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Are you suspecting an Infection ? If so what is the Nature of infection, eg Bacterial, Viral, Mycological or Parasitological Which tests are your priority ? When to collect the specimen ? How to collect the specimen ? Am I choosing the correct container ? Why to send the specimens promptly if not what I should do ?
The physicians and Microbiologists should be aware of the clinical manifestations, before undertaking the test. Microbiological tests are expensive and technically demanding Causal testing of Microbiological tests are counterproductive.
Your request is a legal document. Identifies all the outcome of test. No interchange of results. Short forms are dangerous Signature of the Doctor / Nurse is essential in legible form, can help to contact in case of results which can save a patient. When the patient is serious, write a Tele contact number which can help in prompt delivery of results
Name xxxx Age Sex IP/ OP No xyz Time Date Ward xx123 Urgent / Routine Nature of specimen Investigation needed Doctor/Staff Contact No 1234567
When facilities are not available to perform the desired tests at the place of collection or laboratory located far away, request the Diagnostic laboratories to advice on transportation of specimens, and consider how to preserve and transport in ideal medium before it is processed
Unbreakable
For
Most important investigation An appropriate procedures in collection and processing, identifying and timely reporting can be Life saving
Collection of Blood
A scientific approaches and dedicated staff participating in blood collection will eliminate the basic failure as Contamination Improper handling of syringes increases chances of contamination Contamination hampers the ideal reporting, A valuable time is lost The goal in blood collection is avoiding the contamination
Teach the staff how to collect the Blood. The nurse are advised on principles of aseptic precautions by self as washing hands and wearing gloves Proper areas of disinfection with good antiseptic solutions.
The staff should be advised how to disinfect the skin over vein, to use a fresh sterile syringe for the venepuncture with fresh sterile needle before inoculating culture bottle The staff should disinfect their hands before doing the procedure.
The staff should hold the needle by its butt, not shaft. Either with sterile forceps or with fingers covered with a dry sterile rubber glove, and protect self with potentially infective pathogens
staff are warned that contamination is very likely if the specimen is collected from an indwelling peripheral venous catheter instead of from a fresh venepuncture.
The
All procedures in relation to processing of the samples should be done in a sterile environment, or bacteria free areas. Despite insistence on aseptic precautions, most laboratories report finding contamination in 1-5% of the blood cultures.
Lumbar puncture to collect the CSF for examination to be collected by Physician trained in procedure with aseptic precautions to prevent introduction of Infection.
The trained physician will collect only 3-5 ml into a labeled sterile container Removal of large volume of CSF lead to headache, The fluid to be collected at the rate of 4-5 drops per second. If sudden removal of fluid is allowed may draw down cerebellum into the Foramen magnum and compress the Medulla of the Brain
Fresh sterile screw capped container to be used. Reused containers, not to be used, contamination from the previous specimens misrepresent the present specimen.
The best site for puncture is inter space between 3 and 4 lumbar vertebrae
( Corresponds to highest point of iliac crest )
The Physician should wear sterile gloves and conduct the procedure with sterile precautions, The site of procedure should be disinfected and sterile occlusive dressing applied to the puncture site after the procedure.
Transportation to Laboratory
The collected specimen of CSF to be dispatched promptly to Laboratory , delay may cause death of delicate pathogens, eg Meningococci and disintegrate leukocytes
Preservation of CSF
It is important when there is delay in transportation of specimens to Laboratory do not keep in Refrigerator, which tends to kill H. Influenza If delay is anticipated leave at Room Temperature.
In most cases the primary infections are caused by virus, difficult to isolate. But many infections are caused by concomitant carriage or secondary infection with one of the potential pathogens present in the Nasopharynx 1 Pneumococcus .Haemophilus influenza Staphylococcus aureus, and Streptococcus pyogenes. Drug resistant coli form bacilli or yeasts may dominate the throat flora in patients receiving antibiotics.
A plain cotton wool swab should be used to collect as much exudates as possible from tonsils, posterior pharyngeal wall and other area that is inflamed or bears exudates
If cooperated by patient, the swab should be rubbed with rotation over one tonsillar area of the soft palate and uvula, the other tonsillar area and finally the posterior pharynx
An adequate view of throat should be ensured by good lighting conditions and the use of a disposable wooden spatula or a tongue depressor to pull outwards and so depress the tongue.
swab should be replaced in its tube with care not to soil the rim If it cannot be transported immediately to laboratory it should be placed in a refrigerator at 4c until delivery or preferably submitted in a tube of transport medium
Nasal specimens
A deep nasal swab generally yields the same information as throat swab. Nasal swabs are taken to detect healthy carriers than diagnose deep infection Deep nasal are taken to diagnose S.pyogenes and Diphtheria bacillus.
