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clean-catch

September 13, 2008

the prescription pill bottle is a very popular patient choice for urine storage and transport.  i do not understand why this is, or how this method has become so prevalent in my workplace.  it is equally popular among both elderly and young patients, usually a trend like this will remain in one demographic.  even our prenatal patients who must bring a first-morning urine sample to every routine visit use prescription bottles on occasion, even though we supply them with a urine container at the first visit, and any subsequent visit that the patient asks for a fresh container.

it could be that the amber color of the plastic has become linked with medical purpose, or perhaps the idea that a substance used for medical treatment had once occupied the container.

and why is this container, when filled with urine always placed in a plastic baggie?  well, this is because the prescription bottle makes a rather useless vessel for liquid.  the childproof cap is not easy to open and close, and after it has been opened and closed many times (like when used daily for dispensing medication) the cap becomes loose on the bottle and is no longer air-tight.  the liquid stored in the bottle will seep out and run down the sides.

now that i have gotten through this explanation, let me tell you about what happened yesterday morning:

a patient calls with a complaint of painful, burning urination.  she knows that she must have a urinary tract infection, not only this, but she has already prepared a urine sample for testing that she would like to drop off to the office.  she is told by the office staff member that we need a “clean-catch” kit urine sample.  the patient stated that she had in fact used a clean-catch kit, so the patient was told to bring the sample in to the office and we would transfer it to the lab for testing, and meanwhile we would prescribe an antibiotic and some medication for the pain, which would be called into her pharmacy.  who’s to argue if the patient seems confident that she has done what was needed, and seems to understand the proper terminology.

the patient drops off the sample, and a different staff member had taken it from her.  so, now, here is an old prescription bottle filled with urine stashed in the usual plastic sandwich bag.  the urine has coated the inside of the bag, this normally would not bother any of us because urine is sterile . . . unless the producer of the urine is harboring an infection which causes painful burning and bloody urine.  this sample was visibly nasty-ed up with germs.  the patient ran out the door too fast for one of the medical assistants to stop her and have her leave a clean-catch sample.

the medical assistant had performed a dip-stick test and the sample was indeed teeming with bacteria, so the nurse decided that the patient should have the antibiotics right away, but the patient should come back in for a clean-catch.  after things had slowed down in the office i called the patient to explain what we actually needed from her to make an accurate diagnosis.   the patient argued with me (and not in the nicest manner) that she already did the clean-catch, and she did not want to come back in to the office, she said that the bottle she used was clean.  i explained that the urine had to be in a sterile container and the genitalia needed to be cleaned with special towelettes first.  the patient was rather insulted, and told me that she is very clean, and she had washed out the pill bottle, which had not contained her prescription for a long time, so it must be sterile.

the conversation continued, but by this point i was too distracted by the whole situation to remember the rest now.  i laughed for hours.  i called liz to tell her about it all, and she laughed too.  every one in the office was very amused with the entire thing.

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2 Comments leave one →
  1. September 14, 2008 5:45 pm

    I don’t even know what to say. I’m amazed ONE person would use a pill bottle, let alone many. And an empty pill bottle as a “clean-catch” sample?!?! WTH?!?!

  2. jvalways permalink*
    September 14, 2008 6:34 pm

    mmm, yes, really stunning isn’t it.

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