Specimen Guidelines Table of Contents
Laboratory Services Section Home
Guidelines for Specimen Collection and Submission: Bacteriology Collection, Transport and Storage
- Abscess General
- Abscess - Open
- Abscess - Closed
- Bite wound
- Blood
- Bone Marrow aspirate
- Burn
- Catheter i.v.
- Foley catheter
- Cellulitis, aspirate from area of
- CSF
- Decubitis ulcer
- Dental Culture
- Ear - Inner
- Ear - Outer
- Eye
- Eye - Corneal scrapings
- Eye - Vitreous fluid aspirates
- Feces Routine culture
- Feces- C. difficile culture
- Feces- E.coli O157: H7, other Shiga-toxin-producing serotypes
- Feces- Leukocyte detection
- Feces- Rectal Swab
- Fistula (See Abscess)
- Fluids: abdominal, amniotic, ascites, bile, joint, paracentesis, pericardial, peritoneal, pleural, synovial, thoracentesis
- Gangernous tissue (See Abscess)
- Gastric Wash or lavage for mycobacteria
- Biopsy for H. pylori
- Genital, female Amniotic fluid
- Bartholin gland secretions
- Cervical secretions
- Cul-de-sac fluid
- Endometrial tissue and secretions
- Products of conception
- Urethral secretions
- Vaginal Secretions
- Genital, female or male lesion
- Genital, male Prostate
- Urethra
- Pilonidal cyst
- Respiratory, lower Bronchoalveolar lavage, brush or wash, endotracheal aspirate
- Sputum, expectorated
- Sputum, induced
- Respiratory, upper Oral
- Nasal
- Nasopharynx
- Throat or pharynx
- Tissue
- Urine Female, midstream
- Urine Male, midstream
- Straight catheter
- Indwelling catheter
- Wound (See Abscess)
| Specimen type (reference): Abscess (14) General | |
| Collection guidelines: Remove surface exudate by wiping with sterile saline or 70% alcohol | |
| Transport device and/or minimum vol.: | |
| Transport time and temp: | |
| Storage time: | |
| Replica limits: | |
| Comments: Tissue or fluid is always superior to a swab specimen. If swabs must be used, collect two, one for culture and one for Gram staining. Preserve swab material by placing in Stuart's or Amie's medium | |
| Specimen type (reference): Abscess - Open | |
| Collection guidelines: Aspirate if possible or pass a swab deep into the lesion to firmly sample the lesion's "fresh border" | |
| Transport device and/or minimum vol.: Swab transport system | |
| Transport time and temp:<2 h, RT | |
| Storage time:<2 h, RT | |
| Replica limits:1/day/source | |
| Comments: Samples of the base of the lesion and abscess wall are most productive. | |
| Specimen type (reference): Abscess - Closed | |
| Collection guidelines: Aspirate abscess material with needle and syringe; aseptically transfer all material into anaerobic transport device. | |
| Transport device and/or minimum vol.:Anaerobic transport system, >1 ml | |
| Transport time and temp:<2 h, RT | |
| Storage time:<2 h, RT | |
| Replica limits:1/day/source | |
| Comments: Contamination with surface material will introduce colonizing bacteria not involved in the infection process. | |
| Specimen type (reference): Bite wound | |
| Collection guidelines: See Abscess | |
| Transport device and/or minimum vol.: | |
| Transport time and temp: | |
| Storage time: | |
| Replica limits: | |
| Comments: Do not culture animal bite wounds <12 h old (agents are usually not recovered) unless signs of infection are present | |
| Specimen type (reference): Blood (139) | |
| Collection guidelines: Disinfect culture bottle; apply 70% isopropyl alcohol or phenolic to rubber stoppers and wait 1 min. Palpate vein before disinfection of venipucture site. Disinfect of venipuncture site: 1. Cleanse site with 70% alcohol 2. Swab concentrically, starting at the center with an iodine preparation 3. Allow the iodine to dry 4. Do no palpate vein at this point without sterile glove 5. Collect blood 6. After venipucture, remove iodine from the skin with alcohol |
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| Transport device and/or minimum vol.:Blood culture bottles for bacteria; adult, >20 ml/set (higher vol most productive) | |
| Transport time and temp:<2 h, RT | |
| Storage time:<2 h, RT, or per instructions | |
| Replica limits:3 set in 24 h | |
| Comments: Acute febrile episode, antimicrobials to be started or changed immediately: 2 sets from separate sites, all within 10 min (before antimicrobials). Nonacurate disease, antimicrobials will not be started or changed immediately: 2 or 3 sets from separate sites all within 24 h at intervals no closer than 3 h (before antimicrobial[s]). Endocarditis, acute; 3 sets from 3 separate sites, within 1-2 h, before antimicrobials if possible. Endocarditis, subacute; 3 sets from 3 separate sites >1h apart, within 24 h. If cultures are negative at 24 h, obtain 2-3 more sets. Fever of unknown origin: 2 or 3 sets from separate sites >1 h apart during a 24-h period. If negative at 24-48 h, obtain 2 or 3 more sets. Some data indicate that an additional aerobic bottle is more productive that the anaerobic bottle. Pediatric: Collect immediately, rarely necessary to document continuous bactermia with hours between cultures. | |
