SPECIMEN PROCESSING CHART Urines

Transcription

1 Policy #MI\SPEC\ Page 1 of 15 Specimen Type Gram Routine Voided urines (midstream, neonatal bagged, indwelling catheter foley catheter, ileal conduit urine) Aseptically collected urine (nephrostomy,bladder/ cystoscopy/ in & out catheter/ catheter insertion Suprapubic urine aspirate Segmented urines VB 1, VB 2, VB 3, EPS Urine for yeast, Candida or unspecified fungi Urine for dimorphic fungi or Cryptococcus (unspun) (unspun) (unspun) (unspun) (unspun) (unspun) BA, MAC BA, MAC BA, MAC, BRUC BA, MAC (2 sets use both 0.01ml and 0.001ml loops) BA, MAC Urines Special request and/or Eosinophilcystospin Bacterial latex Agg nnot available Anaerobes- BRUC Chlamydia- Virology Leptospirafrozen sediment for send out to PHL AFB Fungus Virology Legionella Ag Detection Send to Virology Send to Virology Send to Virology Send to Virology Spin at 3500 rpm for 15 minutes. Inoculate 1 drop of sediment per plate Parasitology Temperature delay in

2 Policy #MI\SPEC\ Page 2 of 15 Wounds/Tissues/Aspirates Cultures Specimen Type Gram Routine Special request and/or Superficial swabs and drainage (decubitus ulcers, episiotomies, nonintravenous or central line exit sites, chest-tube drainage, abdominal drainage, tracheal swabs) Wound swabs Bite wound swabs Skin biopsies BA, MAC, CNA For tracheal swab and chest tube drainage add HI BA, MAC, CNA If ANO 2 swab rec d add BRUC, KV BA, MAC, CHOC If ANO 2 swab rec d add BRUC, KV BA, MAC, CHOC, - O 2 RT-ANO 2 Pus and abscess material (other than liver, brain and rectal) BAC, MAC, CHOC, BRUC, KV If Nocardia is requested add Na Pyruvate and Fungus culture (IMA, EBM). Do modified AFS if Actinomyces or Nocardia is requested or suggested on Gram stain IMA, EBM

3 Policy #MI\SPEC\ Page 3 of 15 Specimen Type Gram Routine Special request and/or media Wounds/Tissues/Aspirates Cultures AFB Fungus Legionella Parasitology Temperature Rectal abscess BA, MAC, CNA Liver & brain aspirates (pus/cyst fluid or abscess material) Surgical biopsy/tissue BA, MAC, CHOC, BRUC, KV, THIO, NOTE: ANO2 media set-up separate jar for 72 hrs. Set-up right away BA, MAC, CHOC, BRUC, KV, THIO,, BEAA not done on wound debridement tissue, joint capsules, gas gangrene tissue, necrotizing fasciitis tissue unless specifically requested Mon-Fri send portion of fresh specimen to Parasitology section, Weekends and holidays, mix equal volume of specimen with SAF and send to Parasitology section. Note on the spec that it has been mixed with SAF

4 Policy #MI\SPEC\ Page 4 of 15 Wounds/Tissues/Aspirates Cultures Specimen type Gram Routine Speci al request and/or media Autopsy tissue Bone BA, MAC CHOC, CNA THIO AFB Fungus Virology Legonella Parasitology Temperature IMA, EBM Lung tissue adult Lung tissue baby/nb Intravascular catheter tips (central, CVP, Hickman, Brovial, peripheral, arterial, umbilical, hyperalimentation, hemodialysis, port-acath, Swan-Ganz catheters) Bile BA, MAC, CHOC, CNA, BA, MAC, CHOC, CNA, BA roll (4x) BA, MAC If ANO 2 culture is requested or collected by PTC add: BRUC, KV, THIO

