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Microbiology Specimen Collection

In-patient

GENERAL CONSIDERATIONS

All specimens must be properly marked with the following:

  • Patient name
  • Patient hospital number
  • Patient room number
  • Source of specimen
  • Date and time of collection

All requisitions must contain the following information

  • Patient name
  • Patient hospital number
  • Date of Birth
  • Patient room number
  • Name of ordering physician
  • Test or tests ordered
  • Source of specimen
  • Date and time of collection
  • Diagnosis
  • Acute: reason for submitting specimen for testing
  • Chronic: any outgoing, underlying condition that may predispose the patient to infection (diabetes, rheumatoid arthritis, cancer, immune compromised, etc.)
  • Any antibiotics the patient is currently receiving

UNACCEPTABLE SPECIMENS include those that are

  • Leaky
  • Unlabeled
  • Mislabeled or a discrepancy between requisition form and specimen labels
  • Specimens sent in outdated collectors
  • Incorrect sample for the test ordered
  • Specimens delayed in transport to the lab, affecting results


The lab will notify the floor of all rejected specimens. Documentation of notification will be kept by the lab.  Specimens will be held and processed only at the request of the physician.

PNEUMATIC TUBE USAGE   

Most specimens for Microbiology can be sent to the lab via the Pneumatic Tube System. Those specimens that should NEVER be sent through the tube are

  • Biopsy specimens from surgery
  • Bone marrow
  • Any Body Fluid
  • CSF, if counts have also been ordered
  • Any specimen that could be considered irreplaceable
  • Any specimen too large to be properly wrapped and contained within the carrier

Out-patient

AFB CULTURE AND/OR DIRECT AFB STAIN

Serial specimens must be at least one day apart.

SPUTUM
Have patient rinse mouth and throat with fresh water, cough deeply and expectorate into Sputum Collector.  An early morning specimen is usually more productive.  5-10 cc of specimen is desired.

Label specimen and send to laboratory immediately.
If there is a delay in transport to the lab, specimen should be refrigerated.
Multiple specimens may be labeled with name, date and time, refrigerated and sent together.
Mark AFB Culture, Direct AFB Stain (if ordered) and appropriate source on requisition.

URINE
Collect CVMS or catheterized first morning specimen.   

Label specimen and send to laboratory immediately.
If there is a delay in transport to the lab, specimen should be refrigerated.
Mark AFB Culture, Direct AFB Stain (if ordered) and appropriate source on requisition.

BRONCHIAL WASHINGS / BAL / BRONCHIAL BRUSHES
Surgical procedure.

5 cc if possible, minimum 1 cc.
Label specimen and send to laboratory immediately
If there is a delay in transport to the lab, specimen should be refrigerated.
Mark AFB Culture, Direct AFB Stain (if ordered) and appropriate source on requisition.

CSF AND OTHER BODY FLUIDS
Obtain as for Routine Culture.  A minimum of 1 cc of specimen is required.

Label specimen and send to laboratory immediately.
Mark AFB Culture, Direct AFB Stain (if ordered) and appropriate source on requisition.


ANAEROBE CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

ABSCESS, WOUND AND BODY FLUID
Preferred Collection Technique
Decontaminate surface area with mild antiseptic. Aspirate specimen into a sterile syringe and immediately expel any air that may have been aspirated into the syringe with the specimen.  Remove the needle into a “sharps” container and cap the syringe with the syringe cap.  If all of the aspirated material remains in the needle (very minute amount), aspirate a small amount of sterile saline through needle to flush specimen into the syringe.  Discard the needle into a sharps container and cap the syringe with the syringe cap. Label specimen, mark Anaerobe Culture on requisition.  Send to laboratory immediately.
*NOTE: May also mark for aerobic culture (if ordered)
Optional Collection Technique
Decontaminate surface area with mild antiseptic. Carefully remove anaerobe collector from package.
Remove swab only from collector and obtain specimen with swab. Return swab to collector and push until ring of swab handle is flush with gray stopper.

