Basic Concepts. Abscess. Specimen Collection

Transcription

1 Basic Concepts 1. Collect the specimen from the actual site of infection, avoiding contamination from adjacent tissues or secretions. 2. Collect the specimen at optimal times (for example, first morning urine or sputum for culture). 3. Collect a sufficient quantity of material. 4. Use appropriate collection devices: sterile, leak-proof specimen containers. 5. When possible, collect specimens prior to administration of antibiotics or anti-virals. 6. Properly label the specimen and complete the requisition slip. The source of specimen is required. 7. Minimize transport time. Delays in transport time decrease specimen quality and the quality of results. 8. If appropriate, decontaminate the skin surface. Use 70-95% alcohol and 1-2% tincture of iodine or Chloroprep to prepare the site. Allow a contact time of two minutes to maximize the antiseptic effect. 9. Clinical specimens must be collected so that contamination of the specimens with the normal flora of the mucous membranes or skin is avoided. Special care must be exercised in the preparation of the skin before collection, since the skin may contain large numbers of Propionibacterium species. 10. Sputum specimens must represent what is in the patient s lungs and not what is in the oral cavity. Abscess Specimen Collection 1. Decontaminate the surface with 70-95% alcohol and 1-2% tincture of iodine or Chloroprep. 2. Collect purulent material aseptically from an undrained abscess using a sterile needle and syringe. Open miliary abscesses with a sterile scalpel and collect the expressed material with a sterile needle and syringe. 3. Expel air from the syringe, remove needle and cap the syringe. Do not submit specimens with attached needles to the laboratory. Alternately, inject 5-10 ml of the aspirated material to a gel anaerobic evacuated transport vial. 4. Swabs are of limited value due to the small amount of material, possible inadequacy of the sample and their tendency to dry easily. Swabs are not acceptable for mycobacterial cultures. 5. Transport to the laboratory immediately. Acid-fast Bacilli Culture & Smear (Performed at ARUP Laboratory) Specimen Collection 1. Recommended collection: three sputum specimens at 8-24 hour intervals (24 hours when possible) and at least one first-morning specimen. An individual order must be submitted with each specimen. 2. Collect sputum OR body fluid, CSF, gastric aspirate, tissue, or urine.

2 3. Sputum: Transfer 5-10 ml (for each collection) to a sterile container (Min: 1 ml). 4. Body Fluid or CSF: Transfer 5 ml to sterile container (Min: 1 ml). 5. Gastric aspirate: Must be neutralized (ph 7) with sodium carbonate (available in laboratory). Transfer 5-10 ml to sterile container (Min: 1 ml). 6. Tissue: Transfer to a sterile container. There must be visible tissue in the container. 7. Urine: Transfer at least 40 ml to a sterile container (Min: 10 ml). 8. Specimen source is required. 9. Acid fast stain will not be performed on stool specimens, CSF if less than 5 ml, or urine specimens if less than 40 ml. 10. Transport to the laboratory within 24 hours of collection. Anaerobic Culture Since oxygen is toxic to the anaerobes, specimens for anaerobic culture must be submitted in an anaerobic transport tube. (Supplied by the Microbiology Laboratory upon request). Appropriate specimen sources are deep wounds, sterile fluids, abscess material, and tissue. Anaerobic microorganisms are the predominant microflora of humans and are present in the intestine, upper respiratory, and genito-urinary tracts. They can invade both usual and unusual anatomical sites, giving rise to severe and often fatal infections. Proper Selection of Specimen: Pus from deep wound or soft tissue abscess, especially if associated with a foul odor. Necrotic tissue or debrided material from suspected gas gangrene or less serious gas forming or necrotizing infections. Material from infections close to a mucous membrane. Material from abscesses of the brain, lung, liver, or other organ or from intraabdominal, perirectal, subphrenic, or other sites. Aspirated fluids from infections of normally sterile sites, including blood and peritoneal, pleural, synovial, or amniotic fluids. Material from an infected human or animal bite. Exudates with black discoloration. Specimen Collection 1. Cleanse the area with alcohol, followed by iodine before puncturing the skin. 2. Collect material from a decontaminated site Pus from a closed abscess Pleural fluid, by thoracentesis Urine, by suprapubic bladder aspiration. Pulmonary secretions, by transtracheal aspiration. Sinus tract material specimen is collected by the insertion of a small gauge pediatric intravenous type catheter through a decontaminated area and aspiration with a syringe. 3. All air and gas should be expelled from the syringe and needle and their contents injected into a gassed out /vacuum sterile tube. Alternatively, one may remove the needle and cap the syringe.

