URINE SPECIMEN FOR CULTURE Urine Specimen Collection - Male - Clean-Catch Urine Specimens Wet paper towel and open soap towelette.

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1 URINE SPECIMEN FOR CULTURE Urine Specimen Collection - Male - Clean-Catch Urine Specimens Wet paper towel and open soap towelette. Retract the foreskin if uncircumcised, and cleanse end of penis with soap towelette. Cleanse again with wet paper towel to remove soap. Urinate small amount into toilet and continue to urinate remainder into specimen container, being careful not to touch the top or inside of container. DISCARD TOWELETTE AND PAPER TOWEL IN WASTE CONTAINER. DO NOT THROW IN TOILET. Place lid on container and give urine specimen to nurse. If immediate transport (<1 hour) to the lab is not possible, nursing staff will transfer the specimen to a urine transport device Urine Specimen Collection - Female - Clean-Catch Urine Specimens Remove underclothing completely and sit comfortably on seat, swinging one knee to the side as far as you can. Spread the labial folds with one hand and continue to hold the labial folds apart while you clean and collect the specimen. Wash. Be sure to wash and rinse well before you collect the urine sample. Using the cleaning materials supplied, wipe from the front of your genital area towards the back. Wash between the folds of the skin as carefully as you can. Repeat. Rinse. After you have washed with each soap pad, rinse with a water-moistened pad with the same front-to-back motion. Do not use any pad more than once. Hold yourself apart with one hand and allow the first few drops of urine to pass into the toilet bowl. With the other hand, hold the collection cup on the outside and pass the remaining urine into the cup. Place the lid on the container and give the urine specimen to the nurse. If immediate transport (<1 hour) to the lab is not possible, nursing staff will transfer the specimen to a urine transport device. Urine Specimen Collection - Catheterized Place patient in a comfortable supine position. If female, have legs drawn up with heels together and knees spread wide apart. Use aseptic technique. Wear sterile gloves and work from an appropriate sterile field. Use of a commercially prepared kit that contains all of the necessary materials is recommended. With sterile soapy cotton balls, or equivalent, cleanse urethral meatus and around the meatus. Rinse cleansed area beginning at urethra and working away from it with two successive cotton balls. Pass the sterile catheter (size 10 or 12 French) into the urethra and advance until urine flows freely. The first several milliliters from the catheter should be discarded, then collect the specimen into a sterile specimen cup. Urine samples can be obtained from indwelling catheters using a #28 needle and syringe. Be sure to disinfect the area where the needle puncture is to be made. Urine can be aspirated through the soft rubber connector between the catheter and collecting tubing. Do not obtain urine from catheter bags except in the case of neonates or young infants when special precautions have been taken.

2 COLLECTION OF A 24-HOUR URINE SPECIMEN Your physician has requested a test or tests that requires you to collect all urine for a 24- hour period for submission to the laboratory for testing. It is important that you follow these instructions carefully to ensure that the test results are as accurate as possible. If you should miss collecting any urine into the container during the 24-hour period, you should discard the entire specimen and start over using a new collection container. 1. On the beginning of the day of collection, when you rise in the morning, note the time and empty your bladder into the toilet as usual. (Do not save this first urine in the collection container.) 2. Begin collecting every urine specimen thereafter. Keep the container cold, on ice, in the bathroom or in your refrigerator. 3. It is important to collect ALL urine for the 24-hour period. If you get up during the night, be sure to add the urine to the container. Your physician needs a total volume and all specimens to ensure accurate results. 4. When you rise in the morning of the second day, collect this specimen into the container as the last specimen of the collection period. Try to arise at approximately the same time as the previous day to reflect collection for a full 24 hours. EXAMPLE: If you start the collection at 8:00 a.m. on Monday morning, the last collection should be approximately 8:00 a.m. on Tuesday morning. 5. Label the container with your first and last name, as well as the start and end times and dates for the collection. Keep the container cold and deliver to the laboratory as soon as possible, preferably on the day the collection is complete.

3 STOOL SPECIMEN COLLECTION for ROTAVIRUS AND CLOSTRIDIUM TESTING COLLECTION OF SPECIMENS 1. C. difficile - Stool/feces: Collect a minimum of 2 ml of stool sample in an appropriately labeled sterile container. Specimens should be liquid or soft. (Formed, hardened stool specimens are not acceptable for Clostridium difficile testing.) Store and transport to the laboratory at 2-8 C. 2. Rotavirus - Stool/Feces: Collect a minimum of 2 ml of stool sample in an appropriately labeled sterile container. Store and transport to the laboratory at 2-8 C.

