthcare now, 33(5), 284-285.

McPherson, R. A., & Pincus, M. R. (2021). Henry's clinical diagnosis and management by laboratory
methods E-book. Elsevier Health Sciences.

MLabs. (2020). General specimen collection guidelines - mlabs. University of Michigan.

https://mlabs.umich.edu/sites/default/files/2020-10/file/gl-specimen-collection_guidelines.pdf

North Oaks Health System. (2007). Instructions for Collecting a Clean Catch Midstream Urine Specimen
(CCMS). P. O. Box 2668. Hammond, LA 70404. Retrieved from www.northoaks.org

Simerville, J. A., Maxted, W. C., & Pahira, J. J. (2005). Urinalysis: a comprehensive review. American
Family Physician, 71(6), 1153–1162.