3 Anthrax 4. Label the specimen with patient s name, date of birth or medical record number and date and time of collection. Send to Microbiology within 48 hours. Contact Butte County Public Health for specimen collection and submission guidelines. Bacterial Food Poisoning Contact Butte County Public Health for specimen collection and submission guidelines. Blood The classic syndrome of a septicemia includes chills, fever, and prostration due to the presence of actively multiplying bacteria and their toxins in the blood stream. Since there is usually a lag period of 1-2 hours between the times of entrance of the bacteria into the circulation and subsequent chill, blood for culture should be drawn, ideally shortly before the expected temperature rise. 1. Palpate the skin to determine the venipuncture site. 2. Swab the tops of blood culture bottle(s) with alcohol. Do not allow alcohol to pool. Allow to dry while preparing the patient. 3. Cleanse the skin with Chloroprep. Move in an ever increasing circular pattern, starting at the point of projected needle insertion. Allow the Chloroprep to dry. 4. Apply a tourniquet proximal to the point of venous entry. The venipuncture site should not be palpated following disinfection unless sterile gloves are worn. If it is a short draw, an aerobic bottle only is drawn. One may use the direct draw line system. Make sure one does NOT overdraw. The bottles have sufficient vacuum to draw more than the required amount. Frequency of A series of two to three is usually requested. If the physician does not specify the interval, collect each culture minutes apart, from different sites. If the physician specifies, collect according to MD instructions. If the request is for more than three blood cultures during a 24-hour period, contact the Pathologist before drawing more blood. Each case is to be evaluated in consultation with the requesting physician. Body Fluids Acceptable specimens include: Peritoneal, Ascitic, Synovial, Amniotic, Bone Marrow and others; except urine and CSF Fluids should be collected using sterile disposable needles with a sterile disposable plastic syringe.

4 1. Prepare the skin as for blood cultures. 2. The percutaneous aspiration of these fluids must be performed aseptically to avoid contamination of the specimen and to prevent the accidental introduction of microorganisms into these anatomic spaces. Collect the fluid using a sterile needle and syringe. 3. Submit the specimen for analysis as follows: Microbiology A minimum of 3.0 ml should be collected in a sterile vial or send syringe after expelling air bubbles and removing needle. Cap syringe for transport and keep at room temperature Submit to lab as soon as possible, within 48 hours A larger volume may be required if tuberculosis or fungal infections are suspected, refer to Acid Fast Bacilli for collection guidelines. Cell Count & Crystals (if ordered) A minimum of 1 ml should be collected in an anticoagulated tube (EDTA). The specimen tube should be inverted gently 5-10 times to mix properly. Chemical and Immunological Studies (if ordered) The remainder is placed in a plain tube (red top tube containing no additives). A minimum of 3.0 ml is required for routine tests. Brucellosis Brucella species causes septicemic illness or localized infection of bone, tissue, or organ systems in humans. The isolation of Brucella is not difficult if the specimen is collected and handled properly. 1. Blood Use aseptic technique as for blood culture. Notify Microbiology that the culture is for Brucellosis; an extended period of incubation is needed. 2. Urine ml catheterized urine. 3. CSF 1-2 ml CSF, obtained by physician. 4. Tissue 1 gm of tissue, obtained by physician. 5. Body Fluid 5 10 ml of body fluid, obtained by physician. 6. Serology Acute and convalescent serum samples should be obtained from the patient to establish any changes in titer against Brucella antigens. 7. Blood Draw aseptically, as outlined in the Blood culture procedure. 8. Body Fluids 5-10 ml body fluid. 9. Tissue gm tissue.