5 Policy #MI\SPEC\ Page 5 of 15 Specimen Type Gram Routine Special request and/or media Bone Bank, Bone graft and cadaver fascia/tissue/swab specimens Wounds/Tissues/Aspirates Cultures THIO - O 2 RT-ANO 2 Breast milk BA, MAC Total Parenteral Nutrition (TPN) Intravenous and central line catheter exit site swabs BA, THIO, IMA, IMA with sterile olive oil overlay BA, MAC Eye/Corneal scrapings, contact lenses and solutions Intraocular aspirates Lacrimal (tear duct) stone/secretions THIO, IMA BRUC, KV, THIO THIO Chlamydia Giemsa stain Acanthamoeba 35 0 C All other sp. received for Acanthamoeba RT -O 2 RT- ANO 2

6 Policy #MI\SPEC\ Page 6 of 15 Wounds/Tissues/Aspirates Cultures Specimen Type Gram Routine Special request and/or Facial specimens In Vitro tissue culture specimens (Cytogenetics) Peritoneal Dialysis Catheter/Canula and Prosthetic Devices Ear specimens- Ear swabs Tympanocentesis Fluid Eye/conjunctiva/ Lid swabs (STAT) MAC If Actinomyces is requested or ANO 2 swab collected or thick pus is rec d add BRUC, KV, THIO MAC, THIO If Actinomyces is requested or suggested on gram stain, do modified AFS THIO If plates rec d, no Gram stain will be performed BA, MAC, CNA BRUC, KV, THIO BA,CHOC For all neonates (<1 wk of age) or if GC is requested add ML - O 2 RT- ANO C-plates

7 Policy #MI\SPEC\ Page 7 of 15 Genital Tract Cultures Specimen Type Gram Routine Bartholin s abscess swab/aspirate Cervical (Endocervical) swab Endometrial biopsies and curettings ML, MAC Special request and/or ML If GBS is requested refer to the GBS screen section ML, MAC STAT ZN If aspirate or ANO2 swab rec d add BRUC,THIO, KV Genital ulcer swab Requests should be referred to PHL: T. pallidum C. trachomatis (LGV serotypes) Calymatobacterium granulomatis H. ducreyi (chanroid) specimen in C trachomatis (CT) (HSV, CT) HSV Group B streptococcus screen CNA, GBS

8 Policy #MI\SPEC\ Page 8 of 15 Genital Tract Cultures Specimen Type Gram Routine Special request and/or Intra Uterine Device (IUD) Placenta swab/tissue and products of conception Penis swab Post-partum, postoperative, posttherapeutic abortion vaginal specimens Culture not indicated BA, CNA, CHOC, ML, MAC BA, MAC, CNA, ML CNA, GBS STAT ZN Prostatic/seminal fluid BA, MAC, ML Molecular Detection of GC and CT Upper Genital Tract swabs and aspirates (Endometrial,/ uterine, cul-desac/transvaginal, fallopian tube, tubo-ovarian swabs or aspirates ML, MAC If aspirate or ANO 2 swab received add BRUC, KV and THIO (CT)

9 Policy #MI\SPEC\ Page 9 of 15 Genital Tract Cultures Specimen Type Gram Routine Special request and/or Urethral swab ML (CT) Vaginal swab GM+WM GC culture Children under 14 years old GM+WM ML GC culture TSS/TTH-In & MSH-In GM+WM CNA, GBS

10 Policy #MI\SPEC\ Page 10 of 15 Sterile Fluids Specimen Type Gram Routine Special request and/or Cerebrospinal Fluids (CSF) THIO, MAC If only VDRL is requested the sp will not be cultured. If any of the following is requested, perform a Cryptococcal Ag test: Cryptococcus/crypt ococcal Ag, India Ink preparation Fungal culture RT Pleural (Thoracentesis/empyema) fluids Peritoneal (ascites) fluids BA, CHOC BRUC THIO BA, CHOC BRUC,KV, THIO Bacterial Ag test is no longer available Peritoneal Dialysis Effluent Clear Cloudy BacT/Alert bottles BA, MAC, CHOC BacT/Alert bottles Cell count TML Hematology RT

