Randomized Crossover Evaluation of Quick-Wee Versus Urine Collection Bag for Infant Urine Collection

Abstract

Background: Accurate diagnosis of urinary tract infection (UTI) in infants requires a minimally contaminated urine sample. Urine-collection bags are noninvasive but prone to contamination; invasive methods reduce contamination but cause discomfort. Quick-Wee, a stimulation-based clean-catch technique, may offer a faster, cleaner alternative. Objectives: To compare microscopy-defined urine contamination — white blood cells (WBCs), red blood cells (RBCs), epithelial cells, and bacteria as primary outcomes — and collection time and caregiver satisfaction as secondary outcomes, between Quick-Wee and urine-bag collection in infants using a within-subject crossover design. Methods: We conducted a randomized two-period, two-sequence (AB/BA) crossover study. Each infant provided two samples about 6 hours apart within one shift. Sequence (Quick-Wee → bag or bag → Quick-Wee) was assigned via a computer-generated list and sealed, opaque, sequentially numbered envelopes. A single trained pediatric nurse collected all samples per standard operating procedure (SOP); diapers were changed, and the peri-urethral/genital area was washed and dried before each attempt. Laboratory staff were blinded to method/sequence; samples bore anonymized codes. Primary outcomes were quantitative microscopy counts [cells/high-power field (HPF) or semi-quantitative categories]; secondary outcomes were time to collection (minutes) and caregiver satisfaction (5-point Likert). Results: Versus urine-bag collection, Quick-Wee yielded lower counts of WBC (-1.19; P < 0.001), RBC (-0.32; P = 0.007), and epithelial cells (-1.78; P < 0.001); bacterial counts did not differ (P = 0.096). Collection time was markedly shorter with Quick-Wee (10.7 ± 8.9 vs. 52.4 ± 10.3 minutes; difference -41.7; P < 0.001). Caregiver satisfaction was higher with Quick-Wee (median 5 vs. 3; P < 0.001). Conclusions: Quick-Wee is a rapid, noninvasive method that reduces several microscopy-defined contamination indices, substantially shortens collection time, and improves caregiver satisfaction compared with urine-bag collection, with no significant difference in bacterial counts. Findings support Quick-Wee as a pragmatic first-line option for infant urine collection.