TISSUE
Preferred Collection Technique
Decontaminate surface area with mild antiseptic.
Carefully remove anaerobe collector from package.
Remove swab only from collector, insert specimen into small glass tube inside the collector.
Return swab to collector and push until ring of swab handle is flush with gray stopper.
Label specimen & mark Anaerobe Culture on requisition.  Send to laboratory as soon as possible.
*NOTE: May also mark for Aerobic Culture (if ordered)
Optional Collection Technique
*Use ONLY when obtaining a specimen larger than the diameter of the small tube inside the anaerobic collector
Decontaminate surface area with mild antiseptic. If possible, obtain a cubic centimeter section of infected tissue. Place tissue in a sterile screw capped container containing a sterile piece of gauze dampened with sterile saline. Label specimen & mark Anaerobe Culture on requisition.  Send to laboratory immediately.
*NOTE: May also mark for Aerobic Culture (if ordered)


BAL(BRONCHIAL ALVEOLAR LAVAGE) CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Collected by physician.
This specimen is quantitative.
Label specimen as BAL and send to laboratory immediately.
Mark Aerobic Culture and Sensitivity and specific site (i.e.: right, left, upper, lower) on requisition.


BLOOD CULTURE (Includes Anaerobic & Aerobic)

Drawn by laboratory personnel or physician.  Special precautions must be taken when collecting for blood culture.

Prep for infants of 2 months of age or more or patients with NO KNOWN allergies to chlorhexidine gluconate or isopropyl alcohol
Scrub venipuncture site with ChloraPrep solution (chlorhexidine gluconate 2% w/v & isopropyl alcohol 70% v/v)
Allow to dry at least 1 minute. The intended venipuncture site should not be touched unless the finger used for palpation is also similarly disinfected.
Prep for infants of 2 months of age or more or patients with KNOWN allergies to chlorhexidine gluconate or isopropyl alcohol
Wipe the venipuncture site with alcohol swabs and then use providone iodine or 2% tincture of iodine. Allow to dry at least 1 minute. The intended venipuncture site should not be touched unless the finger used for palpation is also similarly disinfected.
Pediatric
Remove cap for peds Bactec bottle, disinfect stopper with 70% alcohol only. Use syringe or butterfly technique, add 1-3 ml blood to peds bottle. Mix gently. Label Bactec bottles with patient’s name, date, time, site( L hand, AC etc.) and “set” (1of 2, 2 of 2).
Keep at room temperature, and send to lab as soon as possible.
Mark Culture and Sensitivity and Blood on requisition.
Adult
Remove cap from aerobe and anaerobe Bactec bottles, disinfect stoppers with 70% alcohol only. Using syringe or butterfly technique, add 10 ml blood to anaerobe bottle and 10 ml blood to aerobic bottle. Mix gently.

*NOTE: As blood cultures always include both anaerobic and aerobic cultures, it is NOT necessary to order these separately.


BODY FLUID – BACTEC BOTTLES

A Gram stain is NOT included when specimen is sent in the Bactec bottles. If a gram stain is requested, submit a small amount of the original fluid.

Direct inoculation into alcohol sterilized Bactec Blood culture bottles is recommended for improved recovery of microorganisms.
Refer to Blood Culture procedure for specifics.
Label Bactec bottles with patient’s name, date, time.
Keep at room temperature, and send to lab as soon as possible.
Mark Body Fluid- Bactec Bottles Culture and Sensitivity and fluid type on requisition.


BODY FLUID CULTURE – (Other than Blood, CSF or Urine)

Gram stain result is routinely reported with this type of culture and does NOT require a separate order.

Decontaminate skin with an antiseptic.
Aspirate several cc’s of fluid into a syringe or other sterile container (CSF tubes).
If a very large volume of fluid is to be taken from patient, decontaminate tubing and use a needle and syringe to aspirate a portion for culture.  DO NOT send an entire bag or bottle of fluid for culture.  If needle and syringe are used, discard needle into sharps container and cap the syringe with syringe cap.  If all aspirated material remains in the needle (very minute amount, as from small joints), aspirate a small amount of sterile saline through needle to flush specimen into the syringe.  Discard needle into a “sharps” container and cap the syringe with the syringe cap.
Label and send to laboratory immediately.
Mark Aerobic Culture and Sensitivity and Body Fluid and fluid type on requisition.


BRONCHIAL WASHINGS CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Surgical procedure.
Minimum of 1 cc in a sterile container.
Label and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and specific site (right, left, upper, lower) Bronchial Washing on requisition.


CANDIDA SCREEN

Using culturette swab, collect specimen as for Aerobic Culture of particular site.
Label and send to laboratory as soon as possible.
Write Candida Screen under Other Test and mark appropriate source on requisition.


CATHETER TIP CULTURE

Decontaminate skin surface with mild antiseptic.
Remove catheter and aseptically sever 2-3 centimeters of tip into a sterile container.
Label container and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and Cath Tip on requisition.  Specify type of cath tip.


