Specimen Specimen CollectionCollection

In Infectious In Infectious DiseasesDiseases

Dr.T.V.Rao MDDr.T.V.Rao MDProfessor Of MicrobiologyProfessor Of Microbiology

Why specimen collection Why specimen collection is Important in is Important in MicrobiologyMicrobiologySpecimen collection in Microbiology to Specimen collection in Microbiology to

isolate and identify the causative isolate and identify the causative agents forms back bone of the agents forms back bone of the

investigative procedures.investigative procedures.

In developing world, lack of awareness In developing world, lack of awareness and casual attitude among junior staff and casual attitude among junior staff

hampers the definitive diagnosis.hampers the definitive diagnosis.

Specific procedures in collecting Specific procedures in collecting specimens will certainly improve the specimens will certainly improve the

quality of services of Microbiology quality of services of Microbiology DepartmentsDepartments

Important questions Important questions before before collecting a collecting a

specimenspecimen Are you suspecting an Infection ?Are you suspecting an Infection ?

If so what is the Nature of infection, eg Bacterial, If so what is the Nature of infection, eg Bacterial, Viral, Mycological or ParasitologicalViral, Mycological or Parasitological

Which tests are your priority ?Which tests are your priority ? When to collect the specimen ?When to collect the specimen ? How to collect the specimen ?How to collect the specimen ? Am I choosing the correct container ?Am I choosing the correct container ? Why to send the specimens promptlyWhy to send the specimens promptly

if not what I should do ?if not what I should do ?

Fishing for Diagnosis in Fishing for Diagnosis in Laboratories, Laboratories, Is it worth? Is it worth?

The physicians and The physicians and Microbiologists should Microbiologists should be aware of the clinical be aware of the clinical manifestations, before manifestations, before undertaking the test.undertaking the test.

Microbiological tests Microbiological tests are expensive and are expensive and technically demandingtechnically demanding

Causal testing of Causal testing of Microbiological tests Microbiological tests are counterproductive.are counterproductive.

Policies on Specimen Policies on Specimen Collection.Collection.Every laboratory should formulate Every laboratory should formulate

guidelines on procedures for each guidelines on procedures for each major category of specimens and major category of specimens and

requests.requests.

Every laboratory should assist extra Every laboratory should assist extra examinations,outwith the standard examinations,outwith the standard

procedures may be required if procedures may be required if specifically requested by the Physician specifically requested by the Physician or if the clinical information provided or if the clinical information provided on the request form suggests that an on the request form suggests that an

unusual infection may be present.unusual infection may be present.

Why Proper written Why Proper written RequestRequest

Your request is a legal document.Your request is a legal document. Identifies all the outcome of test.Identifies all the outcome of test. No interchange of results.No interchange of results. Short forms are dangerousShort forms are dangerous Signature of the Doctor / Nurse is essential Signature of the Doctor / Nurse is essential

in legible form, can help to contact in case of in legible form, can help to contact in case of results which can save a patient.results which can save a patient.

When the patient is serious, write a Tele When the patient is serious, write a Tele contact number which can help in prompt contact number which can help in prompt delivery of resultsdelivery of results

An Ideal Request formAn Ideal Request form

Name xxxx Age SexName xxxx Age Sex IP/ OP No xyz Time DateIP/ OP No xyz Time Date Ward xx123 Urgent / Routine Ward xx123 Urgent / Routine Nature of specimen Nature of specimen Investigation neededInvestigation needed Doctor/StaffDoctor/Staff Contact No Contact No

12345671234567

When one Expects the When one Expects the ResultsResults

On sending the sample the On sending the sample the Physician will be anticipating the Physician will be anticipating the early reports, the Microbiologists early reports, the Microbiologists

should promptly dispatch results in should promptly dispatch results in all life saving investigations.all life saving investigations.

