Is it acceptable to use a hat for urine collection?

Urine Collection with a Hat

Yes, using a "hat" (a plastic collection device that sits in the toilet bowl) is acceptable for urine collection for culture and analysis, as it functions equivalently to a standard sterile collection container when proper technique is followed.

Collection Container Requirements

The specific type of collection container has minimal impact on culture accuracy, provided basic principles are maintained:

• Containers should be clean and preferably sterile, made of materials like high-density polyethylene or polypropylene that do not bind urinary components or shed particles 1
• A lid or cover is preferable to prevent introduction of external contaminants 1
• The collection method and timing matter far more than the container type - proper midstream technique and rapid processing are the critical factors 1

Proper Collection Technique with a Hat

When using a hat for urine collection, follow these guidelines:

• Midstream collection with cleansing is recommended for all adults (both men and women) to minimize contamination 1
• For women: Cleanse the perineal area, begin voiding into the toilet, then collect midstream urine in the hat 1
• For men: Cleanse the urethral meatus, discard first-void urine, and collect midstream specimen 1
• First-void urine collection is not recommended due to significantly higher contamination rates 1

Critical Timing and Storage Requirements

The timing of specimen processing is more important than the collection device:

• Process within 1 hour if kept at room temperature 2, 3
• Refrigerate immediately (4-10°C) if processing will be delayed beyond 1 hour 2, 3
• Maximum refrigeration time is 24 hours for specimens with high bacterial counts (≥10⁵ CFU/mL) 2
• Specimens held at room temperature >4 hours should not be processed due to overgrowth of both pathogenic and contaminating flora 1

Contamination Rates by Collection Method

Understanding contamination rates helps contextualize why the container matters less than technique:

• Midstream clean-catch with cleansing: 7.8% contamination 4
• Midstream without cleansing: 23.9% contamination 4
• Sterile urine bags (pediatric): 46-68% contamination - not recommended 4
• Catheterized specimens: 4.7-12% contamination 4

Common Pitfalls to Avoid

• Do not collect first-void urine - this significantly increases contamination rates compared to midstream collection 1
• Do not leave specimens at room temperature >1 hour - bacterial overgrowth leads to false-positive results 2, 3
• Do not skip perineal cleansing - this triples the contamination rate in women 4
• Do not transfer urine from the hat after prolonged sitting - transfer immediately to preserve specimen integrity 2

Special Populations

For children who cannot provide midstream specimens: Collection hats are not appropriate; catheterization or suprapubic aspiration is required for diagnostic accuracy 1, 4, 3

For elderly incontinent men: External collection devices (condom catheters draining into collection containers) show 86% positive predictive value and 90% negative predictive value when organisms are present at ≥10⁵ CFU/mL 5

Evidence Quality Note

While high-quality evidence (2016 systematic review in Clinical Microbiology Reviews) strongly supports midstream collection with cleansing over other non-invasive methods 1, no studies have specifically compared sterile cups versus collection hats 1. The container type appears less critical than collection technique and specimen handling, as even "unsterile disposable plastic cups" showed 95% correlation with catheterized specimens in one study 6.