CERVIX/ENDOCERVIX CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Use sterile water or saline, not lubricant on speculum.
Wipe cervix clean of vaginal secretions and mucous.  Discard these into appropriate contaminated waste containers.
Insert swab into Endo-Cervical canal – Rotate twice briskly and allow swab to remain in canal a full 30 seconds.
Return swab to holder, label and send to laboratory *as soon as possible.
Mark Aerobic Culture and Sensitivity and Cervix.  A Routine Culture includes Neisseria Screen (Neisseria gonorrhoeae) so this test does not need to be marked too.
*NOTE: It is recommended by the Culturette manufacturer that cultures for Neisseria gonorrhoeae be planted within 8 hours of collection for optimal recovery.


CHLAMYDIA TRACHOMATIS/NEISSERIA GONORRHOEAE AMPLICOR

Endocervical Swab
Wear powder free gloves. Use the large sterile swab provided in the collection kit to remove any excess mucus, blood, or examination lubricants. Discard this swab.
Insert the second, large sterile swab into the endocervical canal. Rotate swab clockwise for 3-5 seconds and withdraw.
Insert swab into transport tube. Break shaft of swab and close securely. Leave swab in the transport tube media.
Label and date specimen.
Male Urethral Swab
Wear powder free gloves. Insert the small sterile swab provided in the collection kit 2-4 cm into the urethra. Rotate 3-5 seconds and withdraw.
Place swab into transport tube. Break shaft of swab and close securely. Leave swab in the transport tube.
Label and date specimen.
Male and Female Urine
*Patient should not urinate 2 hours prior to sampling.
Direct patient to collect the beginning of the urine stream: Begin urinating. Collect the first 10-50 mL of urine.
Close the lid of the urine cup securely.
Label and date specimen.


Specimen Transport and Storage: After collection, transport and store the swabs and urine at refrigerated temperature.


CLOSTRIDIUM DIFFICILE TOXINS A & B, EIA

Have patient pass stool specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap or disinfectants.  Transfer specimen to sterile, leak proof wide-mouth container.
Label and send to laboratory immediately.  Refrigerate if delay anticipated.
Mark Clostridium Difficile Toxin and Feces on requisition.


CRYPTOCOCCAL ANTIGEN

CSF
Physician collected in same manner as for cultures.  Minimum of 1cc required.
Serum
Collect in a non-SST tube (red-topped tube) and separate serum from RBC. Refrigerate serum.  Minimum of 1cc required.
Label and send to laboratory as soon as possible.
Mark Cryptococcal Antigen and appropriate source on requisition.


CRYPTOSPORIDIUM ANTIGEN

Collect stool before administration of antidiarrheal compounds, antibiotics, antacids, bismuth, barium or fiber containing stool enhancers.

Unpreserved Specimen
Have patient pass specimen into commode hat avoiding contamination with urine, residual soap or disinfectants. Transfer specimen to sterile, leak proof, wide-mouth container.
Label specimen and send to laboratory within one hour.
Mark Cryptosporidium Antigen and Feces on requisition.
Preserved Specimen
Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap, or disinfectants.
Mix a portion of the specimen into the 10% Formalin vial of Ova and Parasite collection kit, bringing the level of combined specimen and preservative up to the “fill” line.
Cap the vial tightly.  Mix well.
Label specimen with name, date, and time; check whether stool was formed, soft, or liquid.
Send to laboratory as soon as possible.
Mark Cryptosporidium Antigen and Feces on requisition.
Multiple Specimen
As parasites are not shed on an even, regular basis, a single specimen cannot be relied upon to reveal the presence of Cryptosporidia.  Therefore, three specimens should be collected over a period of several days (2-3 days between specimens).  In cases of acute diarrhea in a pediatric or geriatric patient, specimens may be collected one day apart.

*NOTE:  If a specimen for Ova & Parasites is also being submitted, a separate specimen for Cryptosporidium is not necessary.  Order both Cryptosporidium Antigen and O&P.


CSF CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Obtained by physician, in sterile, leak proof, screw-capped tubes. The skin in the area to be sampled is carefully disinfected.
Label the tubes and send to the laboratory immediately.
*The second tube drawn should generally be designated for culture
Mark Aerobic Culture and Sensitivity and Spinal Fluid (CSF) on requisition.
*NOTE: Specimens should NOT be refrigerated.  Anaerobic cultures are performed ONLY on those specimens that have a specific request for anaerobes.


EAR CULTURE

Gram stain result is routinely reported with this type of culture &does NOT require a separate order.

