4. RED AND BLUE TOP COLLECTION SWABS WILL NO LONGER BE SUPPLIED FOR BACTERIAL CULTURE

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1 Laboratory Testing Update Specimen Transport Changes dated SEH Laboratory is making significant changes to specimen transports! The Laboratory is introducing new testing platforms along with working with Infection Control to improve the safety for all who handle specimens by introducing leak resistant transports. These improvements necessitate specimen transport changes for several commonly ordered tests. Culture Swab Changes SEH Laboratory is changing collection swabs; blue top swabs will no longer be in use, and red top swabs will be limited to throat collections for Rapid Strep Screen and Group A DNA testing. We are changing to a simpler and improved collection/transport system for most swab collected samples. The preferred specimen for bacterial, fungal, and acid fast cultures is fluid/tissue from the body site, transported in a sterile container, but for instances when swab collections are needed, the ESwab will now be used. 1. The ESwab transport contains a single collection swab that can be used for bacterial cultures, including anaerobes, and for fungus culture swab collections. 2. ESwab samples should be sent as soon as possible, but are stable for up to 48 hours at refrigerated or room temperature. Exception: cultures for Neisseria gonorrhea are stable for 24 hours only. 3. Two ESwab transports will be available. The multipurpose ESwab is a single swab that can be used for most aerobic and anaerobic collections. The mini-tip ESwab contains a smaller, flexible shaft swab that can be used when narrow body sites need to be collected, such as urethral or nasopharyngeal swabs. 4. RED AND BLUE TOP COLLECTION SWABS WILL NO LONGER BE SUPPLIED FOR BACTERIAL CULTURE

2 5. NEW: ESwab tranports for aerobic, anaerobic, and fungal swab collections Multipurpose ESwab for most cultures Item# Mini-tip ESwab for narrow sites Call Microbiology for Mini-tip swab 6. Eswab is used for Strep B DNA collection.

3 EXCEPTIONS 1. BBL Red top swabs will continue to be used to collect Strep Screens and Group A DNA swabs. 2. Swab samples are unnacceptable for Acid Fast Bacillus cultures. The only acceptable specimens for AFB cultures are fluid, lower respiratory samples, and tissues. URINE AND SPECIMEN CONTAINER CHANGES Leak proof Urine and Specimen transports The SEH Laboratory is working with Infection Control to provide sample transport containers that can diminish the possibility of samples leaking and contaminating the outside of the transport containers. In that effort we are adding 10 ml urine additive free collection tubes that work with the current urine transport kit. The urine transport is a closed system that allows fast, easy transfer of urine from the cup to a urinalysis tube, a culture (C&S) tube, and a closed tube transport of the samples to the laboratory. The no additive tube (s) can be used for urine chemistries, drug screen testing (3 tubes required), urine antigen tests, or urine testing that cannot have any preservative additives, using the same access port on the collection cup. These tubes are ordered separately from par level. The collection cup should be discarded as they are not intended for use as the transport vessel for testing. Additionally, a new sterile leak proof specimen container will replace other specimen cups for transporting fluids, other specimens, such as stool samples that require a clean preservative free container.

4 These new containers will reduce specimen rejections due to external contamination and be safe for transport through pneumatic tube systems. They will improve the quality of specimens and the safety of all who handle patient samples. The yellow lid non-sterile, and various sterile cups will no longer be supplied. Urine cup used with transport tubes Additive Free urine tube Leak proof specimen container Item # Item # NEW Item #83581, 100 per bag NEW

5 Change in Transports and Instrumentation for Chlamydia trachomatis and Neisseria gonorrhoeae Molecular Testing Starting December 16th, 2014, the Molecular Lab at St. Elizabeth Healthcare will change testing platforms for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to the Aptima Combo 2 test by Gen- Probe/Hologic. The Aptima Combo 2 amplification and nucleic acid probe test utilizes target capture for the in vitro, qualitative detection and differentiation of ribosomal RNA (rrna) of CT and NG. This assay is FDA cleared to test the following specimens from symptomatic and asymptomatic individuals: clinician-collected endocervical swab, vaginal swab, or male urethral swab specimens, patient-collected vaginal specimens within a clinic setting, clinician-collected Thin Prep Specimens in PreservCyt Solution, and first-stream, unpreserved male urine specimens. The laboratory at St. Elizabeth has developed and verified the performance of this test for first-stream unpreserved female urine as well, but it is not FDA approved. This test is intended for medical purposes only and is not valid for the evaluation of suspected sexual abuse or for other forensic purposes. To order in EPIC, choose Chlamydia/GC by TMA and select the appropriate source. Please note that collection requirements have changed for some specimen types: First Stream Urine Specimens (Yellow tube): Male and female urine must be first stream, with no urination within the previous hour. Female patients should not cleanse external genitalia prior to collection. Clean catch and catheterized urines are not acceptable. First stream urine samples are to be collected in a clean cup without preservative. Patient collection volumes for urine must be no less than 2mL, and no more than 30mL AT COLLECTION. Higher collection volumes of urine will result in decreased sensitivity. Using the pipette provided in the collection kit, add enough urine (approximately 2 mls) to the tube so that the final volume falls between the two black lines on the collection tube. NOTE: Collection tubes may not be used for other testing such as urinalysis or urine culture. Store and transport at 2 C to 30 C. Unisex Genital Kit (White tube with White Cleaning Swab and Blue Collection Swab): Genital Swabs collected in M4 media will no longer be accepted after 12/16/2014. Male urethral and female endocervical swabs are collected with the Unisex Genital Kit. Males should not have urinated within the last hour before collecting the specimen. Note: two swabs are provided in the Unisex Genital Kit. Use the white swab to remove excess mucous from Female patients and discard. Use the blue shafted swab in the package to collect the specimen and ensure that the blue swab is present in the tube. Specimens received with the white swab will not be processed and the specimen must be recollected. NOTE: These swabs are NOT acceptable for culture of any type. Store and transport the swab in the transport tube at 2 C to 30 C. Vaginal Swab (Orange tube with Pink Collection Swab): Vaginal specimens are collected in the Vaginal Swab Kit and may be collected by the clinician or patient within a clinic. Vaginal Swab Kits are not for home use. NOTE: These swabs are NOT acceptable for culture of any type. Store and transport the swab in the transport tube at 2 C to 30 C. Thin Prep Specimens: requirements for Thin Prep Specimens remain the same. Please send the original Thin Prep vial. must be ordered at the same time as the Pap Smear and CANNOT be added on at a later time. Collection NOTE: CT/NG The following specimens will not be performed at the St. Elizabeth Laboratory and will be sent to a reference laboratory: rectal, pharyngeal, and ocular specimens, and specimens collected on patients younger than 14. Please call the Molecular laboratory at prior to collection.

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9 Please contact the Microbiology at if you have any questions or concerns.