5 Catheter Tip When colonization of an indwelling catheter is suspected of being the focus for septicemia, the catheter tip may be cultured to determine its status. Note: Urinary catheter tip is NOT a suitable specimen for culture. 1. Disinfect the skin around the catheter with an iodine preparation. Remove the catheter aseptically. 2. With a pair of Sterile scissors cut off a 2-inch segment of the catheter, including the area directly beneath the skin. 3. Cut the piece directly into a sterile, dry container. A sterile urine container may be used. 4. Label with the patient s name, medical record number, date and time of collection. 5. Identify the source of the specimen including where the catheter tip was removed. 6. Send specimen immediately to the Laboratory. Cerebrospinal Fluid (CSF) Acute bacterial meningitis is an infection of the meninges, which can be caused by a variety of microorganisms. Submit immediately to the Laboratory. Specimen Collection 1. Prepare patient for aseptic procedure. 2. Perform lumbar puncture under strict aseptic conditions. 3. Collect specimen in sterile screw cap tubes. These tubes are usually in a set of three or four labeled as such. Collection is to be done in this numbered sequence. 4. Label the tubes with complete patient name, date of birth or medical record number, date and time of collection. 5. Distribute collected fluid as follows: Chlamydia & Gonorrhea Tube 1: Chemical and immunologic studies A minimum volume of 0.5 ml is required for routine tests of protein and glucose determination. An additional 1.0 ml is required for protein electrophoresis, immunoglobulin, quantitation and/or other serological tests. Tube 2: Microbiologic examination 1-2 ml is generally adequate for routine culture. Additional minimum volume of 1.0 ml should be obtained for mycobacterial and/or fungal culture. Tube 3: Cell Counts 1.0 ml is required for cell count and differential. Cell counts are performed immediately (within 30 minutes after collection) along with differential counts performed on stained smear and reported in percentage. Cell counts will not be performed on clotted specimens however a differential count will be performed if possible. Due to the intracellular nature of Chlamydia, a direct culture of specimen is not performed. Acceptable specimens include endocervical/vaginal swabs and urine. Testing for Chlamydia is performed using PCR.

6 Endocervix 1. Remove excess mucus from the cervical and surrounding mucosa using the large individually wrapped cleaning swab B. Discard the swab. 2. Open package A that contains the pink-capped Xpert Swab Transport Reagent tube and individually wrapped collection swab. Set the tube aside before beginning to collect sample. Open the collection swab wrapper by peeling open the top of the wrapper. 3. Hold the swab in your hand, placing your thumb and forefinger in the middle of the swab shaft. 4. Insert the collection swab into the endocervical canal. Rotate the swab clockwise for seconds in the endocervical canal. Withdraw the swab carefully. 5. Unscrew the cap from the transport tube. Immediately place the specimen collection swab into the transport reagent tube. 6. Identifying the score line, break the swab shaft against the side of the tube. Discard the top portion of the swab shaft. 7. Re-cap the swab transport reagent tube and tighten the cap securely. Label the transport tube with the sample identification information, including date of the collection, as required. Patient-Collected Vaginal Swab 1. Open the individual collection package A that contains the pink-capped Xpert Swab Transport Reagent tube and individually wrapped collection swab. Set the tube aside before beginning to collect sample. Discard the larger swab B. 2. Open the collection swab wrapper by peeling open the top of the wrapper. Remove the swab, taking care not to touch the tip or lay it down. 3. Hold the swab in your hand, placing your thumb and forefinger in the middle of the swab shaft across the score line. 4. Carefully insert the swab into your vagina about two inches inside the opening of the vagina. 5. Gently rotate the swab for seconds. Ensure the swab touches the walls of the vagina so that moisture is absorbed by the swab. Withdraw the swab and continue to hold it in your hand. 6. Unscrew the cap from the transport tube. Immediately place the collection swab into the transport tube. 7. Identifying the score line, break the swab shaft against the side of the tube. Discard the top portion of the swab shaft. Avoid splashing contents on the skin. Wash with soap and water if exposed. 8. Re-cap the transport tube and tighten the cap securely. Label the tube with name and date of birth. Return the tube as instructed by your doctor, nurse, or careprovider. First Catch Urine 1. Direct patient to provide first-catch urine (20-50 ml) into a urine collection cup. Note: The patient should not have urinated for at least 1 hour prior. Patient should not cleanse the genital area prior to collection.