Internal
Cleanse external ear with mild antiseptic.  Take swab (culturette) of secretions.
Return swab to holder, label and send to laboratory as soon as possible.  If there are no secretions, the physician will need to aspirate fluid from behind the eardrum.
Mark Aerobic Culture and Sensitivity and Ear (Internal) on requisition.
External
Cleanse external ear canal with mild detergent.  Use culturette to swab infected site.
Return swab to holder, label and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and Ear (External) on requisition.

 

EYE/CONJUNCTIVA CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Cleanse area around eye with mild antiseptic.  With separate sterile swab, remove all matter from eye and discard in appropriate container for contaminated material. With culturette or mini-tip culturette, gently, but thoroughly, swab conjunctiva of lower eyelid avoiding border and eyelashes. Return swab to holder, label and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and Eye on requisition.
*NOTE: Physician may prefer to inoculate appropriate media directly.  Contact Microbiology to obtain media.  If direct inoculation is done, please include a smear on a slide or an extra culturette for gram stain.


FECAL LEUKOCYTES

Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap or disinfectants.  Transfer specimen to sterile, leak proof, wide-mouth container. Label and send to laboratory within one hour.
If there is a delay in transport, the specimen may be placed in a PVA vial of the Ova & Parasites transport vials.
Mark Fecal Leukocytes  (Fecal WBC’s) and Feces on requisition.


FUNGUS CULTURE

Respiratory Specimens (fungal cuture and fungal stain)
Collect sputum as for Aerobic Culture and Sensitivity.
Collect Bronchial Washings as for Aerobic Culture and Sensitivity.  Minimum amount 1 cc.
*NOTE: If Routine Culture and Sensitivity, AFB, Fungus & Cytology are ordered on sputum or bronchial washings, at least 3 cc of specimen are needed.
Skin, Hair, Nail Scrapings (fungal culture & KOH)
Decontaminate skin and nails with isopropyl alcohol before collection.
Put scrapings in sterile, dry container.
Mark Fungus Culture and appropriate source on requisition.
Other Source: Wounds, Body Fluids (fungal culture & fungal stain)
Collect with culturette or needle and syringe (preferred) with same technique used for Aerobic Culture and Sensitivity for the particular body site.
Label specimen and send to laboratory as soon as possible. (If syringe, do not send with needle attached)
Mark Fungus Culture and appropriate source on requisition.


GASTRIC ASPIRATE CULTURE (Routine Culture & Sensitivity)

Newborns only
Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Collect a minimum of 1 cc gastric contents in a sterile container.
Label and send to laboratory immediately.
Mark Aerobic Culture and Sensitivity and Gastric Aspirate on requisition.


GC SCREEN ONLY

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Women:  Obtain cervical (not vaginal), urethral, throat or rectal swab.
Men:  Obtain urethral, throat or rectal swab.

CERVIX/ENDOCERVIX
Use sterile water or saline, not lubricant on speculum.
Wipe cervix clean of vaginal secretions and mucous.
Insert swab (culturette) into Endo-Cervical canal – Rotate twice briskly and allow swab to remain in canal a full 30 seconds. Return swab to holder, label. Send the specimen to the laboratory as soon as possible.
Mark Neisseria (GC) Screen and Cervix on requisition.
*NOTE: It is recommended by the Culturette manufacturer that cultures for Neisseria gonorrhoeae be planted within 8 hours of collection for optimal recovery.
DO NOT REFRIGERATE CULTURETTE!
URETHRA
*Patient should not have voided within the past hour.
Wipe urethral opening clean with sterile gauze or pad.
Obtain minitip swab of urethral secretions or discharge.
Return swab to holder, label.
Mark Neisseria (GC) Screen and Urethra on requisition.
Send the specimen to the laboratory *as soon as possible.
*NOTE: It is recommended by the Culturette manufacturer that cultures for Neisseria gonorrhoeae be planted within 8 hours of collection for optimal recovery.
DO NOT REFRIGERATE CULTURETTE!
THROAT
Swab back of throat and tonsils with culturette swab avoiding tongue and uvula.
Return swab to holder, label.
Mark Neisseria (GC) Screen and Throat on requisition.
Send the specimen to the laboratory *as soon as possible.
*NOTE: It is recommended by the Culturette manufacturer that cultures for Neisseria gonorrhoeae be planted within 8 hours of collection for optimal recovery.
DO NOT REFRIGERATE CULTURETTE! 


GIARDIA ANTIGEN

Collect stool before administration of antidiarrheal compounds, antibiotics,     antacids, bismuth, barium or fiber containing stool enhancers.