Specimens in sinusitis
Pus
collected or aspirated from sinus, or a saline wash out should be examined in a Gram film and by culture on aerobic and anaerobic blood agar plates.
Acute otitis Media as long as eardrum remains intact, none of the infected exudates can be collected on an ear swab , though culture of the throat swab may give a provisional indication of casual organism
of the discharge in the external meatus should be cultured to guide the choice of antibiotics for systemic and topical therapy.
Otitis externa
A swab should be taken from the meatus and cultured aerobically on blood agar and MacConkey agar plates for the bacteria. All specimens should also cultured on Sabourauds agar plate with Nystatin 50 units for Candida and Aspergillus.
Eye Swabs
Obtaining a adequate specimen is difficult. It is best to make smears and seed culture plates beside the patient immediately after collecting the material from the eye.
It is ideal to pick up the material with a loop or on the smoothly rounded tip of a thin glass rod or on the thin serum coated swab Clinical material from Conjunctiva, i.e. from everted eyelid, The margin of the eyelid should be avoided.
Sputum is the material from the lower respiratory infections most commonly submitted for bacteriological examination. The sputum is a mixture of bronchial secretions and inflammatory exudates coughed up into the mouth and expectorated There are several difficulties both in collecting a suitable sample and interpreting the results of the culture Busy and uninstructed staff may send collection of saliva to the laboratory. On several occasions repeat sample may be required to isolate the causative agent.
Make the collection in a disposable and wide mouthed screw capped plastic container of 50 100 ml capacity. Collect sputum before antibiotics are given. Ideal to have when patient wakes up and with first cough.
Collect the Mid stream specimens of Urine Do not collect spontaneously passed urine without instructions, which can lead to contamination with commensals bacteria Colonized on urethral orifice and perineum
Specimen Collection
The urine collected in a wide mouthed container from patients A mid stream specimen is the most ideal for processing Female patients passes urine with a labia separated and mid stream sample is collected
All collected specimens of urine to be transported to laboratory with out delay Delay of 1 2 hour deter the quality of diagnostic evaluations. If the delay is anticipated the specimens are at preserved at 40c In field conditions Boric acid can be added at a concentration of 1.8 %
Genital infections present with, urethritis, vaginosis, genital ulceration, cervicitis, uterine sepsis, salphingits, oophoritis, and pelvic inflammatory disease.
Collection of specimens
The specimen commonly collected for the diagnosis of vaginitis, vaginosis or uterine sepsis is high vaginal swab The swab is inserted into upper part of the vagina and rotated there before withdrawing it.
An endocervical swab must be collected for examination for gonococci. A vaginal speculum must be used to provide a clear sight of the cervix and swab is rubbed in and around the introitus of the cervix and withdrawn without contamination from vaginal wall.
Other swabs should be collected from any exudate discharged from the meatus of the urethra or a Bartholin's gland. Rectal or pharyngeal swabs should be considered depends on sexual habits of the patient
Transportation of specimens the swabs to be promptly transported to laboratory, in cases of delay or in cases of delicate microbes to be transported in Amie's transport medium. If possible two swabs to be collected and submitted for each site.
All
The specimen is collected by milking the urethra and urethral discharge is smeared on slides and inoculated on warmed plates of heated blood agar or selective medium for isolation of Gonococci
When prostatitis is suspected and there is no spontaneous discharge from urethra, massage of the prostate per rectum may express some exudate for examination, and culture.
The examination of chancre requires the careful collection of exudates and its preparation for dark ground microscopy. Many patients need clotted blood for specific serological investigation.
Collection of specimens
The ideal sample is pus or exudates should be submitted in a small screwcapped bottle in firmly stoppered tube or syringe or a sealed capillary tube. Fragments of excised tissue removed at wound toilet or curettings from infected sinuses and other tissues should be sent in a sterile container.
Gastrointestinal Infections
Collection of specimens
Whenever possible, a specimen of faeces should be collected. A rectal swab is unsatisfactory, unless it is heavily charged and visibly stained with faeces collected from rectum, not anus
Collection of Faeces
The
specimen may be collected from faeces passed into a clean bed pan, not mixed with urine, or disinfectant or from the surface of heavily soiled toilet paper. The specimen is collected into 25 ml screw capped wide mouthed disposable container.
Transportation of specimen
Collect 1-2 ml of faeces, and apply the cap tightly. Take care not to soil the rim or outside of the bottle. Transmit the container quickly to laboratory. If delay is unavoidable and particularly when the weather is warm collect the specimens in a container holding 6 ml buffered glycerol saline transport medium