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Specimen Collection for Microbiology

Specimen Labeling Information accompanying microbiology specimens must include: 1. Patient Name, SSN, Date of Birth, sex . !e"uesting Physician #. $ests ordered %. Specimen source &. Date of specimen collection Specimen Collection Blood for Culture Blood for culture should be collected into bottles pro'ided by Perll Diagnostics (appropriate adapters are also pro'ided): *erobic +ulture: ,* bottle *naerobic +ulture: ,N bottle Pediatric: P, bottle Perform 'enipuncture as recommended by your facility-s appro'ed procedure. Bottle should remain upright .hile collecting blood. *l.ays collect blood for culture before collecting blood for other tests. If collecting more than one blood culture bottle, collect into the aerobic bottle before the anaerobic bottle. /ar0 the li"uid le'el on the bottle before blood. 1ine demarcations on the bottle label indicate sufficient blood 'olume fill. *dults: Pediatric: collect 2314ml of blood collect 13%ml of blood

N5$6: the pro'ided adapter insert can be used for collection of blood for other tests if needed.

Endocervical Swabs $he order of testing for specimen collection should be +hlamydia test, 7onorhhea culture8gram stain, pap smear. Since the 'isible presence of blood may interfere .ith test results, it is ad'isable to collect the Pap smear last .hen using the cytobrush because of induced bleeding that might occur.

Specimens for +hlamydia testing Specimens are to be collected using the +lear'ie. ,emale Specimen +ollection 9it pro'ided by Perll Diagnostics. !emo'e excess mucus from the exocer'ix .ith a separate s.ab or cotton ball and discard. Insert the s.ab into the endocer'ix and rotate against the surface of the cer'ical canal for 14 to #4 seconds. *'oid touching any 'aginal surface .hen the s.ab. !eturn the s.ab to the transportation. Specimens for 7onorrhea +ulture Specimens should be collected using an anaerobic *mies s.ab .ith charcoal (example: Star S.ab SP1#1:). !otate s.ab against the .all of the endocer'ical canal se'eral times for 43#4 seconds and .ithdra. .ithout touching the 'aginal surface. Nasal Specimens N5$6: If Influen;a *8B and !S< testing re"uired, one sample may be submitted for both tests. Nasopharyngeal Swab Method: ,or Influen;a *8B and !S< $o collect a nasopharyngeal s.ab sample, carefully insert the s.ab into the nostril and using gentle rotation, push the s.ab into the posterior nasopharynx. 7ently rotate the s.ab three times, then remo'e it from the nasopharynx. S.ab should be stored and transported in =ni'ersal $ransport /edia. ,or /!S* screening S.ab both anterior nares (inner nose surfaces) utili;ing one culture s.ab. !otate moistened s.ab in each nares t.o to fi'e times cloc0.ise and countercloc0.ise. $he process should gently rub across the nasal mucous membranes about three3fourths of an inch into the nasal passage (adult) so that s"uamous epithelial cells from the inside of the nose are obtained. Store and transport in Stuarts or *mies media. Nasopharyngeal Aspirate Method:

,or Influen;a *8B and !S< Instill a fe. drops of sterile saline into the nostril to be suctioned. Insert the flexible plastic tubing along the nostril floor, parallel to the palate. *fter entering the nasopharynx, aspirate the secretions .hile remo'ing the tubing. $he procedure should be repeated for the other nostril if inade"uate secretions .ere obtained from the first nostril. Nasal/Nasopharyngeal ash Method:

,or Influen;a *8B and !S< ,ollo. your Institution-s Protocol for obtaining .ash specimens. =se the minimal amount of saline that your procedure allo.s, as excess 'olume .ill dilute the amount of antigen in the specimen. $he are examples of procedures used by clinicians: $he child should sit in the parent-s lap facing for.ard, .ith the child-s head against the parent-s chest. ,ill the syringe or aspiration bulb .ith the minimal 'olume of saline re"uired per the sub>ect-s si;e and age. Instill the saline into one nostril .hile the head is tilted bac0. *spirate the .ash specimen bac0 into the syringe or bulb. $he aspirated .ash sample .ill li0ely be at least 1 cc in 'olume. *lternati'ely, instillation of the saline, tilt the child-s head for.ard and let the saline drain out into a clean collection cup.

!ectal Swabs !ectal s.abs are not recommended for stool culture except for infants. ,or 7onorrhea culture insert sterile s.ab approximately 131.& inches in the anal canal. /o'e s.ab from side to side in the anal canal to sample crypts. *llo. s.ab to remain 143#4 seconds for absorption of organisms onto the s.ab.

Sputum E"pectorated Patient should rinse or gargle .ith .ater to remo'e excess oral flora. Patient is then to cough deeply to produce sputum specimen from respiratory tract into a sterile container. Specimen should be at least 1ml in 'olume.

#nduced Patient should brush tongue and gums and rinse mouth thoroughly .ith .ater. Patient should inhale &ml of #314? sterile saline through a nebuli;er. Saline is to be collected in a sterile container. Specimen should be at least 1ml in 'olume.

Stool Specimen is to be passed into a bedpan or on plastic .rap o'er a toilet seat. Specimens for culture, C$ difficile% and8or 'ancomycin resistant 6nterococcus (<!6) screening should be aseptically transferred to a sterile .ide mouth container for transport. !ectal s.abs are not recommended except for infants. Specimens for 5'a and parasite screening should be transferred into each 'ial pro'ided using the included spoon, agitate sample .ith spoon, tighten cap, and sha0e tube until specimen appears homogeneous.

