Microbiology Specimen Collection Instructions. Table I Culture and Sensitivities/TB

Transcription

1 Specimen Page 1 of 10 Source / Type of Specimen Culture and Sensitivities () Abscess aspirate, wound aspirate in sterile screw cap or swab in charcoal. Obtain anaerobic swab from lab. Pilonidal and perirectal abscesses are unsuitable for culture. Note: Open wounds and ulcers frequently become contaminated with skin, mucosal or airborne micro-organisms and the use of a swab to collect material from these sites is of limited value. A sterile needle and syringe should be used to collect pus or liquid from the lesion. If a swab is used, collect pus from deep in the lesion and avoid contact with the surrounding skin. Acinetobacter Screening Misc. swab AFB Stain only Misc. specimen Varies according to Culture should accompany slide. specimen Anal swabs Not recommended for enteric pathogen testing. Submit faeces. If faeces cannot be obtained a swab will be accepted. Indicate unable to obtain faeces on lab requisition. For rectal lesions refer to wound. Indicate organism queried on lab requisition. Antral lavages/ aspirates sterile screw cap Ascites Fluid Bile Sterility testing Biological Indicators Steam/Gas Label as control or test. Refer to SCI [Para-Link] Biopsies Indicate special requests eg. Legionella for lung tissues See also gastric biopsy for Helicobacter pylori. TB, AFB, MAI Biopsies

2 Specimen Page 2 of 10 Source / Type of Specimen Blood Culture Adult including yeast Refer to the Sunnybrook Patient Care Manual, Procedures: Patient Care, Blood Culture - Adult VI-B Blood BACTEC plus Aerobic/F and BACTEC plus Anaerobic/F 8-10 ml of blood per bottle. It is recommended that two sets (aerobic and anaerobic bottles) be taken. Indicate any special requests; e.g. subacute bacterial endocarditis, brucellosis etc. Do not refrigerate. Deliver A.S.A.P. to the lab. At Sunnybrook Campus a 35 C incubator is situated in lab vestibule for storage of cultures after hours. Blood culture Infant including yeast Blood BACTEC PEDS Plus/F Blood collection system recommended for post-partum infants in the WNIC. For isolation of aerobic micro-organisms associated with paediatric sepsis in infants in the immediate post-partum period. If M. furfur suspected, please indicate ml blood required. Do not refrigerate. Deliver A.S.A.P. to the lab. Blood isolator Infant Blood WAMPOLE ISOLATOR 1.5 Blood collection system recommended for infants greater than 24 hours old in the WNIC. For isolation of aerobic and anaerobic microorganisms associated with paediatric sepsis. 1.5 ml blood is optimum for culture. Do not refrigerate. Deliver to lab immediately. Women s College Campus: Isolators are processed by Core lab between 2100h -0800h.

3 Specimen Page 3 of 10 Source / Type of Specimen Blood culture for TB, AFB, MAI Blood Liquoid (SPS) Liquoid tubes available from lab. 5 ml blood required. Deliver A.S.A.P. to the lab. Bone TB, AFB, MAI Bone Bone marrow Liquoid (SPS) TB, AFB, MAI Bone marrow Liquoid (SPS) Breast milk Liquoid tubes available from lab. Deliver A.S.A.P. to the lab. Liquoid tubes available from lab. Deliver A.S.A.P. to the lab. Indicate plain breast milk or supplemented with fortifier. Catheter tips: Vascular cannulae, C.V.P. lines, I.V. catheters Submit IV tip when bacteremia is suspected. Aseptically detach external components. Submit only the tip in sterile. The following tips are not suitable for culture: foley catheter, peritoneal dialysis, chest tube drain, abdominal drain, ventriculostomy. CSF, LP, ventriculostomy ommaya fluid tube 1 ml per tube; Send first tube to Biochemistry, second tube to, third tube to Haematology; if only one tube is obtained, send to ; will divide samples as required. Keep at room temperature. TB, AFB, MAI CSF tube CJD CSF tube minimum 1 ml, 3 ml recommended minimum 2-3 ml