| Specimen type (reference): Bone Marrow aspirate | |
| Collection guidelines: Prepare puncture site as for surgical incision | |
| Transport device and/or minimum vol.: Inoculate blood culture bottle or a lysis-centrifugation tube; plate specimen delivered to laboratory immediately | |
| Transport time and temp: <24 h, RT, if in culture bottle or tube | |
| Storage time: <24 h, RT | |
| Replica limits: 1/day | |
| Comments: Small volumes of bone marrow may be inoculated directly onto culture media. Routine bacterial culture of bone marrow is rarely useful. | |
| Specimen type (reference): Burn | |
| Collection guidelines: Clean and debride the burn | |
| Transport device and/or minimum vol.: Tissue is placed into a sterile screw-cap container; aspirate or swab exudate; transport in sterile container or swab transport system | |
| Transport time and temp: <24 h, RT | |
| Storage time: <24 h, RT | |
| Replica limits:1/day/source | |
| Comments: A-3 to 4-mm punch biopsy specimen is optimum when quantitative cultures are ordered. Process for aerobic culture only. Quantitative culture may or may not be valuable. Cultures of surface samples of burns may be misleading. | |
| Specimen type (reference): Catheter (96) i.v. | |
| Collection guidelines: 1. Clean the skin around the catheter site with alcohol 2. Aseptically remove catheter and clip 5 cm of distal tip directly into a sterile tube 3.Transport immediately to microbiology laboratory to prevent drying |
|
| Transport device and/or minimum vol.: Sterile screw-cap tube or cup | |
| Transport time and temp: <15 min, RT | |
| Storage time: <2 h, 4°C | |
| Replica limits: None | |
| Comments: Acceptable i.v. catheters for semiquantitative culture (Maki method); central, CVP, Hickman, Broviac, peripheral, arterial, umbilical, hyperalimentation, Swan-Ganz | |
| Specimen type (reference): Foley catheter | |
| Collection guidelines: Do not culture, since growth represents distal urethral flora | |
| Transport device and/or minimum vol.: | |
| Transport time and temp: | |
| Storage time: | |
| Replica limits: | |
| Comments: Not acceptable for culture | |
| Specimen type (reference): Cellulitis, aspirate from area of (14) | |
| Collection guidelines: 1. Cleanse site by wiping with sterile saline or 70% alcohol. 2. Aspirate the area of maximum inflammation (commonly the center rather than the leading edge) with a needle and syringe; irrigation with a small amount of sterile saline may be necessary 3. Aspirate saline into syringe, and expel into sterile screw cap tube |
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| Transport device and/or minimum vol.:Sterile tube (syringe transport not recommended) | |
| Transport time and temp:<15 min, RT | |
| Storage time:<24 h RT | |
| Replica limits:None | |
| Comments: Yield of potential pathogens in minority of specimens cultured. | |
| Specimen type (reference): CSF | |
| Collection guidelines: 1. Disinfect site with iodine preparation | |
| Transport device and/or minimum vol.:Sterile screw-cap tubes Minimum amt required; bacteria, >1 ml; AFB, >5 ml | |
| Transport time and temp: Bacteria; never refrigerate; <15 min, RT | |
| Storage time: <2 h, RT | |
| Replica limits: None | |
| Comments: Obtain blood for culture also. If only 1 tube of CSF is collected, it should be submitted to microbiology first; otherwise submit tube 2 microbiology. Aspirate of brain abscess or a biopsy specimen may be necessary to detect anaerobic bacteria or parasites. | |
| Specimen type (reference): Decubitis ulcer (14) | |
| Collection guidelines: A swab is not the specimen of choice (see Comments) 1. Cleanse surface with sterile saline 2. If a sample biopsy is not available, aspirate inflammatory material from the base of the ulcer |
|
| Transport device and/or minimum vol.:Sterile tube (aerobic) or anaerobic system (for tissue) | |
| Transport time and temp:<2 h RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day/source | |
| Comments: Since a swab specimen of a decubitus ulcer provides no clinical information, it should not be submitted. A tissue biopsy sample or needle aspirate is the specimen of choice. | |
| Specimen type (reference): Dental Culture: gingival, periodontal, periapical, Vincent's stomatitis | |
