Clostridium difficile Specimen Collection

Transcription

1 Clostridium difficile Specimen Collection Collect stool specimens into a clean, airtight container with no preservative. All stool specimens should be tested as soon as possible. Ideally, stool specimens should be tested within 24 hours but specimens may be held at 2-8 ºC for up to 72 hours prior to testing.

2 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.

3 OVA AND PARASITE SPECIMEN COLLECTION with PARA-PAK ULTRA SYSTEMS 1. The patient should be cautioned against the use of antacids, barium, bismuth, antidiarrheal medication, or oily laxatives prior to collection of the specimen. 2. To assure recovery of parasitic elements which are passed intermittently and in fluctuating numbers, three specimens spaced a few days apart must be examined. 3. The specimen is ideally passed into a bedpan but must not be contaminated with urine. Alternatively, plastic wrap may be placed in the toilet seat opening and the specimen passed into the bag. A thoroughly cleaned and dried milk carton cut so as to remove the upper two thirds of the carton may also be used. It will be easier to collect the specimen if the water supply to the toilet is shut off and water drained from the bowl. 4. An appropriate (i.e. bloody, slimy, watery) area of stool should be selected and sampled with the collection spoons provided in the caps of both the Formalin and ZN-PVA vial. Sufficient stool is added to each vial to bring the liquid level up to the Fill to Here line. This will result in approximately 5 ml of sample. To ensure ideal sampling of a formed stool, material should be removed from the sides, ends, and middle of the bolus. 5. Agitate each specimen with the spoon along the sides of the vial, tighten the cap and shake firmly to insure that the specimen is adequately mixed. When mixing is completed the specimen should appear homogeneous. 6. Label each vial appropriately. Return the vials to the ziplock bag, seal the bag. Specimen may be kept at room temperature.

4 STOOL CULTURE COLLECTION WITH CARY BLAIR MEDIUM 1. The patient should be cautioned against the use of antacids, barium, bismuth, antibiotics, anti malarial agents, anti-diarrheal medication, or oily laxatives prior to collection of the specimen. After administration of any of these compounds, specimen collection should be delayed for 5-10 days or at least two weeks. 2. Several specimens, collected intermittently over several days, should be examined to insure recovery of organisms. 3. Specimens must be collected properly to avoid contamination with urine or water. Specimens are best collected in a bed pan. A clean, dry container such as a milk carton may be used by removing the top and washing thoroughly. Another option is to place plastic wrap over the toilet seat. 4. An appropriate (i.e. bloody, slimy, watery) area of stool from the sides, ends, and middle of the stool should be selected and sampled using the collection spoon provided in the cap of the Cary Blair vial. Sufficient stool is added to the vial to bring the liquid level up to the Fill line. This will result in approximately 5 ml of sample. 5. Agitate the specimen with the spoon along the sides of the vial, tighten the cap and shake firmly to insure that the specimen is adequately mixed. When mixing is completed the specimen should appear homogeneous. 6. Label the vial appropriately. Specimen may be refrigerated or kept at room temperature.

5 Influenza A and B and other Respiratory Viral Antigen Detection Acceptable specimens include: Nasal Wash (Syringe Method) 1. Fill syringe with saline; attach tubing to syringe tip. 2. Quickly instill saline into nostril. 3. Aspirate the recoverable nasal specimen. Recovery must occur immediately, as the instilled fluid will drain rapidly. 4. (alternate) in appropriate cases, patients may tilt head forward to allow specimen to drain into suitable sterile container. 5. Inject aspirated specimen from syringe into suitable dry, sterile specimen container or one containing 6. Viral Transport Media. Nasal 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 the bulb to collect recoverable nasal secretion. Empty bulb into suitable dry, specimen container or one containing Viral Transport Media. Nasopharyngeal Swab Method 1. Insert swab into one nostril. 2. Press tip on the mucosal surface of the mid-inferior portion of the inferior turbinate, and rub the swab tip several times across the mucosal surface to loosen and collect cellular material. 3. Withdraw the swab; insert into container with Viral Transport Media. Break end of swab so top of vial can be screwed on securely. Vacuum-assisted Nasal Aspirate Method 1. Attach mucus trap to suction pump and 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 no longer than 10 seconds. 4. Hold trap upright to prevent secretions from going into pump. 5. Rinse catheter (if necessary) with approximately 3.0 ml Viral Transport Media; disconnect suction; connect tubing to arm of mucus trap to seal. Specimens should be refrigerated until transported to the lab.

6 MALE Collection of Mid Stream Urine Please Read Instructions Before Proceeding 1. Wash and dry hands thoroughly. 2. Remove lid from container and set lid upside down. Do not touch the inner surface of the lid. 3. Using the towelette provided. Wash the tip of the penis. 4. Discard the towelette in the waste basket Not in the toilet. 5. Pass a small amount of urine into the toilet then urinate into the container. 6. Be careful not to touch the opening of the container with any part of your body. 7. Replace the lid securely on the container. 8. Wash and dry hands thoroughly. 9. Return the container to the laboratory / phlebotomist. FEMALE Collection of Mid Stream Urine Please Read Instructions Before Proceeding 1. Wash and dry hands thoroughly 2. Remove lid from container and set lid upside down. Do not touch the inner surface of the lid. 3. Squatting over the toilet, separate the skin of the Vulva. 4. Using the towelette provided, Wash the area from front to back. Repeat three times 5. Continuing to hold the skin folds apart, Pass a small amount of urine into the toilet then urinate into the container 6. Be careful not to touch the opening of the container with any part of your body. 7. Replace the lid securely on the container. 8. Wash and dry hands thoroughly 9. Return the container to the laboratory / phlebotomist

7 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.