4 STOOL COLLECTION with ETM NOTE: The patient should be instructed not to take antacids, oily laxatives, or anti-diarrheal medication unless prescribed by a physician, prior to the collection of the sample(s). If you are taking any of these medications, please consult your physician. Radiological examinations utilizing contrast chemicals (e.g., bismuth, barium) should be avoided prior to collection of the fecal specimen for parasite analysis. 1. You have been asked to collect a stool sample for laboratory analysis. The vials will contain liquid. NOTE: The liquids are poisonous. Do not drink or pour out liquid. Keep out of the reach of children or pets. 2. Collect the stool specimen (bowel movement) in any clean, dry wide-mouth container, bedpan, or on a plastic plate or clean newspaper, plastic bag, or clean diaper (please use the outside of the diaper for collection). This prevents the fecal specimen from falling into the toilet bowl. Collection device (e.g. diaper, newspaper, bedpan) must not be sent to the laboratory. The stool sample must be transferred to the appropriate transport device(s) before being sent to the laboratory. 3. Carefully open the ETM. 4. Using the spoon attached to cap, add approximately three spoonfuls of firm stool, or five spoonfuls of soft stool, to each vial. It is important to sample areas of the specimen which appear bloody, slimy, or watery. If the stool is firm, sample small amounts from each end and the middle of the specimen. Fill each vial with enough specimen so that the liquid reaches the fill line located on the label. Do not fill beyond the fill line NOTE: Hard stools are not acceptable for routine culture. 5. Thoroughly mix the specimen and the liquid in the vial using the spatula. Fill only one vial at a time and replace the spoon/cap onto the same vial it came from. Do not mix spoons/caps with other vials. 6. Replace the spoon/cap and close tightly. 7. Shake each vial until the specimen is well mixed with the liquid in the vial. 8. Label the vials with: a. Patient name, medical record number and/or date of birth. b. Date and time specimen was collected. c. Check the box that best describes your stool sample. d. Please note on the label if specimen is bloody. 9. Place the vial in the original package and seal securely. Store and transport specimens at 2⁰- 8⁰C (refrigerated). Return specimen to the laboratory as soon as possible. 10. Wash hands thoroughly with soap and water.

5 OCCULT BLOOD SPECIMEN COLLECTION 1. Open front tab on Hemocult slide. 2. Collect a small amount of stool sample on one end of applicator stick. 3. Apply thin smear inside Box A. 4. Reuse applicator stick to obtain second sample from different part of stool. Apply thin smear inside box B. 5. Close cover. 6. Return slide to your doctor or laboratory. Follow dietary instructions: Diet 2 days prior to testing: Meat small amounts of well-cooked chicken, tuna or turkey. Vegetables generous amounts of cooked vegetables. Raw vegetables are also permitted except for turnips, cauliflower, red radishes, broccoli, cantaloupe, horseradish, and parsnips. Fruits Plenty of fruits especially prunes and apples. Cereals Bran and bran containing cereals, moderate amount of peanuts and popcorn daily. Other restrictions: The following medication restrictions should be followed after consultation with physician: No aspirin or antiinflammatory medicines for 7 days prior to collection; do not use supplements which contain Vitamin C (ascorbic acid) in excess of 250 mg/day; do not use rectal medicines or tonics.

