title guidelines for microbiology specimen collection document type policy issue no. ipct009 version draft


Title
Guidelines for Microbiology Specimen Collection
Document Type
Policy
Issue no.
IPCT009
Version
DRAFT
Issue date
October 2015
Review date
March 2016
Distribution
All NHS Borders Staff
Prepared by
Infection Prevention Control Team
Developed by
Infection Prevention Control Team
Reviewed by
Infection Control Committee
Equality & Diversity Impact Assessed
GUIDELINES FOR MICROBIOLOGY SPECIMEN COLLECTION
Aim: To ensure that all staff are aware of the rationale for
appropriate specimen collection and the correct procedures
Introduction
Specimen collection is taking samples from patients for the purpose of
laboratory examination in order to identify micro-organisms causing
infection.
Healthy individuals are colonised by different bacteria (‘normal
flora’) on sites such as skin, the throat and the vagina. Therefore
samples should only be taken when there clinical suspicion of
infection.
Timely, accurate and useful laboratory reports are possible only if
specimens are properly collected and accompanied by specific detailed
patient information with the request.
Mandatory data includes patient identifiers - surname/forename, date
of birth, CHI/hospital number), location and requestor details and
relevant clinical details.
The specimen container should also be clearly labelled with patient
identification and sample type/source.
General principles
Specimens should be obtained using safe techniques and practices.
Compliance with existing health and safety and infection control
policies/guidelines.
Infection Control Precautions and Hand Hygiene are important when
collecting specimens.
Appropriate personal protective equipment (e.g. gloves and aprons)
should always be worn when collecting/handling blood, body fluids and
tissue specimens/samples.
Waste, including sharps should be disposed of safely and
appropriately.
Specimens should be transported to the laboratory promptly. Delay may
result in the loss of viability of some organisms, or may lead to
overgrowth by contaminating organisms.
General procedure
Action
Rationale
Explain and discuss procedure with patient
Ensure patient understands procedure and gives consent
Decontaminate hands appropriately
Reduce the risk of infection transmission
Minimise contamination
Place specimens and swabs in appropriate, correctly labelled
containers
To ensure organisms for investigation are preserved.
To ensure correct results are attributed to correct patient
Send specimens to laboratory promptly, with fully completed request
form.
If specimens cannot be sent to a laboratory immediately, they should
be stored as follows:
*
Blood culture samples in a 37°C incubator
*
All other specimens in a specimen refrigerator at a temperature of
4°C, where the low temperature will slow the bacterial growth
Resources available
1.
Swabs – microbiology
Black or blue topped swabs with transport media: Use for all swab
samples unless specifically stated otherwise. Dry swabs should not be
sent as this can limit pathogen survival.
Other specimens should be placed into sterile containers.
2.
Swabs – virology
Swabs for viral culture/PCR should be placed into the pink virus
transport media, available from the microbiology department.
3.
Chlamydia
Swabs should be placed into the pink virus transport media, available
from the microbiology laboratory.
Urine should be sent in sterile white topped containers. Boric acid
(red-topped universals) samples are not suitable for Chlamydia.
4.
Mycology
Special transport envelopes available from microbiology laboratory.
Specifics on specimen collection.
Where possible all specimens should be taken prior to commencing
antimicrobial therapy.
Site/Specimen
Action
Comments
Eye swab
1.
Gently evert lower eyelid. Using swab held parallel to cornea
gently rub conjunctiva of lower eyelid.
2.
Chlamydia swab if required should be taken after bacterial swab.
In all but superficial eye infections corneal scrapings may be
required.
Please discuss with opthamology.
If both eyes to be swabbed a separate swab should be used for each.
Ear swab
Place swab into outer ear and rotate gently.
No drops/antibiotics/other chemotherapeutic agents should have been
used in the aural region for 3 hours prior to taking the swab.
Nose swab
1.
Moisten swab with sterile saline or transport media swab the
anterior nares by gently rotating swab.
2.
The same swab can be used for both nostrils.
Pernasal swab
1.
Pass special soft mounted wire swab along the floor of the nasal
cavity, to the posterior wall of the nasopharynx.
2.
Rotate gently.
Swabs can be obtained from the microbiology department.
Care needs to be taken to minimise trauma and to ensure the correct
area is sampled.
Throat swab
1.
The patient should stick out their tongue whilst the swab is
guided down the side of the throat to make contact with the
tonsillar fossa or any other area with a lesion or exudates.
If concerns re atypical pneumonia/viral infections a throat swab
should be sent in virus transport media.
A tongue depressor may be required.
Avoid touching any other area of the mouth or tongue in order to
minimize contamination.
Site/Specimen
Action
Comments
Sputum
1.
Ensure specimen is sputum, not saliva.
2.
Encourage patients who have difficulty producing sputum to cough
deeply first thing in the morning.
3.
Physiotherapy may also be helpful in getting a sample.
Send sputum to lab immediately – delays can lead to overgrowth of
contaminating flora, and the death of potentially pathogenic flora.