However the Doctors must be However the Doctors must be made aware limitation of the made aware limitation of the

investigations and discuss the pros investigations and discuss the pros and cons of the and cons of the LaboratorLaboratory reportsy reports

When to Repeat When to Repeat Diagnostic TestsDiagnostic TestsOn many occasions less than ideal On many occasions less than ideal

sample is received in laboratory.sample is received in laboratory.

The rejection of clinical samples should The rejection of clinical samples should be done with great care and wisdom of be done with great care and wisdom of only senior staff who should take the only senior staff who should take the

responsibility.responsibility.

In the welfare of the patient samples In the welfare of the patient samples can be repeatedly collected for better can be repeatedly collected for better

diagnosis, as we need repeated diagnosis, as we need repeated isolation to confirm uncommon isolation to confirm uncommon

pathogens.pathogens.

When to Collect the When to Collect the Earliest SpecimenEarliest Specimen

Start collection of specimens for all Start collection of specimens for all cultures before starting an Antibiotic.cultures before starting an Antibiotic.

The advice is ideal but may not be The advice is ideal but may not be possible, as many prescribe possible, as many prescribe Antibiotics before considers the Antibiotics before considers the Microbiological diagnostic options. Microbiological diagnostic options.

When to Request Transport When to Request Transport MediumMedium

When facilities are not available to perform When facilities are not available to perform the desired tests at the place of collection or the desired tests at the place of collection or laboratory located far away, request the laboratory located far away, request the Diagnostic laboratories to advice on Diagnostic laboratories to advice on transportation of specimens, and consider transportation of specimens, and consider how to preserve and transport in ideal how to preserve and transport in ideal medium before it is processedmedium before it is processed

Popularly used transport medium arePopularly used transport medium are

Amie 's transport MediumAmie 's transport Medium

Stuart's Transport MediumStuart's Transport Medium

V.R MediumV.R Medium

What containers to useWhat containers to use

Containers must be leak Containers must be leak proof, proof,

UnbreakableUnbreakable For cultures sterile For cultures sterile

containers a Mustcontainers a Must

Label High risk Label High risk SpecimensSpecimens

Sputum with Sputum with suspected suspected TuberculosisTuberculosis

Fecal samples Fecal samples suspected with suspected with Cholera, Typhoid,Cholera, Typhoid,

Anthrax ?Anthrax ? Serum when Serum when

suspected with suspected with HIV/ HBV/HCV, HIV/ HBV/HCV, infectionsinfections

Blood for CulturingBlood for Culturing

Blood Collection for Blood Collection for CulturingCulturing

Most important Most important investigation investigation

An appropriate An appropriate procedures in procedures in collection and collection and processing, processing, identifying and identifying and timely reporting timely reporting can be Life can be Life savingsaving

Collection of BloodCollection of Blood

A scientific approaches and A scientific approaches and dedicated staff participating dedicated staff participating in blood collection will in blood collection will eliminate the basic failure as eliminate the basic failure as ContaminationContamination

Improper handling of Improper handling of syringes increases chances syringes increases chances of contaminationof contamination

Contamination hampers the Contamination hampers the ideal reporting,ideal reporting,

A valuable time is lostA valuable time is lost The goal in blood collection The goal in blood collection

is avoiding the is avoiding the contaminationcontamination

Collecting the Blood for Collecting the Blood for CulturingCulturing

Teach the staff how Teach the staff how to collect the Blood.to collect the Blood.

The nurse are The nurse are advised on principles advised on principles of aseptic of aseptic precautions by self precautions by self as washing hands as washing hands and wearing gloves and wearing gloves

Proper areas of Proper areas of disinfection with disinfection with good antiseptic good antiseptic solutions.solutions.

Hygienic precautions will Hygienic precautions will decrease contaminationdecrease contamination

The staff should be The staff should be advised how to disinfect advised how to disinfect the skin over vein, to the skin over vein, to use a fresh sterile use a fresh sterile syringe for the syringe for the venepuncture with fresh venepuncture with fresh sterile needle before sterile needle before inoculating culture inoculating culture bottlebottle

The staff should The staff should disinfect their hands disinfect their hands before doing the before doing the procedure.procedure.