| Collection guidelines: 1. Carefully cleanse gingival margin and supragingival tooth surface to remove saliva, debris, and plaque 2. Using a periodontal scaler, carefully remove subgingival lesion material and transfer it to an anaerobic transport system 3. Prepare smear for staining with specimen collected in the same fashion |
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| Transport device and/or minimum vol.: Anaerobic transport system | |
| Transport time and temp: <2 h, RT | |
| Storage time: <24 h, RT | |
| Replica limits: 1/day | |
| Comments: Periodontal lesions should be processed only by laboratories equipped to provide specialized techniques for the detection and enumeration of recognized pathogens. | |
| Specimen type (reference): Ear - Inner (4) | |
| Collection guidelines: Tympanocentesis reserved for complicated, recurrent, or chronic persistent otitis media 1. For intact eardrum, clean ear canal with soap solution and collect fluid via syringe aspiration technique (tympanocentesis) 2. For ruptured eardrum, collect fluid on flexible shaft swab via an auditory speculum |
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| Transport device and/or minimum vol.:Sterile tube, swab transport medium, or anaerobic system | |
| Transport time and temp: <2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day/source | |
| Comments: Results of throat or nasopharyngeal swab cultures are not predictive of agents responsible for otitis media and should not be submitted for that purpose. |
|
| Specimen type (reference): Ear - Outer (4) | |
| Collection guidelines: 1. Use moistened swab to remove any debris or crust from the ear canal 2. Obtain a sample by firmly rotating the swab in the outer canal |
|
| Transport device and/or minimum vol.: Swab transport | |
| Transport time and temp:< 2 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day/source | |
| Comments: For otitis externa, vigorous swabbing is required since surface swabbing may miss streptococcal cellulitis | |
| Specimen type (reference): Eye (2, 73) | |
| Collection guidelines: separate swabs (premoistened with sterile saline) by rolling over each conjunctiva 2. Medium may be inoculated at time of collection 3. Smear may be prepared at time of collection; roll swab over 1-2-cm area of slide |
|
| Transport device and/or minimum vol.:inoculation: BAP and CHOC; laboratory inoculation: swab transport | |
| Transport time and temp: | |
| Storage time: | |
| Replica limits:None | |
| Comments: If possible, sample both conjunctiva, even if only one is infected, to determine the indigenous microflora. The uninfected eye can serve as a control with which to compare the agents isolated from the infected eye. If cost prohibits this approach, rely on the Gram stain to assist in interpretation of culture. |
|
| Specimen type (reference): Eye - Corneal scrapings (2, 73) | |
| Collection guidelines: 1. Specimen collected by ophthalmologist 2. Using sterile spatula, scrape ulcers or lesions, and inoculate scraping directly onto medium 3. Prepare 2 smears by rubbing material from spatula onto 1-2-cm area of slide |
|
| Transport device and/or minimum vol.:Direct culture inoculations: BHI with 10% sheep blood, CHOC, and inhibitory mold agar | |
| Transport time and temp:<15 min, RT | |
| Storage time:<24 h, RT | |
| Replica limits:None | |
| Comments: If conjunctival specimen is collected do so before anesthetic application, which may inhibit some bacteria. Corneal scrapings are obtained after anesthesia. Include fungal media. |
|
| Specimen type (reference): Eye - Vitreous fluid aspirates | |
| Collection guidelines: Prepare eye for needle aspiration of fluid | |
| Transport device and/or minimum vol.:Sterile screw-cap tube or direct inoculation of small amount of fluid onto media | |
| Transport time and temp:<15 min, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: Include fungal media. Anesthetics may be inhibitory to some etiologic agents. | |
| Specimen type (reference): Feces Routine culture (53) | |
| Collection guidelines: Pass specimen directly into a clean, dry container; transport to microbiology laboratory within 1 h of collection on transfer to Cary-Blair holding medium |
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| Transport device and/or minimum vol.:Clean, leak-proof, wide-mouth container or use Cary-Blair holding medium (>2 g) | |
| Transport time and temp: Unpreserved; <1 h, RT Holding medium <24 h, RT | |
| Storage time:<24 h, 4°C < 48 h, RT or 4°C | |
| Replica limits:1/day | |