Adults & Older Children
Unpreserved Specimen
Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap or disinfectants.  Transfer specimen to sterile, leak proof, wide-mouth container.
Label and send to laboratory within one hour.
Mark Giardia Antigen and Feces on requisition.
Preserved Specimen
Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soaps or disinfectants.
Mix a portion of the specimen into a vial of Enteric Transport Medium (i.e.: Carey Blair), or in the 10% formalin collector from an Ova and parasite set, bringing the level of combined specimen and preservative up to the “fill” line.
Cap the vial tightly.  Mix well.
Label specimen with patient name, date and time of collection. Also check whether stool was formed, soft, or liquid and send to laboratory as soon as possible.
Mark Giardia Antigen and Feces on requisition.

Infants
U-Bag Collection

Place a U-bag to cover perianal area of the patient to collect specimen.
Pour collected specimen into a clean, leak proof wide-mouth container.
Label specimen and send to laboratory immediately or refrigerate and send within 8 hours.
Mark Giardia Antigen and Feces on requisition.
Culturette Collection

Insert swab into rectum and rotate a few times to obtain fecal material.
*NOTE: Stool specimens obtained from diapers are also acceptable.
Return swab to holder & break the ampule.
Label specimen and send to laboratory immediately or refrigerate and send within 8 hours.
Mark Giardia Antigen and Feces on requisition.
*NOTE:  If a specimen for Ova and Parasites is also being submitted, a separate specimen for Giardia Antigen is not necessary.  Order both Giardia Antigen and Ova & Parasites.


GRAM STAIN

Gram stains are reported as part of all bacterial cultures EXCEPT Urine, Nose, Throat, Strep Screens, Stool, &Body Fluid (Bactec).  Therefore a separate order for gram stain is necessary for those sources only.  If gram stain results are needed STAT for non-urine, nose, throat, stool, body fluid (Bactec) sources, please write “STAT GRAM” on the requisition.

Urine, Nose, Throat, Stool, Body Fluid (Bactec) & Other Sources for Gram Stain Only
Collect specimen as for Aerobic Culture.  If Culture is also ordered, a separate specimen is not necessary exception: body fluid (Bactec) requires original fluid).
Label and send to laboratory immediately.
Mark Gram Stain and appropriate source on requisition.


KOH

Vagina or Urethra
Place swab of secretions into tube of 1 ml sterile saline or collect with Culturette swab with wet sponge.
Label specimen and send to laboratory as soon as possible.
Mark KOH and appropriate source on requisition.
Skin, Hair, or Nail Scrapings
Place scrapings in sterile dry container (petri dish, red-stopper vacutainer tube, clean screw-capped cup).
Label specimen and send to laboratory as soon as possible.
Mark KOH and appropriate source on requisition.
Mouth
Place swab of secretions into tube of 1 ml sterile saline or collect with Culturette swab with wet sponge.
Label specimen and send to laboratory as soon as possible.
Mark KOH and appropriate source on requisition.


 

MRSA SCREEN PCR/NASAL,SKIN

For nasal colonization, collect from lower interior or nose using Copan swabs. Insert the dry swabs 1-2 cm into the nostril and rotate swabs against the inside of the notril for 3 seconds while applying pressure with a finger to the outside of the nose.
Repeat in second nostril with the same swabs.
Place the swabs back into the tube.

For other skin sites, use the Copan dry swabs together rotating swabs against the skin.
Place the swabs back into the tube. Label and send to laboratory as soon as possible.

Mark MRSA screen PCR and source on requisition.


MISCELLANEOUS UNLISTED TESTS

Call Laboratory/Microbiology for instructions.


NASOPHARYNX CULTURE

Clean debris from lower nares.  Using minitip culturette obtain specimen from nasal passages or nasal pharyngeal passages.
Return swab to holder, label and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and Nasopharynx on requisition.


NOSE CULTURE

Clean debris from lower nares.  Using minitip culturette obtain specimen from nasal passage at least 1 cm inside the nares.
Return swab to holder, label and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and Nose on requisition.