4 Specimen Page 4 of 10 PCR for Streptococcus pneumoniae and Neisseria meningitidis Source / Type of Specimen CSF Sterile screw-cap tube Minimum volume is 0.2 ml. Request must be approved by Medical Microbiologist. Cervical swab for Neisseria gonorrhoeae Swab in charcoal Corneal scrapings Corneal scraping collection kit. Kit is supplied by lab. Contact lab tel: 4242 for specimen pick-up. Refer to SCI [Para-Link] for the procedure. Dialysate fluid sterile screw cap Drainage sterile screw cap Ileostomy and colostomy specimens are unsuitable for culture. Ear swab Swab in charcoal Exit site swab Swab in charcoal. Eye swabs Swab in charcoal Indicate if gonococcal infection is suspected Faeces Refer to SCI [Para-Link] Enteric Pathogen Transport media Routine stools for are cultured to exclude the presence of Salmonella, Shigella, Yersinia, Campylobacter and E. coli 0157 species. Refer to SCI [Para-Link] Specimens collected from patients who have been hospitalized for >4 days rarely yield useful information. In this clinical setting, patients with diarrhea are much more likely to have C. difficile infection. Clostridium difficile toxin Faeces Only loose and watery specimens are accepted for C. difficile toxin test.

5 Specimen Page 5 of 10 Source / Type of Specimen TB, AFB MAI Faeces Vibrio Culture Faeces Enteric Pathogen Transport media Fluids Sterile (peritoneal, pleural, thorancentesis) Vacuum bottle or aliquot in sterile dry. DO NOT submit fluids in BACTEC blood culture bottles When collecting pleural fluids into vacuum bottles, heparin must be added to the collection bottle before collection of the fluid. Three units of heparin per ml of body fluid is optimal. If a large volume of fluid is anticipated (1000 ml) add 1 ml heparin. If 500 ml or less is expected, inject 0.5mL heparin into the vacuum bottle. Peritoneal fluids may be handled as for pleural fluids. TB, AFB, MAI Fluids Sterile (peritoneal, pleural, thorancentesis > 10 ml H. pylori Gastric biopsy Sterile screw-cap with small amount of sterile saline or glucose solution For detection of Helicobacter pylori send specimen to lab within one hour of collection of specimen. Chancroid Haemophilus ducreyi Genital ulcer or lesion Swab of chancre/ bubo pus in charcoal. Syphilis Treponema pallidum Genital lesion Serous exudates from primary lesion or secondary lesions. Obtain kit from lab.

6 Specimen Page 6 of 10 Source / Type of Specimen Implantable devices: artificial grafts, implant screws from O.R. (internal), prosthetic heart valve Incision swab Swab in charcoal. Intrauterine device sterile screw cap Miscellaneous swab Swab in charcoal Gram Stain only Mouth swab Swab in charcoal Indicate site of collection Routine examination is a Gram smear; indicate any special requests; eg. thrush, trench mouth MRSA or Staphylococcus aureus Screening Nasal swab Swab in charcoal Taken only for MRSA or S. aureus screening. Whooping cough Bordetella pertussis Nasopharyngeal swab Bordetella pertussis kit. Obtain kit from microbiology. Neonate Endotracheal aspirates E.T. tube or aspirate in sterile screw cap Including yeast Mycoplasma and Ureaplasma urealyticum Neonate Endotracheal aspirates E.T. tube or aspirate in sterile screw cap Serratia Screening Neonate Endotracheal aspirates E.T. tube or aspirate in sterile screw cap