| Comments: Do not perform routine stool cultures for patients whose length of hospital stay is >3 days and the admitting diagnosis was not gastroenteritis, without consultation with physician. Tests for Clostridum difficile should be considered for these patients. Swabs for routine pathogens are not recommended except for infants (see Rectal swabs). | |
| Specimen type (reference): Feces- C. difficile culture (80) | |
| Collection guidelines: Pass liquid or soft stool directly into a clean, dry container; soft stool is defined as stool assuming the shape of its container. | |
| Transport device and/or minimum vol.: Sterile, leak-proof, wide-mouth container, >5 ml | |
| Transport time and temp:<1 h, RT; 1-24 h, 4°C; >24 h, -20°C or colder | |
| Storage time: 2 days, 4°C for culture3 days as 4°C, or longer at -70°C for toxin test | |
| Replica limits:1 or 2 specimens may be necessary to detect low toxin levels | |
| Comments: Patients should be passing >5 liquid or soft stools per 24-h period. Testing of formed or hard stool is not recommended. Freezing at -2°C or above results in rapid loss of cytotoxin activity. | |
| Specimen type (reference): Feces- E.coli O157: H7 and other Shiga-toxin-producing serotypes (3, 44) | |
| Collection guidelines: Pass liquid or bloody stool into a clean, dry container | |
| Transport device and/or minimum vol.:Sterile, leak-proof, wide-mouth container, or Cary-Blair holding medium (>2 g) | |
| Transport time and temp:Unpreserved: <1 h, RT Swab transport system: <24 h, RT or 4°C | |
| Storage time:<24 h, 4°C <24 h, RT | |
| Replica limits:1/day | |
| Comments: Bloody or liquid stools collected within 6 days of onset among patients with abdominal cramps have the highest yield. Shiga toxin assay for all EHEC serotypes is better than sorbitol MacConkey culture for O157:H7 only. | |
| Specimen type (reference): Feces- Leukocyte detection (63) (not recommended for use with patients who have acute infectious diarrhea) | |
| Collection guidelines: Pass feces directly into a clean, dry container; transport to microbiology laboratory within 1 h of collection, or transfer to ova and parasite transport system (10% formalin or PVA) | |
| Transport device and/or minimum vol.:Sterile, leak-proof, wide mouth container 10% formalin and/or PVA; >2 ml | |
| Transport time and temp: Unpreserved: <1 h, RT Formalin/PVA: indefinite, RT | |
| Storage time:<24 h, 4°C Indefinite, RT | |
| Replica limits:1/day | |
| Comments: This procedure should be discouraged because it provides results of little clinical value. A Gram stain or simple methylene blue stain may be used to visualize leukocytes. Commercial detection methods are also available | |
| Specimen type (reference): Feces- Rectal Swab | |
| Collection guidelines: | |
| Transport device and/or minimum vol.:1. Carefully insert a swab ca. 1 in. beyond the anal sphincter 2. Gently rotate the swab to sample the anal crypts 3. Feces should be visible on the swab for detection of diarrheal pathogens |
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| Transport time and temp:Swab transport | |
| Storage time:<2 h, RT <24 h, RT | |
| Replica limits:1/day | |
| Comments: Reserved for detecting Neisseria gonorrhoeae, Shigella, Campylobacter, and herpes simplex virus and anal carriage of group B Streptocoddus and other betahemolytic streptococci, or for patients unable to pass a specimen. | |
| Specimen type (reference): Fistula (See Abscess) | |
| Specimen type (reference): Fluids: abdominal, amniotic, ascites, bile, joint, paracentesis, pericardial, peritoneal, pleural, synovial, thoracentesis (13) | |
| Collection guidelines: 1. Disinfect overlying skin with iodine preparation 2. Obtain specimen via percutaneous needle aspiration or surgery 3. Always submit as much fluid as possible; never submit a swab dipped in fluid |
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| Transport device and/or minimum vol.:Anaerobic transport system, sterile screw-cap tube, or blood culture bottle for bacteria; transport immediately to laboratory Bacteria, >1 ml | |
| Transport time and temp: <15 min, RT | |
| Storage time:<24 h, RT; pericardial fluid and fluids for fungal cultures, <24 h, 4°C | |
| Replica limits: None | |
| Comments: Amniotic and culdocentesis fluids should be transported in an anaerobic system and need not be centrifuged prior to Gram staining. Other fluids are best examined by Gram staining of a cytocentrifuged preparation. | |
| Specimen type (reference): Gangernosu tissue (See Abscess) | |
| Comments: Discourage sampling of surface or superficial tissue. Tissue biopsy or aspiration should be performed. | |
| ^ Top | |
| Specimen type (reference): Gastric Wash or lavage for mycobacteria (20) | |