$hroat S.abs =se of a sterile polyester s.ab should be used for 7onorrhea culture and Strep * testing. !ayon transport s.abs containing modified Stuart@s or *mies li"uid medium can also be used. S.ab the posterior pharynx, tonsils, and other inflamed areas. *'oid touching the tongue, chee0s and teeth .ith the s.ab.

&rethral Swabs Specimens for 7onorrhea culture should be collected using a sterile culturette. Delay obtaining specimens until hrs after patient has last 'oided. 7ently insert the urogenital s.ab into the urethra (.omen 13 cm, men 3% cm). !otate the s.ab in one direction for at least one re'olution for a minimum of 14 seconds.

&rine =rine may be collected into a .ide mouth sterile container or a sterile borate container (see specimen transport conditions)

'emales Specimens for +ulture: Separate the labia and .ith cotton .ool or a sponge moistened .ith .ater, .ipe the 'ul'a from the front to the bac0. Disinfectant MUST NOT be used. Aith the labia still separated allo. some urine to pass into the toilet, then, .ithout stopping, allo. urine to pass into a container and fill to the line. Pass the remaining urine into the toilet. Males Specimens for +ulture: +lean the glans penis .ith soap and .ater. +ommence urination, and .hen a fe. millilitres of urine ha'e been passed introduce a sterile container into the stream and fill the container.

Specimens for +hlamydia and 7onorrhea testing: $he patient should be instructed not to urinate for at least one hour prior to specimen collection. *pproximately 43#4mls of first catch urine should be collected into a clean and dry container. Collection of Catheter Specimens of &rines (CS&)s* $he specimen should not be collected from the drainage bag, only from the sampling port. =sing a needle and syringe insert the needle through the latex or plastic port and aspirate urine. $ransfer 1&ml urine to a red topped sterile container.

ound Specimens for Culture and/or M!SA screening Specimens should be collected through aspiration. If direct aspiration is not possible, abscesses and .ounds can be irrigated .ith sterile saline and then aspirated. Aound biopsies are also acceptable specimens. S.ab specimens are not optimal, as they contain less material and are more li0ely to be contaminated by ad>acent cutaneous microflora. If .ounds or abscesses are to be s.abbed, t.o *mies s.abs must be collected for smear and culture.

Specimen Transport Blood for Culture Blood culture bottles must be transported to the laboratory as soon as possible for processing. Bottles should be transported at room temperature.

Endocervical Swabs S.abs for +hlamydia testing should be transported to the test site at refrigeration temperature. $ransport media should not be used. If the specimen is not to be tested .ithin 1 day, store at 3 2B+ for up to & days. Do not free;e S.abs for 7onorrhea culture should be immediately transported to the laboratory at room temperature due to lo. organism sur'i'al rate.

Nasal Specimens $ransport specimens for Influen;a *8B and !S< testing at %+ .ithin eight hours of collection. Specimens stored in /%3!$, /ultitrans /edia, or Bartels <iratrans only .ill be accepted up to %2 hours after collection. Specimens for /!S* testing can be transported at room temperature and should be recei'ed .ithin % hours.

!ectal Swabs Specimens should be transported at room temperature. S.abs for culture must be recei'ed .ithin % hours. S.abs for 7onorrhea culture should be recei'ed immediately due to lo. organism sur'i'al rate.

Sputum Store8transport specimens at %B+ .ithin % hours of collection.

Stool Stool specimens and rectal s.abs (infants only) for culture and or C$ difficile screening should be transported .ithin % hours at %B+. Stool 'ials for o'a and parasite screening should be placed in the ;iploc0 bag pro'ided and should be transported to the lab .ithin % hours at room temperature.

+hroat Swabs S.ab specimens may be stored in a clean, dry plastic tube for up to 2 hours at room temperature or C hours at 32B+. Do not free;e. S.abs for 7onorrhea culture should be transported at room temperature and recei'ed immediately due to lo. organism sur'i'al rate.

&rethral Swabs S.abs for 7onorrhea culture should be transported at room temperature and recei'ed immediately due to lo. organism sur'i'al rate.

&rine =npreser'ed (no boric acid) samples should be transported to the lab at %B+ .ithin % hours of collection. Samples preser'ed .ith boric acid can be transported to the lab .ithin % hours at room temperature or %B+.

ound Specimens Specimens should be transported .ithin % hours at room temperature.

Specimen Acceptability ,eneral *ny samples recei'ed in damaged containers and8or do not ha'e proper labeling .ill not be accepted for analysis. Samples may also be re>ected if the transport criteria are not met accordingly. *dditional specimen acceptability criteria are listed belo. .here applicable.

Sputum Specimens .ith large numbers of s"uamous epithelial cells are considered unacceptable and .ill not be cultured. &rine Specimens containing e'idence of fecal material .ill be re>ected. ound Specimens containing large numbers of s"uamous epithelial cells (indicating contamination) are considered unacceptable. Nasal Swabs S.abs for !S< testing .ill not be accepted if transported in *mies or /%3# media. S.abs for Influen;a testing .ill not be accepted if transported in /%, /%3!$, *mies, Stuarts, or !emel /D media. Further Testing Blood Cultures Initial results .ill be reported as positi'e or negati'e. ,or positi'e samples, you may re"uest a 7ram stain and8or pathogen isolation. -athogen #dentification and Susceptibility Identification is included in testing for positi'e samples submitted for screening for a specific pathogen (i.e. /!S*, <!6, 7onorrhea). Susceptibility analysis is included in /!S* and <!6 screening. Identification and susceptibility analysis .ill be carried out for an additional charge on pathogens isolated form any culture .hen re"uested. NOTE if ordering susceptibility analysis, you must also order pathogen identification.