PProper handling of Syringe is roper handling of Syringe is essential to obtain a blood essential to obtain a blood

specimenspecimen The staff should The staff should

hold the needle by hold the needle by its butt, not shaft. its butt, not shaft. Either with sterile Either with sterile forceps or with forceps or with fingers covered with fingers covered with a dry sterile rubber a dry sterile rubber glove, and protect glove, and protect self with potentially self with potentially infective pathogensinfective pathogens

Do not collect from existing or Do not collect from existing or indwelling cathetersindwelling catheters

The staff are warned that The staff are warned that contamination is very contamination is very

likely if the specimen is likely if the specimen is collected from an collected from an

indwelling peripheral indwelling peripheral venous catheter instead venous catheter instead

of from a fresh of from a fresh venpuncture.venpuncture.

Always collect the Blood Always collect the Blood specimens in Hygienic areasspecimens in Hygienic areas All procedures in All procedures in

relation to relation to processing of the processing of the samples should be samples should be done in a sterile done in a sterile environment, or environment, or bacteria free areas.bacteria free areas.

Despite insistence on Despite insistence on aseptic precautions, aseptic precautions, most laboratories most laboratories report finding report finding contamination in 1-contamination in 1-5% of the blood 5% of the blood cultures.cultures.

Cerebrospinal fluid Cerebrospinal fluid examinationexamination

Specimen collection for Specimen collection for CSF ExaminationCSF Examination

Lumbar puncture Lumbar puncture to collect the CSF to collect the CSF for examination to for examination to be collected by be collected by Physician trained Physician trained in procedure with in procedure with aseptic aseptic precautions to precautions to prevent prevent introduction of introduction of Infection.Infection.

Procedure to collect CSFProcedure to collect CSF

The trained physician The trained physician will collect only 3-5 ml will collect only 3-5 ml into a labeled sterile into a labeled sterile containercontainer

Removal of large Removal of large volume of CSF lead to volume of CSF lead to headache,headache,

The fluid to be collected The fluid to be collected at the rate of 4-5 drops at the rate of 4-5 drops per second.per second.

If sudden removal of If sudden removal of fluid is allowed may fluid is allowed may draw down cerebellum draw down cerebellum into the Foramen into the Foramen magnum and compress magnum and compress the Medulla of the the Medulla of the BrainBrain

CSF needs a New and Sterile CSF needs a New and Sterile containercontainer

Fresh sterile screw Fresh sterile screw capped container to capped container to be used.be used.

Reused containers, Reused containers, not to be used, not to be used, contamination from contamination from the previous the previous specimens specimens misrepresent the misrepresent the present specimen.present specimen.

Lumbar puncture for CSF Lumbar puncture for CSF collectioncollection

The best site for puncture The best site for puncture is inter space between 3 is inter space between 3 and 4 lumbar vertebrae and 4 lumbar vertebrae

( ( Corresponds to highest point of iliac crest )Corresponds to highest point of iliac crest )

The Physician should wear The Physician should wear sterile gloves and sterile gloves and conduct the procedure conduct the procedure with sterile precautions, with sterile precautions, The site of procedure The site of procedure should be disinfected and should be disinfected and sterile occlusive dressing sterile occlusive dressing applied to the puncture applied to the puncture site after the procedure.site after the procedure.

Transportation to Transportation to LaboratoryLaboratory

The collected The collected specimen of CSF to specimen of CSF to be dispatched be dispatched promptly to promptly to Laboratory , delay Laboratory , delay may cause death of may cause death of delicate pathogens, delicate pathogens, eg Meningococci eg Meningococci and disintegrate and disintegrate leukocytesleukocytes

Preservation of CSFPreservation of CSF

It is important when It is important when there is delay in there is delay in transportation of transportation of specimens to specimens to Laboratory do not Laboratory do not keep in Refrigerator, keep in Refrigerator, which tends to kill which tends to kill H. Influenza H. Influenza

If delay is If delay is anticipated leave at anticipated leave at Room Temperature.Room Temperature.