| Collection guidelines: Collect in early morning before patients eat and while they are still in bed. 1.Introduce a nasogastric tube into the stomach 2. Perform lavage with 25-50 ml of chilled, sterile distilled water 3. Recover sample and place in a leak-proof, sterile container |
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| Transport device and/or minimum vol.:Sterile, leak-proof container | |
| Transport time and temp: <15 min, RT, or neutralize within 1 h of collection | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: The specimen must be processed promptly, since mycobacteria die rapidly in gastric washings.Neutralize with sodium bicarbonate when holding for >1 h. | |
| Specimen type (reference): Biopsy for H. pylori | |
| Collection guidelines: Collected by gastroenterologist during endoscopy | |
| Transport device and/or minimum vol.:Sterile tube with transport medium | |
| Transport time and temp:<1 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:None | |
| Comments: Culture may be needed for antimicrobial testing. | |
| Specimen type (reference): Genital, female Amniotic fluid (182) | |
| Collection guidelines: Aspirate via amniocentesis, or collect during cesarean delivery | |
| Transport device and/or minimum vol.:Anaerobic transport system, >1 ml | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits: None | |
| Comments: Swabbing or aspiration of vaginal secretions is not acceptable because of the potential for contamination with the commensal vaginal flora. | |
| Specimen type (reference): Bartholin gland secretions | |
| Collection guidelines: 1. Disinfect skin with iodine preparation 2. Aspirate fluid from ducts |
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| Transport device and/or minimum vol.:Anaerobic transport system, >1 ml | |
| Transport time and temp: <2 h, RT | |
| Storage time: <24 h, RT | |
| Replica limits: 1/day | |
| Comments: | |
| Specimen type (reference): Cervical secretions (5) | |
| Collection guidelines: 1. Visualize the cervix using a speculum without lubricant 2. Remove mucus and secretions 3. Firmly yet gently sample the endocervical canal with a new sterile swab |
|
| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: See the text for collection and transport need for Chlymidia rachomatis and Neisseria | |
| Specimen type (reference): Cul-de-sac fluid | |
| Collection guidelines: Submit aspirate or fluid | |
| Transport device and/or minimum vol.:Anaerobic transport system, >1 ml | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: | |
| Specimen type (reference): Endometrial tissue and secretions | |
| Collection guidelines: 1. Collect transcervical aspirate via a telescoping catheter 2. Transfer entire amount to anaerobic transport system |
|
| Transport device and/or minimum vol.:Anaerobic transport system, >1 ml | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: | |
| Specimen type (reference): Products of conception | |
| Collection guidelines: 1. Submit a portion of tissue in a sterile container 2. If obtained by cesarean delivery, immediately transfer to an anaerobic transport system |
|
| Transport device and/or minimum vol.:Sterile tube or anaerobic transport system | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: Do not process lochia, culture of which may give misleading results. | |
| Specimen type (reference): Urethral secretions | |
| Collection guidelines: Collect at least 1 h after patient has urinated 1. Remove old exudate from the urethral orifice 2. Collect discharge material on a swab by massaging the urethra; for females, massage the urethra against the pubic symphysis through the vagina |
|
| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: If no discharge can be obtained, wash the periurethral area with Betadine soap and rinse with water. Insert a small swab 2-4 cm into the urethra, rotate it, and leave it in place for at least 2 s to facilitate absorption. | |
| Specimen type (reference): Vaginal Secretions | |
| Collection guidelines: 1. Wipe away old secretions and discharge 2. Obtain secretions from the mucosal membrane of the vaginal wall with a sterile swab or pipette 3. If a smear is also needed use a second swab |
|
| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: For intrauterine devices, place entire device into a sterile container and submit at RT. Gram stain, not culture, is recommended for the diagnosis of bacterial vaginosis. | |
| Specimen type (reference): Genital, female or male lesion | |