6 OVA AND PARASITE SPECIMEN COLLECTION with Proto-fix CLR NOTE: The patient should be instructed not to take antacids, oily laxatives, or anti-diarrheal medication unless prescribed by a physician, prior to the collection of the sample(s). If you are taking any of these medications, please consult your physician. Radiological examinations utilizing contrast chemicals (e.g., bismuth, barium) should be avoided prior to collection of the fecal specimen for parasite analysis. 1. You have been asked to collect a stool sample for laboratory analysis. The collection set may contain 1, 2, or 3 vials. If multiple specimens must be collected, collect on consecutive days, not on the same day. The vials will contain liquid. NOTE: The liquids are poisonous. Do not drink or pour out liquid. Keep out of the reach of children or pets. The number of specimens to be collected will be directed by the physician. 2. Collect the stool specimen (bowel movement) in any clean, dry wide-mouth container, bedpan, or on a plastic plate or clean newspaper, plastic bag, or clean diaper (please use the outside of the diaper for collection). This prevents the fecal specimen from falling into the toilet bowl. Collection device (e.g. diaper, newspaper, bedpan) must not be sent to the laboratory. The stool sample must be transferred to the appropriate transport device(s) before being sent to the laboratory. 3. Carefully open the Proto-fix CLR. 4. Using the spoon attached to cap, add approximately three spoonfuls of firm stool, or five spoonfuls of soft stool, to each vial. It is important to sample areas of the specimen which appear bloody, slimy, or watery. If the stool is firm, sample small amounts from each end and the middle of the specimen. Fill each vial with enough specimen so that the liquid reaches the fill line located on the label. Do not fill beyond the fill line NOTE: Hard stools are not acceptable for this test. 5. Thoroughly mix the specimen and the liquid in the vial using the spatula. Fill only one vial at a time and replace the spoon/cap onto the same vial it came from. Do not mix spoons/caps with other vials. 6. Replace the spoon/cap and close tightly. 7. Shake each vial until the specimen is well mixed with the liquid in the vial. 8. Label the vials with: a. Patient name, medical record number and/or date of birth. b. Date and time specimen was collected. c. Specimen number if more than one specimen was taken, for example #1, #2, and #3. d. Check the box that best describes your stool sample. e. Please note on the label if specimen is bloody. 9. Place the vial(s) in the original package and seal securely. Store and transport specimens at room temperature. Return specimen(s) to the laboratory as soon as possible. 10. Wash hands thoroughly with soap and water.

7 MRSA SCREEN A. Collection Swabs Molecular Testing Swab (preferred). BBL Culture Swab Liquid Stuart. Copan Transystem Liquid Stuart. Copan Venturi Transystem Liquid Stuart. BBL Culture Swab Liquid Amies Copan Venturi Liquid Amies BBL Culture Swab Plus Amies Gel without charcoal Copan Venturi Transystem Amies Gel without charcoal B. Procedure 1. Using an appropriately labeled swab, insert paired swab approximately 1/2 inch into nostril. Rotate swab against inside of nostril for 3 seconds. 2. Apply light pressure on the outside of the nose while rotating swab. 3. Repeat for other nostril with same paired swab. 4. Return both swabs to same transport tube and submit to lab at room temperature (2-30 C) is acceptable. NOTE: A dry swab may be used but must be premoistened with sterile physiological (non-bacteriostatic) saline.

8 Patient Instructions for Collecting a Pinworm Sample Using Swube Pinworm Collector Collection Container PINWORM PADDLE (SWUBE) A. Collect the specimens upon awakening, prior to bathing or going to the bathroom. B. Hold the paddle by the cap and remove from the tube. C. Have the patient lie on his or her side or, while standing, bend over at the waist. D. Separate the buttocks and press the tacky surface of the paddle against several areas of the perianal region. E. Place the paddle back into the appropriately labeled tube. F. Transport the paddle to the Microbiology Laboratory at room temperature within 24 hours of collection. Multiple negative test results may be needed to rule out infection. Swube Collection Device

9 SPUTUM COLLECTION GUIDELINES MATERIALS A. Sputum collection device or sterile specimen cup. B. Glass of water. SPECIMEN COLLECTION A. Collect sputum specimen as soon as possible after waking in the morning. B. Gargle with water immediately prior to obtaining a sputum specimen to reduce the number of oral bacteria. Do not use a mouthwash or any other gargle. C. Press the rim of the specimen container under the lower lip to catch all of the expectorated or coughed sputum. D. Cough deeply and expectorate sputum (not saliva) into the cup. E. Close the lid securely and notify your caregiver that your specimen is ready for transport to the laboratory. F. For acid-fast culture, three (3) specimens collected at a minimal interval of 8 to 24 hours, with one specimen being a first morning specimen, are recommended for adequate recovery. G. Transport the specimen to the Microbiology Laboratory at room temperature within 24 hours of collection for routine respiratory cultures (RESP). For other test requests, refer to specific test catalog instructions.

10 GLUCOSE TOLERANCE All glucose-times collections are from the time the glucose beverage is given. The glucose beverage is to be consumed within approximately five (5) minutes. The grams of glucose given are required in designated area in Harvest. Glucose beverage is available in 50gm, 75gm, and 100gm. Gestational Glucose Tolerance Screen Prenatal Glucose Tolerance Screen Test Code: GTT1HP Patient does not need to be fasting for this test. Glucose challenge is administered without regard to time of day or time of last meal. The patient is given 50gm of glucose beverage. When the patient completes the beverage, a timer is set for 60 minutes. At 60 minutes, a blood sample is collected in a gray top tube The specimen is labeled with patient s full name, date of birth and time specimen collected. The time glucose is given is recorded on the lab requisition.