Upper Respiratory Upper Respiratory InfectionsInfections

What are Upper What are Upper Respiratory InfectionsRespiratory Infections

The commonest respiratory infections The commonest respiratory infections are localised in Oropharynx, are localised in Oropharynx, Nasopharynx, and nasal cavity,Nasopharynx, and nasal cavity,

Causes Causes Sore thraot,nasal discharge and Sore thraot,nasal discharge and often fever. Infect larynx,otitis often fever. Infect larynx,otitis media,sinusitis,conjunctivitis or media,sinusitis,conjunctivitis or keratitis.keratitis.

May present with serious diseases May present with serious diseases whooping cough, influenza , measles whooping cough, influenza , measles and infectious mononucleosis.and infectious mononucleosis.

Aetiological agents in Aetiological agents in Upper Respiratory Upper Respiratory

InfectionsInfections In most cases the primary infections are In most cases the primary infections are caused by virus, difficult to isolate.caused by virus, difficult to isolate.

But many infections are caused by But many infections are caused by concomitant carriage or secondary infection concomitant carriage or secondary infection with one of the potential pathogens present with one of the potential pathogens present in the Nasopharynx 1 in the Nasopharynx 1 Pneumococcus .Haemophilus influenza Pneumococcus .Haemophilus influenza Staphylococcus aureus, and Streptococcus Staphylococcus aureus, and Streptococcus pyogenes.pyogenes.

Drug resistant coli form bacilli or yeasts may Drug resistant coli form bacilli or yeasts may dominate the throat flora in patients dominate the throat flora in patients receiving antibiotics.receiving antibiotics.

Specimen collectionSpecimen collectionin Throat Infectionsin Throat Infections

A plain cotton A plain cotton wool swab should wool swab should be used to collect be used to collect as much exudates as much exudates as possible from as possible from tonsils, posterior tonsils, posterior pharyngeal wall pharyngeal wall and other area and other area that is inflamed that is inflamed or bears exudatesor bears exudates

Cooperation of the patient Cooperation of the patient and ideal techniques and ideal techniques

contributes better resultscontributes better results If cooperated by If cooperated by

patient, the swab patient, the swab should be rubbed should be rubbed with rotation over with rotation over one tonsillar area one tonsillar area of the soft palate of the soft palate and uvula, the and uvula, the other tonsillar other tonsillar area and finally area and finally the posterior the posterior pharynxpharynx

Collecting the SwabCollecting the Swab

An adequate view An adequate view of throat should be of throat should be ensured by good ensured by good lighting conditions lighting conditions and the use of a and the use of a disposable wooden disposable wooden spatula or a spatula or a tongue depressor tongue depressor to pull outwards to pull outwards and so depress the and so depress the tongue.tongue.

Transportation of Throat Transportation of Throat SwabsSwabs

The swab should be The swab should be replaced in its tube replaced in its tube with care not to soil with care not to soil the rimthe rimIf it cannot be If it cannot be transported transported immediately to immediately to laboratory it should be laboratory it should be placed in a refrigerator placed in a refrigerator at 4at 4ºc until delivery or ºc until delivery or preferably submitted preferably submitted in a tube of transport in a tube of transport mediummedium

Nasal specimensNasal specimens A deep nasal swab A deep nasal swab

generally yields the generally yields the same information as same information as throat swab.throat swab.

Nasal swabs are Nasal swabs are taken to detect taken to detect healthy carriers healthy carriers than diagnose deep than diagnose deep infectioninfection

Deep nasal are Deep nasal are taken to diagnose taken to diagnose S.pyogenes and S.pyogenes and Diphtheria bacillus.Diphtheria bacillus.

