Microbiology Collection

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1 Microbiology Collection Notify the Microbiology Laboratory at if any of the following etiological agents are suspected to be present in the specimens sent to the laboratory. Bacillius anthracis Bordetella pertussis Brucella spp. Francisella tularensis Burkholderia psudomallei Yersinia pestis Blastomyces dermatidis Coccidiodes immitis Histoplasma capsulatum Paracoccidioides brasiliensis Instructions for Collection and Handling of Microbiology Specimens for Culture Culture Collection Instructions 1. Identify patient using corporate compliance guidelines. 2. Decontaminate skin. 3. Label specimen with patient s first and last name, patient date of birth, date and time of collection, and source of specimen. Label must be attached directly to culture tube or container. 4. Specimens should be transported to ThedaCare Laboratory via courier on same day of collection. Blood cultures, cerebrospinal fluid, and synovial fluid should never be refrigerated. 5. When possible, specimens should be collected during an acute phase of illness and collected before antibiotics have been administered. Routine Culture Transport Collection Procedure 1. Obtain syringe, sterile container, swab, or culture transport device (supplied). 2. Wash hands. Decontaminate patient s skin. 3. Collect specimen directly from source of infection. 4. Remove needle from syringe and replace with sterile cap or place swab into tube. 5. Label culture transport device and fill out requisition with appropriate information: date, time, specimen source, diagnosis, antibiotics given, and specific culture requested. Specimen (Source) Antrum BD Eswab Blood Body Fluids Cleanse stopper with 70% alcohol. (Do not use iodine.) Draw directly into bottles using blood collection adapter system or by needle and syringe. Adults 10 ml per bottle BacT/ALERT FA Plus Aerobic (green cap) BacT/ALERT FN Plus Anaerobic (orange cap) Pediatric or difficult draw Adults - 1 ml to 5 ml in BacT/ALERT PF Plus (yellow cap) Pediatric - up to 5 ml in BacT/ALERT PF Plus (yellow cap) Send one of the following: 1. Leave in capped syringe or place in sterile, green- top (heparinized) VACUTAINER. 2. Send collection bottle 3. Inject small amount of specimen into Anaerobic Transport device A minimum of 2 and maximum of 3 separate collections per 24 hours is recommended. Specimens should be drawn 30 minutes apart unless otherwise specified. Specimen must be drawn with aseptic technique as follows: 1. Adults and children over 2 months of age: cleanse site with chlorohexidine gluconate 2%; 70% alcohol applications, using a scrubbing motion for 30 seconds. Allow area to dry for 30 seconds. 2. If further palpation of vein is necessary, cleanse finger with same method. 3. Children under 2 months of age: cleanse site with 70% alcohol. Let dry for 30 seconds. Collect with sterile syringe and needle; remove needle from syringe before submitting specimen to laboratory. If submitting in green-top (lithium or sodium heparin) tube, expel air from syringe prior to placing in VACUTAINER. Do not refrigerate.

2 Specimen (Source) Catheter Tips Cerebrospinal Fluid Ear Viral Exudates (Drainages, Transudates, Ulcers) Eyes (Conjunctiva) -Bacterial Pathogens -Chlamydia Nucleic Acid Amplification Fecal Material Clostridium difficile Giardia/ Cryptosporidium Ova and Parasite Rectal Swab Rotovirus Viral Screw-capped, sterile vial or container 2 cm to 3 cm long segments Screw-capped, sterile vial Screw-capped, sterile vial Eswab Syringe (preferred) or Eswab Eswab or small collection swabs GEN-PROBE Aptima Collection Kit Cary-Blair transport media supplied or screwcapped, sterile container or 10% formalin vial ECOFIX vial to Mayo Culture transport swab Screw-capped, sterile vial or rectal swab in viral transport media supplied Disinfect surrounding entry site, remove catheter, and aseptically clip off 2 cm to 3 cm of tube into sterile container. Foley catheter tip is not acceptable. Deliver to laboratory immediately. Do not refrigerate or freeze. Collect >= 2mL of spinal fluid. Deliver to laboratory immediately. Send specimen refrigerated. Specimen cannot be frozen. Remove needle from syringe prior to transport and replace with sterile cap. Send specimen ambient or refrigerated. Refrigerate (preferred)/ambient/frozen Fresh specimen recommended. Send specimen refrigerated. Mix thoroughly Indicate if for Neisseria gonorrhoeae. Send specimen ambient or refrigerated. Fresh specimen recommended. Send specimen refrigerated.