7 2. Open the package of disposable transfer pipette provided in the kit. 3. Remove the yellow cap from the transport tube. 4. Transfer approximately 7 ml of urine into the transport tube, using the disposable transfer pipette, the correct volume is marked by the black dashed line on the label. 5. Replace the yellow cap on the transport tube and tighten securely. 6. Invert the transport tube 3-4 times to ensure that the specimen and reagent are well mixed. Clostridium difficile toxin Clostridium difficile can be isolated from feces of healthy individuals and some individuals with diarrhea, but no pseudomembranous lesions in the colon are present. Laboratory confirmation of C. difficile toxin in a patient with clinical evidence of pseudomembranous colitis who has a history of antibiotic use is based on demonstrating toxin in feces of the patient by PCR. This method detects general C. difficile as well as the epidemic strain 027-NAP1-B1. Repeat stool C. difficile assays are not accepted following treatment. Up to 50% of patients will have positive stool assays for as long as six weeks after the completion of therapy. DNA may persist after eradication of the organism; therefore, this test is not acceptable for clearing patients who have had a positive test. Diphtheria 1. Collect unformed stool in a sterile cup. Specimen must be soft enough to take the shape of the container. 2. Label the cup with the patient name, date of birth, medical record number, and date and time of collection. 3. Deliver to laboratory in a sealed biohazard bag. 4. Specimens are stable 24 hours at room temperature or 5 days at 2-8 C and can be frozen for extended periods of time. Contact Butte County Public Health for specimen collection and submission guidelines. Ear Culture Streptococcus pneumoniae, Haemophililus influenzae and Streptococcus pyogenes are the most common etiologic agents of acute otitis media. However, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa have also been isolated. Acceptable specimen sources include fluid obtained by tympanocentesis and scrapings from external ear. 1. Cleanse the external ear to free the skin of contaminating bacterial flora. 2. Collect specimen using aseptic technique with sterile calcium alginate or polyester swab. A physician usually collects material from the middle or inner ear. 3. Place swab in sterile transport container and label with patient name, date of birth, medical record number, and date and time of collection and send to laboratory within 48 hours.

8 Eye Culture Because of the constant washing activity of tears and their antibacterial constituents, the number of organisms recovered from cultures of many eye infections may be relatively low. Acceptable specimen sources include conjunctiva, cornea, and eyelid margin, aqueous or vitreous fluid. Specify right or left eye. The surrounding skin should be thoroughly cleansed before obtaining the specimen. 1. Preferably, one should request the appropriate media for eye culture and place the specimen on one side of the medium plate. 2. The material is collected with a sterile cotton or calcium alginate swab, or surgical instrument from the lower conjunctival sac and inner canthus of the eye. 3. Specimens for chlamydia culture should be transferred directly to Universal Transport Media (UTM). Calcium alginate swabs are unacceptable for chlamydia culture. 4. Submit specimen to lab within one hour of collection. Note: In patients with conjunctivitis and with keratitis, there are special problems in specimen collection and processing. The problems are the small sample size, and the antimicrobial activity of the topical anesthetics. Therefore, obtain specimen for culture before the application of topical anesthetics. Genital Appropriate specimen sites include cervical, vaginal, penile, or prostate. Bacterial Culture Swab infected area and place swab in aerobic culture transport system. Send immediately to Laboratory. Must be received the same day of collection. Herpes Culture Place swab in universal transport media available from the laboratory. Send immediately to Laboratory. Chlamydia and/or GC by DNA Probe See Chlamydia & Gonorrhea Haemophilus ducreyi (Chancroid) Chancroid is a soft chancre of the genitalia of venereal origin, caused by Haemophilus ducreyi. 1. Wear gloves at all times. 2. Expose the chancroid lesion (usually ragged, necrotic, painful and often found in pairs). Cleanse the area around the lesion with a sterile gauze pad moistened with sterile saline. Use several gauze pads, if necessary.

9 3. Rub the base of the lesion vigorously with a small cotton or Dacron tipped swab. 4. Place swab in Stuart s transport medium (available from laboratory). 5. Use a second swab to collect some more lesion material. Make a smear for Gram stain. 6. Label container and send immediately to the Laboratory. Group B Strep Group B Strep screens are only for prenatal testing. Routine Culture: 1. Collect using Culturette transport swabs. 2. Wipe away excessive amounts of discharge or secretions from vaginal and perirectal region. 3. Carefully insert swab into the vagina and sample the mucosa of the lower one-third part of the vagina. 4. Using the same swabs, carefully insert approximately 2.5 cm beyond anal sphincter and gently rotate to sample the anal crypts. 5. After collection, label swab container with required patient information and date and time of collection. 6. Submit to the lab as soon as possible, within 72 hours. Rapid Testing by PCR 1. Collect using Copan Venturi Transystem swabs. 2. Follow routine culture collection instructions. 3. Submit to the lab as soon as possible. 4. If sample cannot be transported within 24 hours, refrigerate up to 6 days. Nasopharyngeal & Throat Throat and nasopharyngeal cultures are important as an aid in the diagnosis of streptococcal, diphtheria and candida infection. Patient Preparation: 1. Make certain there is no food material in the mouth. 2. Have patient rinse mouth with sterile water. 3. Ask the patient to sit back on a steady chair, and lean the back of the head against a wall for support. 4. Ask the patient to open the mouth wide and say ah. Throat 1. Use the Culturette system for collection of the specimen and transport. 2. With the patient s tongue depressed and the throat well exposed and illuminated, rub the swab firmly over the back of the throat (the posterior pharynx), both tonsils or