| Collection guidelines: 1. Cleanse with sterile saline, and remove lesion's surface with a sterile scalpel blade 2. Allow transudate to accumulate 3. While pressing the base of the lesion, firmly rub base with a sterile swab to collect fluid |
|
| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: For dark-field examination to detect T. pallidum, touch a glass slide to the transudate, add coverslip, and transport immediately to the laboratory in a humidified chamber (petri dish with moist gauze). T. pallidum cannot be cultured on artificial media. | |
| Specimen type (reference): Genital, male Prostate | |
| Collection guidelines: 1. Cleanse urethral meatus with soap and water 2. Massage prostate through rectum 3. Collect fluid expressed from urethra on a sterile swab |
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| Transport device and/or minimum vol.:Swab transport or sterile tube for >1 ml of specimen | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: Pathogens in prostatic secretions may be identified by quantitative culture of urine before and after massage. Ejaculate may also be cultured. | |
| Specimen type (reference): Urethra | |
| Collection guidelines: Insert a small swab 2-4 cm into the urethral lumen, rotate swab, and leave it in place for at least 2 s to facilitate absorption |
|
| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, RT | |
| Replica limits:1/day | |
| Comments: | |
| Specimen type (reference): Pilonidal cyst (See Abscess) | |
| Specimen type (reference): Respiratory, lower Bronchoalveolar lavage, brush or wash, endotracheal aspirate | |
| Collection guidelines: 1. Collect washing or aspirate in a sputum trap 2. Place brush in sterile container with 1 ml of saline |
|
| Transport device and/or minimum vol.:Sterile container, >1 ml | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: A total of 40-80 ml of fluid is needed for quantitative analysis of BAL fluid. For quantitative analysis of brushings, place brush into 1.0 ml of saline. |
|
| Specimen type (reference): Sputum, expectorated (8) | |
| Collection guidelines: 1. Collect specimen under the direct supervision of a nurse or physician 2. Have patient rinse or gargle with water to remove excess oral flora. 3. Instruct patient to cough deeply to produce a lower respiratory specimen (not postnasal fluid) 4. Collect in a sterile container |
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| Transport device and/or minimum vol.:Sterile container >1 ml Minimum amount: bacteria, >1 ml | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: For pediatric patients unable to produce a sputum specimen, a respiratory therapist should collect a specimen via suction. The best specimen should have <10 squamous cells/100X field (10X objective and 10X ocular). | |
| Specimen type (reference): Sputum, induced (8) | |
| Collection guidelines: 1. Have patient rinse mouth with water after brushing gums and tongue 2. With the aid of a nebulizer, have patients inhale approximately 25 ml of 3-10% sterile saline 3. Collect in a sterile container |
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| Transport device and/or minimum vol.:Sterile container, >1 ml | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: Same as above for sputum, expectorated. | |
| Specimen type (reference): Respiratory, upper Oral | |
| Collection guidelines: 1. Remove oral secretions of debris from the surface of the lesion with a swab; discard the swab 2. Using a second swab, vigorously sample the lesion, avoiding any area of normal tissue |
|
| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: Discourage sampling of superficial tissue for bacterial evaluation. Tissue biopsy specimens or needle aspirates are the specimens of choice. | |
| Specimen type (reference): Nasal | |
| Collection guidelines: 1. Insert a swab, premoistened with sterile saline, approximately 1-2 cm into the nares 2. Rotate the swab against the nasal mucosa |
|
| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp:<2 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: Anterior nose cultures are reserved for detecting staphylococcal carriers or for nasal lesions. | |
| Specimen type (reference): Nasopharynx | |
| Collection guidelines: 1. Gently insert a small swab (e.g., calcium alginate) into the posterior nasopharynx via the nose 2. Rotate swab slowly for 5 s to absorb secretions |
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| Transport device and/or minimum vol.:Direct medium inoculation at bedside or examination table, swab transport | |
| Transport time and temp:Plates: >15 min, RT; swabs; <2 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits: 1/day | |
| Comments: | |