Wound swab
1.
Do not routinely sample wounds/ulcers – only sample if infection
suspected.
2.
Take swabs prior to dressing.
3.
Rotate swab gently over area to be sampled.
Pus, if present should be sent in preference to a swab – send in a
sterile screw capped container.
Ulcer swab
1.
Clean chronic ulcers with sterile saline or tap water prior to
sampling.
2.
Slough and necrotic tissue should be removed.
3.
Sample viable tissue with signs of inflammation, gently rotating
the swab.
Do not sample routinely.
High Vaginal swab
1.
Introduce speculum into vagina to separate the vaginal walls.
2.
Roll swab over vaginal vault sampling the lateral and posterior
fornices.
High vaginal swabs are the idea – avoid contamination with vulval/skin
flora by use of a speculum.
Endocervical swab
1.
Introduce speculum into vagina to obtain a clear view of cervix.
2.
Swab should be rotated gently in the endocervicalos.
3.
If testing for Chlamydia, a second swab should be taken and placed
in viral transport media.
Avoid touching vaginal walls to minimise contamination.
Chlamydia swabs should be rotated a little more firmly as seeking to
collect epithelial cells.
Penile swab
1.
Retract prepuce.
Gently rotate swab in urethral meatus.
2.
If gonorrhoea is suspected, send a swab from the distal 1-2cm of
the urethra.
Gently insert and rotate swab. Send to lab promptly in transport
media.
Site/Specimen
Action
Comments
Rectal swab
1.
Pass swab carefully through anus into rectum.
2.
Rotate gently.
3.
If threadworms suspected take swab from perianal region, and break
off into bijou of sterile saline (available from lab).
Alternatively take sellotape slide.
Aiming to minimise trauma and ensure a rectal (and not anal) sample is
taken.
Threadworms lay their ova on perianal skin.
Sellotape slides are taken by pressing a piece of sellotape to the
perianal skin, and placing onto a microscope slide. They are best
taken first thing in the morning.
Faeces
1.
Where possible, ask the patient to defaecate into a clinically
clean bedpan.
2.
Scoop enough material to fill a third of the specimen container
using the spatula / spoon. (If liquid faeces, approximately 15mls
should be collected).
3.
Segments of tapeworm that are seen easily in faeces should be sent
to the laboratory for identification.
4.
Patients suspected of suffering from amoebic dysentery should have
any stool specimens dispatched to the laboratory immediately.
Notifying the laboratory when sending.
Aiming to minimise contamination.
If patient is collecting sample at home advise to avoid contamination
with urine/disinfectants, and to label clearly.
If ova/cysts/parasites suspected, up to 3 samples over the space of a
week may be required to improve detection rates.
The parasite causing amoebic dysentery is characteristic in its fresh
state, but is difficult to identify when dead.
Urine
1.
Specimens of urine should be collected as soon as possible after
the patient wakens in the morning and at the same time each
morning if more than one specimen is required.
2.
Dispatch all specimens to the laboratory as soon after collecting
as possible.
The bladder will be full due to overnight accumulation of urine.
Later specimens may be diluted.
Urine samples should be examined within 2 hours of collection, or
refrigerated. At room temperature bacterial overgrowth will occur and
may lead to misinterpretation.
Site/Specimen
Action
Comments
Midstream specimen of urine (male)
1.
Retract the prepuce and clean the skin surrounding the urethral
meatus with water.
2.
Ask the patient to direct the first and last part of his stream
into a urinal or toilet but to collect the middle part of his
stream into a sterile container.
Aiming to prevent contamination.
Urine for Chlamydia
1.
First void urine of the day should be placed into a sterile
container (White topped).
2.
If first void not collected, wait until patient has not micturated
for 2hours, then collect first void.
Do not use boric acid containers.
Midstream specimen of urine (female)
1.
Clean the urethral meatus with water.
2.
Use a separate gauze swab for each cleansing swab. Clean from the
front to the back.
3.
Ask the patient to micturate into a bedpan or toilet. Place a
sterile receiver or a wide mouthed container under the stream and
remove before the stream ceases.
4.
Transfer the specimen into a sterile container.
Aiming to prevent contamination, particularly with perianal flora.
Vomit
1.
Preferable: Viral Swab - wet swab with vomit and place in viral
transport medium
2.
If no viral transport immediately available, collect small amount
of vomit where practicable [minimum 1ml] in Universal container
3.
Ensure outside of any transport containers used are free from
contamination
For Norovirus only
Do not use boric acid containers
Analysis of antibiotic levels
Detailed information on antibiotic levels is given in NHS Borders
‘Antimicrobial guidelines for hospitals’
http://intranet/new_intranet/resource.asp?uid=2845
Specimens not covered
Further information on specimen collection is available in the
laboratory handbook:
http://intranet/microsites/index.asp?siteid=64&uid=5
For specimens not covered by these policies, please discuss with
Microbiology.
8

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