7 Specimen Page 7 of 10 Source / Type of Specimen Rectal swabs Not recommended for enteric pathogen testing. Submit faeces. If faeces cannot be obtained a swab will be accepted. Indicate unable to obtain faeces on lab requisition. For rectal lesions refer to wound or genital tables. Indicate organism queried on lab requisition. ESBL Screening Rectal/wound swab Swab in charcoal Taken for ESBL producing organisms. Sputum/urine Sterile screw cap VRE Screening Rectal swab Faeces Swab in charcoal Sterile screw cap Rectal swab must be faecally stained. Sigmoid aspirate Refer to SCI [Para-Link] Enteric Pathogen Transport media Cultured to exclude the presence of Salmonella, Shigella, Yersinia, Campylobacter and E. coli 0157 species. Refer to SCI [Para-Link] Specimens collected from patients who have been hospitalized for >4 days rarely yield useful information. In this clinical setting, patients with diarrhea are much more likely to have C. difficile infection. TB, AFB, MAI Sigmoid aspirate Clostridium difficile toxin Sigmoid aspirate Only fluid and unformed specimens are accepted for C. difficile toxin test.

8 Specimen Page 8 of 10 Source / Type of Specimen Vibrio Culture Sigmoid aspirate Enteric Pathogen Transport media Sputa, endotracheal aspirates, bronchial washings, B.A.L. Refer to MIC [Para-Link] or sputum trap Collect specimen resulting from deep cough; sputum contaminated with saliva will be rejected TB, AFB, MAI Sputa, endotracheal aspirates, bronchial washings, B.A.L. Refer to MIC [Para-Link] Collect three early morning sputum specimens resulting from deep cough or sputum induction. Do not pool specimens. Legionella Sputa, endotracheal aspirates, bronchial washings, B.A.L. Refer to MIC [Para-Link] Mycoplasma pneumoniae Sputa, endotracheal aspirates, bronchial washings, B.A.L. Refer to MIC [Para-Link] M4 kit M4 kit obtained in. Important: On requisition indicate source/type of specimen, date of onset, clinical diagnosis and antimicrobials administered before collection of specimen. Synovial / joint fluids sterile dry Collect synovial fluid for bacterial culture in a sterile dry. Indicate any special requests eg. gonococcal arthritis. If gonococcal arthritis is suspected, it is recommended that blood cultures be taken. DO NOT submit fluids in BACTEC blood culture bottles TB, AFB, MAI Synovial / joint fluids sterile dry

9 Specimen Page 9 of 10 Source / Type of Specimen Tissue Indicate special requests eg. Legionella for lung tissues. TB, AFB, MAI Tissue Throat swabs swab in charcoal Indicate any special requests; eg. gonorrhoeae or diphtheria. Trichomonas Urethral swab (male) Vaginal swab Swab collected in Diamond s Media. Obtain Trichomonas from microbiology lab. Deliver to lab A.S.A.P. Do not refrigerate. Urethral swab (male) Vaginal swab swab in charcoal Indicate any special requests; eg. Gonorrhoeae, yeast Urine, Urine Cystoscopy sterile dry Refer to SCI [Para-Link] Including yeast Legionella Antigen Urine, Urine Cystoscopy sterile dry TB, AFB, MAI Urine, Urine Cystoscopy sterile dry Bacterial vaginosis/yeast Vaginal smear Slide holder Obtain slides and slide holders from microbiology lab. Culture for yeast will only be performed on a vaginal swab if recurrent infection or treatment failure is indicated. Grp B strep Screen Vaginal / Introital / Rectal swabs Swab collected in Amies media or charcoal. Cervical swabs are not appropriate for Grp B Strep screening. Toxic shock syndrome or Staphylococcus aureus Vaginal swab Swab in charcoal Indicate request on requisition. eg. toxic shock syndrome Vitreous fluids sterile dry

10 Specimen Page 10 of 10 Source / Type of Specimen Wound Swab in charcoal media. Obtain anaerobic swab from lab. Note: Open wounds and ulcers frequently become contaminated with skin, mucosal or airborne micro-organisms and the use of a swab to collect material from these sites is of limited value. A sterile needle and syringe should be used to collect pus or liquid from the lesion. If a swab is used, collect pus from deep in the lesion and avoid contact with the surrounding skin