OVA & PARASITES

Feces
Unpreserved Specimen
Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap, or disinfectants.
Transfer specimen to clean, leak proof, wide-mouth container.
Label specimen and send to laboratory within one hour.
Mark Ova and Parasite and Feces on requisition.
Preserved Specimen
Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap, or disinfectants.
Mix a portion of the specimen into each vial of preservative of an Ova and Parasites collection kit, bringing the level of combined specimen and preservative up to the “fill” line.
Cap each vial tightly.   Mix well.
Label specimen with name, date, and time. Check whether stool was formed, soft, or liquid.
Send to laboratory as soon as possible.
Mark Ova and Parasite and Feces on requisition.
Multiple Specimen
As parasites are not shed on an even, regular basis, a single specimen cannot be relied upon to reveal the presence of parasites.  Therefore, three specimens should be collected over a period of several days (2-3 days between specimens).  In cases of acute diarrhea on a pediatric or geriatric patient, specimens may be collected one day apart.
*NOTE: Specific guidelines have been established with clinicians to determine the efficacy of ova & parasite collections particularly on inpatients.
Without prior consultation, no more than three stool specimens for parasitology should be submitted.
Without prior consultation, stool specimens for parasitology should not be submitted after the fourth hospital day.

Sigmoidoscopic Material
Submit unpreserved material to the laboratory or place in PVA preservative bringing the level of combined specimen and preservative up to the “fill” line.
Cap the PVA vial tightly.  Mix well.
Label specimen and send to laboratory immediately.
Mark Ova and Parasite and appropriate source on requisition.
Liver Abscess Aspirates for Entamoeba Histolytica
Submit aspirate to the laboratory.
Label specimen and send to laboratory immediately.
Write R/O Entamoeba histolytica under Other Test and mark appropriate source on requisition.
Duodenal Contents for Giardia Lamblia or Strongyloides Stercoralis
Submit specimen to the laboratory or place in 10% formalin preservative.  Mix well.
Label specimen and send to the laboratory immediately.
Write R/O Giardia lamblia or Strongyloides stercoralis under Other Test and mark appropriate source on requisition.


PERTUSSIS PCR (State of Idaho)

The State of Idaho will perform PCR.

Materials Required

  • Kits from State Lab available at PRL including instructions for nasal pharyngeal swab
  • Completed Pertussis requisition form
  • 1 polyester wire swab
  • 15 mL sterile screw cap tube with conical bottom
  • Nasopharyngeal swab

Swab

Place swab in sterile transport tube.
Refrigerate until shipment

All specimens can be shipped cool from your office directly to the Boise State Lab. Pathologists' Regional Laboratory can ship specimens on to the Boise State Lab Monday -Thursday.  However, please be aware that handling and shipping charges will be applied and turnaround time will be affected.


PINWORM

Obtain swab coated with vaspar for collection of Pinworms from Microbiology.
To increase the chance of picking up eggs, collect the specimen between 10 p.m. & midnight.  Otherwise, early-morning testing is critical.

Perianal
Remove coated swab from the transport tube.
Separate the patient’s buttocks and press the gummed swab against several areas of the perianal region.
Replace the swab back into the transport tube.
Label specimen and send to laboratory as soon as possible.
Mark Pinworm and Perianal as source in Other Test on requisition.


PNEUMOCYSTIS CARINII STAIN

BAL/Bronchial Washings (Preferred Specimen)
Surgical procedure.
5 cc if possible, minimum 1 cc.
Label specimen and send to laboratory immediately.
Mark Pneumocystis Carinii Stain and specify source on requisition.
Sputum, Induced
After treatment, have patient rinse mouth and throat with fresh water and then cough deeply to obtain sputum, not saliva.  Specimen should be expectorated into a sterile, leak-proof specimen cup.
Label specimen and send to laboratory immediately.
Mark Pneumocystis Carinii Stain and Sputum-Induced on the requisition.
Tissue (Transbronchial, Open-lung, or Other Biopsy Specimen)
Transport specimen in a sterile container on gauze slightly moistened with sterile saline.  Do not immerse in saline or allow to dry.
Label specimen and send to laboratory immediately.
Mark Pneumocystis Carinii Stain and specify source on requisition.
*NOTE: If Aerobic Culture & Sensitivity, AFB, Fungus and Cytology are also ordered on sputum or bronchial washings, at least 3 cc of specimen are needed.


ROTAVIRUS/ADENOVIRUS EIA

Collect stool specimens as soon after onset of symptoms as possible.  Peak viral counts are reported to occur on days 3-5 after onset of symptoms.  Samples collected 8 days or more after onset of symptoms may not contain enough viral antigen to produce a positive reaction.