11 Policy #MI\SPEC\ Page 11 of 15 Sterile Fluids Specimen Type Gram Routine Special request and/or Predialysis Fluid Clear THIO Cloudy Synovial (Joint) Pericardial fluids Amniotic fluids/swab BA, MAC, CHOC, THIO BRUC, KV, THIO ML, BRUC, KV, THIO Bone marrow (aspirates or biopsies) If received in BacT/Alert bottles) process as a routine blood cultures BRUC, KV, THIO, IMA, EBM,BEAA Blood, platelets and other transfusion products (2 orders, 1 for the tubing, 2 nd for the bag) THIO Other Sterile fluids: Tympanocentesis fluid, intravascular fluid, hydrocele fluid, cyst fluid, etc. BRUC, KV, THIO

12 Policy #MI\SPEC\ Page 12 of 15 Specimen Type Gram Routine Broncho alveolar lavage (BAL) Bronchoscopy aspirates/washings routine Routine Lung Transplant Bronchoscopy specimen BA, HI, MAC,, BEAA BA, HI, MAC, BEAA Respiratory Tract Cultures Special request and/or B. cepacia } OCBL Cystic fibrosis} Nocardia-Na Pyruvate C. pneumoniae-phl PCP-Virology B. cepacia } OCBL Cystic fibrosis} Nocardia-Na Pyruvate C. pneumoniae-phl PCP-Virology CMV Surveillance Bronchoscopy specimens Bronchial Brush BA, HI, MAC B. cepacia } OCBL specimens (1:100) Cystic fibrosis } Epiglottal swabs BA, HI Lung biopsies (open lung/transthoracic needle/transbronchial lung biopsy) MAC, BRUC, THIO, IMA, EBM, BEAA B. cepacia } OCBL Cystic fibrosis } Nocardia-Na pyruvate Mouth swabs Culture not Indicated

13 Policy #MI\SPEC\ Page 13 of 15 Respiratory Tract Cultures Specimen Type Gram Routine Special request and/or Nasal swabs for MRSA MSAO S. aureus -CNA N. meningitidis - ML Nasopharyngeal Sent to PHL swabs/auger suctions for Bordetella pertussis Oral abscess swabs BA, HI If ANO 2 swab If received do not Actinomyces process but issue requested or report stating suggested Inappropriate on gram specimen for ANO2 stain add culture therefore not BRUC, KV processed. Sinus/Antral specimens BA, HI, MAC, IMA, EBM If ANO 2 culture requested add: KV, BRUC, THIO

14 Policy #MI\SPEC\ Page 14 of 15 Respiratory Tract Cultures Specimen Type Gram Routine Sputum (including endotracheal tube and tracheostomy specimens) BA, HI, MAC Special request and/or STAT ZN B. cepacia} OCBL C. fibrosis } Nocardia Na Pyruvate Throat swabs BA Mycoplasma } Diphtheria } PHL N. gonorrhoeae ML If yeast (thrush)/ Vincent s angina is suspected/requested do GRAM stain IMA,EBM BEAA

15 Policy #MI\SPEC\ Page 15 of 15 Enterics Specimen Type Gram Routine Special request and/or Faeces/Rectal swab Duodenal or small bowel aspirate/biopsy For faecal WBC MAC, HEK, SMAC, CAMPY, SEL Processed for O&P only Yersinia on children between 1mo.-12 yrs old except for NICU add CIN Vibrio -TCBS, APB GC (rectal swab only) ML C.difficile-Virology also set up for VRE Campylobacter other than C. jejuni/coli PHL to keep specimen in delay in Chlamydi a Detection Viral isol n Duodenal or small bowel swab Rectal/large bowel (colon) biopsies Gastric aspirates/biopsies (for Helicobacter pylori) BA, MAC, BRUC, KV MAC, HEK, SMAC, CAMPY, SEL BA, Campy Urea slant (inoculated with piece of nonmacerated tissue)