10 tonsillar crypts, and any areas of inflammation, exudation or ulceration. Avoid touching the tongue, cheeks, or lips with the swab. 3. Replace the swab in the tube, push the swab down until it comes in contact with the cotton pledget. 4. Label the specimen with complete patient name, date of birth, medical record number, and date and time of collection. Send the specimen immediately to the Laboratory. Nasopharyngeal Swab 1. Use a sterile rayon-tipped wire applicator to collect the specimen. 2. Insert gently the wire swab (without force) through the nose to the posterior nasopharynx where it is rotated gently and then allowed to remain for 20 to 30 seconds and withdrawn. 3. Place the specimen in transport system. Label the specimen with that patient s name, ID number, date and time of collection. 4. Send immediately to the Laboratory. Nasopharyngeal for RSV 1. Use the sterile rayon-tipped wire applicator provided in the RSV kits. These can be obtained from the laboratory. 2. Gently insert the wire swab through the nose to the posterior nasopharynx where it is rotated gently and withdrawn. 3. Place the specimen in the provided conical tube containing sterile saline. Make sure the swab is pushed all the way down into the saline and that the tube can be capped tightly. 4. Label the specimen with the patient s name, date of birth, medical record number, and date and time of collection. Place in provided biohazard bag and send immediately to laboratory. Nasopharyngeal for MRSA Screen 1. A Copan Venturi Transport double-swab must be used to collect the specimen. This is a special scored swab specific to the rapid PCR test, not to be confused with Culturette swabs. 2. Insert the dry swabs 1-2 cm into the nostril and rotate swabs against the inside of the nostril for 3 seconds while applying pressure with a finger to the outside of the nose. 3. Repeat step 2 in second nostril with the same swab. 4. Place the swabs back into the tube. 5. Specimens that can be tested within 24 hours can be kept at room temperature. If not, it is recommended that they be refrigerated. Specimens stored at 2-8 C are stable for up to 5 days. Nasopharyngeal for Flu 1. Use the swab and transport vial provided in the flu collection kit (available from Laboratory). 2. Follow the instructions outlined under Nasopharyngeal Swab

11 Nasopharyngeal Aspirates 1. Attach mucus trap to suction outlet and catheter, leaving wrapper on suction catheter; turn on suction and adjust to suggested pressure. 2. Without applying suction, insert catheter into the nose, directed posteriorly and toward the opening of the external ear. NOTE: Depth of insertion necessary to reach posterior pharynx is equivalent to distance between anterior naris and external opening of the ear. 3. Apply suction. Using a rotating movement, slowly withdraw catheter. NOTE: catheter should remain in nasopharynx for a minimal period of time, not to exceed 10 seconds. 4. Hold trap upright to prevent secretions from going into pump. 5. Rinse catheter (if necessary) with approximately 2 ml viral transport media; disconnect suction; connect tubing to arm of mucus trap to seal. 6. Repeating procedure for the second nostril will deliver optimal combined sample. 7. After collection, immediately transport specimen to the laboratory. Nasopharyngeal Wash Bulb Method 1. Suction 3-5 ml saline into a new sterile bulb. 2. Insert bulb into one nostril until nostril is occluded. 3. Instill saline into nostril with one squeeze of the bulb and immediately release bulb to collect recoverable nasal specimen. 4. Empty bulb into sterile specimen container. 5. Repeating procedure for the second nostril will deliver optimal combined sample. 6. After collection, immediately transport specimen to the laboratory. Syringe Method 1. Fill syringe with saline; attach tubing to syringe tip. 2. Quickly instill saline into nostril. 3. Aspirate the recoverable nasopharyngeal specimen. Recovery must occur immediately, as the instilled fluid will rapidly drain. 4. Alternatively, in appropriate cases, patients may tilt head forward to allow specimen to drain into sterile container. 5. If aspirated, inject aspirated specimen from syringe into sterile specimen container. 6. After collection, immediately transport specimen to the laboratory. Pertussis (Performed at ARUP Laboratory) Bordetella pertussis Culture: 1. Collect a respiratory aspirate, washing, or nasopharyngeal swab. Sputum is unacceptable for culture, see PCR. 2. Transfer fluid specimens (Min: 0.5 ml) into sterile container. 3. Place swab in Regan-Lowe transport media and incubate for hours at 35 C. 4. Also acceptable: swab in Jones Kendrick media, Amies with charcoal media, or swabs in described media sent directly without incubation. 5. Label with patient s name, date and time of collection.