Infants (</= 36 months)
U-Bag Collection
Place a U-bag to cover perianal area of the patient to collect specimen.
Pour collected specimen into a clean, leak proof, wide-mouth container.
Label specimen and send to laboratory immediately or refrigerate and send within 8 hours.
Mark Rota/Adenovirus and Feces on requisition.
Culturette Swab (Must be a Dry Swab - No Preservative)
Insert swab into rectum and rotate a few times to obtain fecal material.
Return swab to holder.
Label specimen and send to laboratory immediately or refrigerate and send within 8 hours.
Mark Rota/Adenovirus and Feces on requisition.
Geriatric Patients
Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap, or disinfectants.  Transfer specimen to clean, leak proof, wide-mouth container.
Label and send to laboratory immediately or refrigerate and send within 8 hours.
Mark Rota/Adenovirus and Feces on requisition.


RSV ANTIGEN

Nasal Wash Sample - collected in standard collection cup
For nasal washing, place about 4ml of sterile saline in a 1oz tapered rubbed bulb.
Tilt the patient’s head back about 70˚, insert the bulb into the nose until the nostril is occluded, and squeeze the bulb to dispense the saline.
Hold for a few seconds and then release the bulb to aspirate the fluid.
Transfer the fluid to a sterile container and transport it to the laboratory immediately.
Nasopharyngeal Swab - do NOT use calcium alginate swabs
Remove excess secretions or exudate from the anterior nares.
Gently pass a nasopharyngeal swab through the nose and into the nasopharynx.
Rotate the swab on the nasopharyngeal membrane.  Rotate briskly to collect columnar epithelial cells.
Remove the swab carefully and place it in the transport medium.

Acceptable transport media includes: Amies Media, Binax Elution Solution, Hanks Balanced Salt Solution, M4Media, M4-RT Media, M5 Media, Saline, Stuart’s Media.
Transport to laboratory immediately. Mark RSV Antigen on requisition.


SPUTUM CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Expectorated
*All expectorated sputums will automatically be screened for acceptability of the specimen. Based on the cellular contents, “acceptable” sputums will be processed for culture & “rejected” sputums will be held, but NOT processed for culture. The floor/office will be notified if another sputum is requested.

Have patient rinse mouth and throat with fresh water and then cough deeply to obtain sputum, not saliva.  Specimen should be expectorated into a sterile, screw-capped specimen cup.
Label and send to laboratory immediately.  Refrigerate if delay prior to sending to laboratory to prevent overgrowth of normal oral/pharyngeal organisms.
Mark Aerobic Culture and Sensitivity and Sputum-Expectorated on requisition.
Induced
After treatment, have patient rinse mouth and throat with fresh water and then cough deeply to obtain sputum, not saliva.  Specimen should be expectorated into a sterile, screw-capped specimen cup.
Label and send to laboratory immediately.  Refrigerate if delay prior to sending to laboratory to prevent overgrowth of normal oral/pharyngeal organisms.
Mark Aerobic Culture and Sensitivity and Sputum-Induced on requisition.
Aspirated
Suction material following aseptic technique.
Label and send to laboratory immediately.  Refrigerate if delay prior to sending to laboratory to prevent overgrowth of normal oral/pharyngeal organisms.
Mark Aerobic Culture and Sensitivity and Sputum-Aspirated on requisition. 


STOOL CULTURE

Have patient pass specimen into commode hat avoiding contamination with urine.  If specimen must be collected in bedpan, care must be taken to avoid contact with urine, residual soap, or disinfectants.  Transfer specimen to sterile, wide mouthed, leak proof container.
Label and send to laboratory within one hour.

If specimen cannot be sent immediately, mix a portion of the specimen into a vial of Enteric Pathogen Transport medium, bringing the level of combined specimen and preservative up to the “fill” line.  Cap firmly.  Mix well.   Send to the lab as soon as possible.
Mark Aerobic Culture and Sensitivity and Feces on requisition.

* NOTE:  Stool for Bacterial Pathogens is equivalent to Routine Culture. If Campylobacter and/or Yersinia only are ordered, indicate this under Other Test. If these are ordered in addition to the Routine Culture, no separate orders are necessary as Routine Culture includes these two pathogens as well as Salmonella, Shigella, E.coli 0157-H7, and Vibrio parahemolyticus. 

Includes EIA for Enterohemorrhagic (Shiga toxin) E.Coli.

Multiple Specimen
*Specific guidelines have been established with clinicians to determine the efficacy of multiple stool culture collections particularly on inpatients.
Without prior consultation, no more than two stool specimens for bacteriology should be submitted.
Without prior consultation, stool specimens for bacteriology should not be submitted after the third hospital day.
C. Difficile Toxin testing should be considered in cases of diarrhea when the admitting diagnosis was not gastroenteritis.