| Specimen type (reference): Throat or pharynx | |
| Collection guidelines: 1. Depress tongue with a tongue depressor 2. Sample the posterior pharynx, tonsils, and inflamed areas with a sterile swab |
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| Transport device and/or minimum vol.:Swab transport | |
| Transport time and temp: | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: Throat swab cultures are contraindicated in patients with epiglottis. Swabs for Neisseria gonorrhoeae should be placed in charcoal-containing transport medium and plated <12 h after collection. JEMBEC, Biobags, and the GonoPak are better for transport at RT. |
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| Specimen type (reference): Tissue | |
| Collection guidelines: Collected during surgery or cutaneous biopsy procedure | |
| Transport device and/or minimum vol.:Anaerobic transport system or sterile, screw-cap container; add several drops of sterile saline to keep small pieces of tissue moist | |
| Transport time and temp: | |
| Storage time: | |
| Replica limits:1/day | |
| Comments: Always submit as much tissue as possible. If excess tissue is available, save a portion of surgical tissue at -70°C in case further studies are needed. Never submit a swab that has been rubbed over the surface of a tissue. For quantitative study, a sample of 1 cm3 is appropriate. |
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| Specimen type (reference): Urine Female, midstream (25) | |
| Collection guidelines: 1. While holding the labia apart, begin voiding 2. After several milliliters has passed, collect a midstream portion without stopping the flow of urine 3. The midstream portion is used for bacterial culture |
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| Transport device and/or minimum vol.:Sterile, wide-mouth container, >1 ml, or urine transport tube with boric acid preservative | |
| Transport time and temp: Unpreserved: <2h, RT; preserved: <24 h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: Chlamydial antigen detection in urine from women is less sensitive than in urine from men (148). Urine is toxic to cell lines and is therefore not the specimen of choice for chlamydial culture. Cleansing before voiding does not improve urine specimen quality; i.e. midstream urines are equivalent to clean-catch midstream urines (91, 132). | |
| Specimen type (reference): Urine, Male, midstream | |
| Collection guidelines: 1. While holding foreskin retracted, begin voiding 2. After several milliliters has passed, collect a midstream portion without stopping the flow of urine 3. The midstream portion is used for culture |
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| Transport device and/or minimum vol.:Sterile, wide-mouth container, >1 ml, or urine transport tube with boric acid preservative | |
| Transport time and temp:Unpreserved: <2h, RT | |
| Storage time:<24 h, 4°C | |
| Replica limits:1/day | |
| Comments: First part of urine stream is used for probe tests and antigen test for chlamydia. Collect specimen for probe and antigen tests at least 2 h after last urination | |
| Specimen type (reference): Straight catheter (25) | |
| Collection guidelines: Thoroughly cleanse the urethral opening with soap and water 2. Rinse area with wet gauze pads 3. Aseptically, insert catheter into the bladder 4. After allowing approximately 15 ml to pass, collect urine to be submitted in a sterile container |
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| Transport device and/or minimum vol.:Sterile, leak-proof container or urine transport tube with boric acid preservative | |
| Transport time and temp:Unpreserved: <2h, RT; preserved <24 h, RT | |
| Storage time: | |
| Replica limits: | |
| Comments: Catheterization may introduce members of the urethral flora into the bladder and increase the risk of iatrogenic infection | |
| Specimen type (reference): Indwelling catheter | |
| Collection guidelines: 1. Disinfect the catheter collection port with 70% alcohol 2. Use needle and syringe to aseptically collect 5-20 ml of urine 3. Transfer to a sterile tube or container |
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| Transport device and/or minimum vol.:Sterile leak-proof container or urine transport tube with boric acid preservative | |
| Transport time and temp:Unpreserved; <2 h, RT; preserved: <24 h, RT | |
| Storage time: | |
| Replica limits: | |
| Comments: Patients with indwelling catheters always have bacteria in their bladders. Do not collect urine from these patients unless they are symptomatic | |
| Specimen type (reference): Wound (See Abscess) | |