12 6. Send specimen immediately to the Laboratory. If specimen cannot be immediately sent, refrigerate specimen until transport is available (up to 48 hours). Bordetella pertussis by PCR Pinworm 1. Collect a respiratory specimen: Aspirate, bronchoalveolar lavage, swab, or sputum. 2. Transfer 2 ml (min: 0.5 ml) respiratory specimen to sterile container. Also acceptable: transfer to universal transport media (UTM). 3. Place nasopharyngeal swabs in universal transport media. Calcium alginate swabs are unacceptable for pertussis testing. 1. Wear gloves during collection as pinworm eggs are usually infectious and can be airborne. 2. Collect specimen in the morning before bathing or using the toilet. 3. Use one inch piece of clear cellulose (Scotch) tape to collect sample. 4. Separate buttocks, then press the sticky side of tape firmly to the perianal folds on each side of the anus. 5. After collection, affix sticky side of tape as smoothly as possible onto microscope slide. 6. Submit tape/slide in urine cup to lab with required patient information and collection date and time. RSV (See Nasopharyngeal) Sputum Bacterial pneumonia, pulmonary tuberculosis and chronic bronchitis constitute one of the most important groups of human diseases. Since specific treatment depends on a bacteriologic diagnosis, prompt and accurate examination of properly collected sputum by smear, culture and antimicrobial susceptibility testing are important. Recovery of an etiologic agent from sputum or other appropriate specimen depends not only on the laboratory methods used but also on the care taken in securing the specimen. 1. Assure patient cooperation to get an adequate specimen. The laboratory will determine numbers of squamous epithelial cells present to determine specimen adequacy. 2. Instruct the patient to rinse mouth with sterile water to remove food particles and debris. 3. Have patient breathe deep and cough several times to receive deep specimen. 4. Patient should expectorate into a dry, sterile container without holding sputum in mouth. 5. If patient is unable to produce sputum, induce using saline nebulization. Consult respiratory therapy for assistance. 6. Transport specimens to the laboratory within 1 hour of collection.

13 Stool Proper collection and preservation of feces are frequently neglected but are important requirements for isolation of microorganisms contributing to intestinal diseases. Specimens must be delivered promptly to the laboratory for microorganisms to remain viable. Keep specimens at room temperature. Rectal Swab (usually for children) 1. Using a sterile swab, pass beyond the anal sphincter, carefully rotate the swab and withdraw. 2. Place the swab in transport system. 3. Label the specimen with patient s name, medical record number, date of birth, and date and time of collection. 4. Place the swab in a biohazard bag and transport to laboratory immediately. Fresh Stool 1. Collect stool in a clean, dry bedpan, or suitable wide mouth container without contamination from urine or toilet water. 2. Choose portions of the stool that display either mucus or blood, if present. 3. Place specimen in a clean, dry plastic container. Replace the lid completely. 4. If specimen cannot be transported to laboratory within one hour, place specimen in Para-Pak C&S container (orange cap) to fill to here line. Transport to the laboratory within 72 hours. 5. Label the container with patient s name, medical record number, date of birth, and date and time of collection. 6. Place specimen in biohazard bag and transport to laboratory immediately. Ova and Parasites Note: Ova and Parasite examination and Trichrome stain are not routinely performed without patient history documenting recent travel to endemic locations. Routine examination is for Cryptosporidium and Giardia only. 1. Collect stool in a clean, dry bedpan, or suitable wide mouth container without contamination from urine or toilet water. 2. Place specimen in Proto-Fix container for ova and parasites (white cap) to fill to this line. 3. Label the container with patient s name, medical record number, date of birth, and date and time of collection. 4. Place specimen in biohazard bag and transport to laboratory immediately. Strep A Screen (See Nasopharyngeal) Throat (See Nasopharyngeal)