11 Gestational Glucose Tolerance Diagnostic 3-Hour Glucose Tolerance on Pregnant Female Test Code: GTT3HR The patient is to arrive in the morning after an 8-10 hour fast. A fasting blood sample is obtained in a gray top tube labeled fasting and patient full name and date of birth. The patient is given 100gm of glucose beverage. The drink should be finished in approximately five (5) minutes. The time glucose is given is recorded on the lab requisition. When the drink is finished, set blood collection times from the completion of the glucose drink for: o 30 minutes Times o 1 hour Post o 2 hours Glucose o 3 hours Beverage Collect specimens at designated time and label correct time with patient full name and date of birth. The specimens all have the same accession number and therefore must be labeled with collection time and time post glucose beverage (i.e. 1hr, 2hr, etc.) All specimens are collected in a gray top tube All specimens from the tolerance test are sent to the lab together at the completion of the test Collection example: to be used as guide only Fasting blood glucose 7:45a.m. 100gm oral glucose beverage 8:00a.m. 30 minutes post glucose beverage 8:30a.m. 1 hour post glucose beverage 9:00a.m. 2 hour post glucose beverage 10:00a.m. 3 hour post glucose beverage 11:00a.m.

12 3 Hour Glucose Tolerance Male or Non-Pregnant Female Test Code: GTT3HR The patient is to arrive in the morning after an 8-10 hour fast. A fasting blood sample is obtained in a gray top tube labeled fasting and patient full name and date of birth. The patient is given 75gm of glucose beverage. The drink should be finished in approximately five (5) minutes. The time glucose is given is recorded on the lab requisition. When the drink is finished, set blood collection times from the completion of the glucose drink for: o 30 minutes Times o 1 hour Post o 2 hours Glucose o 3 hours Beverage Collect specimens at designated time and label post glucose beverage time. The specimens all have the same accession number and therefore must be labeled with collection time and time post glucose beverage (i.e. 1hr, 2hr, etc.) All specimens are collected in a gray top tube All specimens from the tolerance test are sent to the lab together upon the completion of the test Collection example: to be used as guide only Fasting blood glucose 7:45a.m. 75gm oral glucose beverage 8:00a.m. 30 minutes post glucose beverage 8:30a.m. 1 hour post glucose beverage 9:00a.m. 2 hour post glucose beverage 10:00a.m. 3 hour post glucose beverage 11:00a.m. Additional hours of collection can be collected if physician has requested a 4 or 5 hour tolerance.

13 2-hour Postprandial Glucose Test Code: GLU2PP This is a 2-hour glucose level after a meal or glucose beverage. The physician orders meal or glucose beverage. Adequate meal must be completed in minutes. The blood specimen is collected in a gray top tube two (2) hours after the beginning of the meal. Ask the patient the time the meal started and record it on the lab requisition. Label tube with patient full name, date of birth and time 2-hour post meal specimen was collected. ALTERNATE: A 75gm glucose beverage may be used. The blood specimen is collected in gray top tube 2 hours after the glucose beverage. Label the tube with patient full name, date of birth and 2-hour post glucose collection time. The time glucose is given is marked on the lab requisition. Pediatric Glucose Tolerance Test Code: GTT3 Pediatric patients up to 12 years old Obtain fasting glucose specimen Amount of glucose to be given is as follows: o Child s weight in pounds x 0.08 = number of ounces from 100gm glucose beverage to be given as glucose challenge o This is an example to be used as a guide only 50 lb child x 0.08 = 4oz of 100gm glucose beverage Pour the 4oz into cup for child to drink. Discard remainder of glucose beverage. o Do not give a child more than 7.5 ounces of 100gm bottle of glucose beverage Collect sample 30 minutes after glucose beverage Collect sample 1 hour after glucose beverage Collect sample 2 hours after glucose beverage Collect sample 3 hours after glucose beverage

14 Documentation When Patient Refuses Blood Draw If a patient refuses to be drawn for blood tests the physician has ordered: 1. Document all information on the laboratory order in reference to patient s/resident s refusal. 2. Notify the charge nurse at the unit of patient s/resident s refusal 3. Record the nurse s full name on the laboratory requisition 4. Make a copy of the laboratory requisition 5. Hand a copy of the laboratory requisition to the nurse 6. Send second copy of the laboratory requisition to the lab to be scanned. 7. If a collection list is printed at the unit, document the refusal on this list. Many times if the nurse speaks to the patient/resident he/she will be willing to be drawn.

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