3 Genitourinary (Cervix, Vagina) Candida (yeast) DNA Probe Chlamydia RNA amplicfication Herpes Neisseria gonorrhoeae -RNA amplification -Culture ESwab Affirm VPIII Collection Kit supplied APTIMA collection device Herpes transport media-supplied APTIMA collection kit for male and female-supplied ESwab Forward promptly at ambient or refrigerated temperature. Indicate if for Neisseria gonorrhoeae. Using the swab from the kit, obtain a specimen from the posterior vaginal fornix. Twist or roll swab 3 times. Swab lateral vaginal wall while removing the swab. Immediately place swab into specimen collection tube. With swab touching bottom of tube, break swab off at second prescored line. Swab handle will fit into cap. Transport collection device within 72 hours at ambient or refrigerated temperature. Follow collection instruction outlined in kit Follow collection instructions outlined in kit. Deliver to laboratory immediately Follow collection instructions outlined in kit Trichomonas vaginalis -Wet Prep -Nucleic Acid Probe for Trichomonas, Gardnerella, Candida sp Copan swab in small amount of sterile saline in sterile vial or vacutainer Affirm ambient transport system Obtain swab of fresh vaginal discharge. Deliver to laboratory immediately. DO NOT REFRIGERATE or FREEZE Follow collection instructions outlined in kit

4 Specimen (Source) Respiratory (Bronchial, Sputum, Washings) Collect a fresh specimen from deep cough or induced by respiratory therapy. A first-morning specimen is preferred. Deliver to laboratory immediately. Culture processing preceeded by Gram stain demonstrating <10 epithelial cells per low power field and many PMN s. Send refrigerated. Fungi Legionella Mycobacteria AFB (TB) Early morning specimen preferred. Throat Rapid Strep Group A Strep DNA Probe Transtracheal Aspirate Eswab Copan Dual Swab Copan Dual Swab Eswab or screw-capped, sterile container Swab tonsillar areas, pharynx, and areas of ulcerations. Avoid oral contamination. Sinus Syringe (preferred) or Eswab Remove needle from syringe prior to transport and replace with sterile cap. Tissue Place representative specimen aseptically into container. Do not add fluid. Larger specimens (>1cm tolerate short exposure to air Urine (Midstream, Indwelling Cath, Straight Cath, Suprapubic, or Indwelling suprapubic ) Mycobacteria AFB (TB) Cytomegalovirus (CMV) ; syringe with sterile cap; or Becton-Dickinson urine tube (as much urine as possible [minimum volume: 40 ml]) For midstream, clean voided, or catheterized collection, a first-morning, clean-catch, midstream specimen is recommended. If catheterized, obtain free flow from mouth of catheter. Catheter bag is not acceptable for culture. Deliver to laboratory immediately; refrigerate specimen after collection if transport will be delayed. For suprapubic aspirate, this technique should be used if anaerobic bacteriuria is suspected. Collect with sterile needle and syringe, expel air from syringe, remove needle and replace with sterile cap. A first-morning, clean-catch, midstream specimen is recommended. Deliver to laboratory immediately; refrigerate specimen after collection if transport will be delayed. 15 ml to 20 ml of fresh urine. Refrigerate specimen after collection. Deliver to laboratory immediately.

5 Wounds (Abscesses) Syringe (preferred), Eswab Collection with needle and syringe is preferred. Expel air before injection into VACUTAINER. Swabs can be used but provide limited material. If swab is used, avoid skin contamination. Deliver to laboratory immediately.

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