14 Tissue (See Abscess) For anaerobic culture, be sure to inoculate into glass/gel anaerobic transport media. Urine Urine must be obtained properly and transported and processed as soon as possible. No more than ONE hour should lapse between the time the specimen is obtained and testing. If this time schedule cannot be followed, the urine MUST BE TRANSFERRED TO A TIGER (RED/YELLOW) TOP URINE TUBE AND A GREY TOP CULTURE TUBE CONTAINING APPROPRIATE PRESERVATIVE. These tube sets and transfer devices can be obtained from the laboratory. Preserved specimens are stable up to 48 hours. Midstream Clean Catch: 1. Give the patient several packages of towelettes and a sterile cup. 2. Ask the patient to open the towelette packages and cup. Lay them on the edge of the sink so they can be reached while on the toilet. Female Patient: 1. Remove underwear so that they will not interfere with urine collection. 2. Ask the patient to sit backwards on the toilet so that the legs are apart. 3. With two fingers of one hand, hold the outer folds of the vagina apart. With the other hand, gently wash the vaginal area from FRONT to BACK with the towelettes. Discard the used towelettes in the wastebasket. 4. Still holding the outer vaginal skin away from the opening through which one urinates, wash the area with additional towelettes. 5. Continue holding the outer vaginal folds apart; begin to urinate into the toilet. Lean slightly forward so that the urine flows directly down without running along the skin. 6. After voiding the first 10-mL into the toilet, place the sterile cup under the stream of urine, and collect ml of urine in the container. Void the rest of the urine stream into the toilet. 7. After finishing, tighten the cap on the container securely, wipe off any spilled urine on the outside of the cup. Wash hands. Make certain to label the container with the patient s name, medical record number, date of birth, and date and time of collection. Male Patient: 1. Holding back the foreskin with one hand, wash the end of the penis with the towelettes. Discard used towelettes into the wastebasket. 2. Continue holding back the foreskin and begin to urinate into the toilet. After voiding 10 ml into the toilet, place the sterile cup under the stream of urine and collect the next 25 to 30 ml of urine. Pass the rest of the urine into the toilet. 3. After finishing, tighten the cap; wipe off any spilled urine on the outside of the container. Wash hands. Label the container with patient's name, medical record number, date of birth, and date and time of collection.

15 Catheterized Urine 1. Discard the initial 1 to 2 ml of urine flow. Collect at least 1 ml in sterile cup for bacterial culture. 2. Label container with patient s name, medical record number, date of birth, and date and time of collection. Urostomy or Bagged Urine 1. Replace with a new bag, just before collection. 2. Collect 1 to 2 ml of urine for bacterial culture. 3. Transfer aseptically to a sterile cup or urine preservative tube (grey top). 4. Label with patient's name, medical record number, date of birth, and date and time of collection and send the cup to the laboratory immediately. Preserved urine is stable up to 48 hours. Foley Urine 1. Cleanse the tubing near the port with 70% alcohol. 2. Insert a 20-gauge needle upward, against the flow, collect 1 to 2 ml of urine, and transfer to a sterile cup. 3. Label with patient s name, medical record number, date of birth, and date and time of collection. Do NOT sample from bag. Note: If the catheter appears to be plugged or contaminated, place a new Foley catheter, then take a sample as above for culture. Vaginal (See Genital) VRE Screen Specimen Collection Urine 1. Collect into clean sterile container. 2. Transfer to grey top preservative tube used for urine culture. Rectal Swab or Stool (See Stool) Wound Distinguish between surface wounds and deep or surgical wounds. Refer to abscess for deep or surgical wounds. 1. Clean the sinus tract opening of the wound surface mechanically using sterile saline, without using a germicidal agent, to remove as much of the superficial flora as possible.

16 2. Attempt collection from the base or edges of the wound to avoid collecting normal flora organisms using a wound culture swab. 3. Place the swab into the transport tube, pushing down until tip is pressed against the sponge at the bottom. 4. Label with patient s name, medical record number, date of birth, and date of time of collection and transport preferably within 2 hours (up to 48 hours) at room temperature.