STREP SCREEN (GROUP A) THROAT

Using culture swab, swab back of throat and tonsils with culture swab (culturette) avoiding tongue and uvula.
Return swab to holder, label and send to laboratory as soon as possible.
Mark Strep Screen and Throat on requisition.


STREP SCREEN (GROUP B) VAGINAL-ANORECTAL

Cervical specimens are not recommended for recovery of Group B Streptococcus, & a speculum should not be used for collection.

Swab the mucosal wall of the vaginal introitus, then the anorectum.
Return swab to holder, label and send to laboratory as soon as possible.
Mark Strep Screen (Group B) and Vaginal/Anorectal on requisition.
Mark sensitivity to clindamycin and erythromycin if needed.


THROAT CULTURE

Swab back of throat and tonsils with culture swab (culturette) avoiding the tongue and uvula.
Return swab to holder, label and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and Throat on requisition.


TISSUE CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Decontaminate surface area with mild antiseptic.
Place 1 cm3 (if possible) size piece of tissue in sterile container containing a sterile gauze moistened with sterile saline.
Label and send to laboratory immediately.  DO NOT FIX.
Mark Aerobic Culture and Sensitivity and specify type of tissue on requisition.


URETHRA CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.
Patient should not have voided within the past hour.

Wipe urethral opening clean with sterile gauze or pad.
Obtain minitip swab of urethral secretions or discharge.
Return swab to holder, label.
Mark Aerobic Culture and Sensitivity and Urethra on requisition.
Send the specimen to the laboratory * as soon as possible.

A Routine Culture includes a Neisseria Screen (Neisseria gonorrhoeae) so this test does NOT need to be ordered too.

*NOTE: It is recommended by the Culturette manufacturer that cultures for Neisseria     Gonorrhea be planted within 8 hours of collection for optimal recovery.

DO NOT REFRIGERATE CULTURETTE!


URINE CULTURE

All specimens for culture must be either clean void midstream (CVMS), catheterized, or supra pubic taps.

Female Midstream
Wash hands with soap.
Cleanse perineal area with towelettes or sterile gauze.
While holding labia apart, begin voiding. Allow first voided specimen to pass.
Collect midstream portion without stopping flow of urine.
Male Midstream
Wash hands with soap.
Clean the glans with soap and water or towelette. Rinse. 
While holding foreskin retracted, begin voiding.  Allow first voided specimen to pass.
Collect midstream portion.

Label and send to laboratory immediately.  Refrigerate specimen if delay in transport.
*Alternately: Transfer urine into a B-D vacutainer transport tube*. Leave at room temperature.
Mark Aerobic Culture and Sensitivity and Urine CVMS, Urine-Foley Cath, Urine-Straight Cath, or Urine-Supra Pubic Tap on requisition.


VAGINAL CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Use sterile water or saline, not lubricant on speculum.
Remove most of discharge or secretions with sterile gauze and discard in contaminated waste container.
Swab the mucosal wall high in vaginal canal.
Return swab to holder, label.
Mark Aerobic Culture and Sensitivity and Vagina on requisition.
Send the specimen to the laboratory  as soon as possible.

A Routine Culture includes a Neisseria Screen (Neisseria gonorrhoeae) so this test does NOT need to be ordered too.
*NOTE: It is recommended by the Culturette manufacturer that cultures for Neisseria gonorrhoeae be planted within 8 hours of collection for optimal recovery.

DO NOT REFRIGERATE CULTURETTE!


WET MOUNT FOR TRICHOMONAS & CLUE CELLS

Use sterile water or saline, not lubricant on speculum.
Remove vaginal secretions with sterile gauze and discard in contaminated waste container.
Swab vaginal wall briskly and place swab into a tube of 1 cc of sterile saline or collect with culturette swab.
Label and send to laboratory immediately.
*NOTE:  Motility of Trichomonas, a key feature for identification, disappears rapidly.
Mark Wet Mount and appropriate source on requisition.


WOUND CULTURE

Gram stain result is routinely reported with this type of culture & does NOT require a separate order.

Decontaminate surface area with mild antiseptic.
Carefully rub inside area of wound with culture swab.
Return swab to holder, break ampule to moisten, label and send to laboratory as soon as possible.
Mark Aerobic Culture and Sensitivity and type of wound and body site on requisition.
*NOTE: Deep wound may be suitable for anaerobic culture (if ordered).  Refer to Anaerobic Culture collection.