Name of Student: _ Date Performed: _

Level & Section: _

legend (Rating Criteria):
5- Expert (student performsall tasks proficiently and independently).
4- Competent (student performs efficientlyinan effective andefficient manner).
3- Progress Acceptable(performanceis usually effectiveand but not always).
2- Needs Improvement (progress inperformance is too slowto judge satisfactorily; taskperformance isnot
most of the time).
1 - Progress Unacceptable (no progress in performance has been demonstrated, and or performance is
consistentlyineffectiveand inefficient).
CollectingUrine: Clean-catch midstream- is a procedure likely to be done as part of theprenatal assessment of
thewomaninorder to rule out urinarytract infections.
Materialls:
• Sponge soaked in a soap solution
• Sterilecup or sterilewide-mouthed botHe withcover
PROCEDURE 1 2 3 4 5
1. Exolain the procedure andits reasoo
2. Instruct the client to first wash her hands thoroughly and be ready with the
sterilesoecimencontainer.
Instruct the woman to wash the perineal area with soap and water and rinse it
4. well.
Using sponges soaked in a soap solution, cleanse the area around the
5. urinarymeatus observinq the"front toback" technique· rinse thorouqhlv.
6. While keeping the labia separated withher fingers, instruct thewomanto void
forcibly and stop at the midstream.
7. The initial streamof urine is enough to flush the urethra of microorganism
that may result in a false-positive result.
8. Catch tlle midstreamurine in a sterile cup or wiide-rmuthbottle that is made
surenot come in contact with the aenitalia.
9. Screw the lid of the cup securel:v, keeoinq the inner oortion of the lid sterile.
After hand washing, label the bottle with tlhepatient's name, plus the date
10. and time of voidina.
11. Brinq thesoecimen bottle to the center or to the laboratory.
TOTAL

Clinical Instructor
(Sign over printedname)