Specimens in sinusitisSpecimens in sinusitis

Pus collected or Pus collected or aspirated from aspirated from sinus, or a saline sinus, or a saline wash out should wash out should be examined in a be examined in a Gram film and Gram film and by culture on by culture on aerobic and aerobic and anaerobic blood anaerobic blood agar plates.agar plates.

Collection of Ear SwabsCollection of Ear SwabsAcute Otitis MediaAcute Otitis Media

Acute Otitis Media – Acute Otitis Media – as long as eardrum as long as eardrum remains intact, none remains intact, none of the infected of the infected exudates can be exudates can be collected on an ear collected on an ear swab , though swab , though culture of the throat culture of the throat swab may give a swab may give a provisional provisional indication of casual indication of casual organismorganism

Chronic suppurative Chronic suppurative Otitis mediaOtitis media

Swabs of the Swabs of the discharge in the discharge in the external meatus external meatus should be should be cultured to cultured to guide the guide the choice of choice of antibiotics for antibiotics for systemic and systemic and topical therapy.topical therapy.

Otitis externaOtitis externa A swab should be taken A swab should be taken

from the meatus and from the meatus and cultured aerobically on cultured aerobically on blood agar and blood agar and MacConkey agar plates MacConkey agar plates for the bacteria.for the bacteria.

All specimens should All specimens should also cultured on also cultured on Sabouraud’s agar plate Sabouraud’s agar plate with Nystatin 50 units with Nystatin 50 units for Candida and for Candida and Aspergillus.Aspergillus.

Eye SwabsEye Swabs Obtaining a Obtaining a

adequate specimen adequate specimen is difficult.is difficult.

It is best to make It is best to make smears and seed smears and seed culture plates beside culture plates beside the patient the patient immediately after immediately after collecting the collecting the material from the material from the eye.eye.

Collection of Eye swabsCollection of Eye swabs It is ideal to pick up It is ideal to pick up

the material with a the material with a loop or on the loop or on the smoothly rounded tip smoothly rounded tip of a thin glass rod or of a thin glass rod or on the thin serum on the thin serum coated swabcoated swab

Clinical material from Clinical material from Conjunctiva, i.e. from Conjunctiva, i.e. from averted eyelid,averted eyelid,

The margin of the The margin of the eyelid should be eyelid should be avoided.avoided.

Specimens for Lower Specimens for Lower Respiratory Infections.Respiratory Infections.

Lower Respiratory Lower Respiratory InfectionsInfections

Sputum is the material from the lower Sputum is the material from the lower respiratory infections most commonly submitted respiratory infections most commonly submitted for bacteriological examination. The sputum is a for bacteriological examination. The sputum is a mixture of bronchial secretions and mixture of bronchial secretions and inflammatory exudates coughed up into the inflammatory exudates coughed up into the mouth and expectoratedmouth and expectorated

There are several difficulties both in collecting a There are several difficulties both in collecting a suitable sample and interpreting the results of suitable sample and interpreting the results of the culturethe culture

Busy and uninstructed staff may send collection Busy and uninstructed staff may send collection of saliva to the laboratory.of saliva to the laboratory.

On several occasions repeat sample may be On several occasions repeat sample may be required to isolate the causative agent.required to isolate the causative agent.

Instruction for collecting Instruction for collecting sputumsputum

Make the collection Make the collection in a disposable and in a disposable and wide mouthed screw wide mouthed screw capped plastic capped plastic container of 50 – 100 container of 50 – 100 ml capacity.ml capacity.

Collect sputum Collect sputum before antibiotics are before antibiotics are given.given.

Ideal to have when Ideal to have when patient wakes up and patient wakes up and with first cough.with first cough.

Precautions in handling Precautions in handling the specimensthe specimens

Avoid spilling the Avoid spilling the material over the material over the rim.rim.

Tightly screw on the Tightly screw on the cap of the container.cap of the container.

Wipe off any spilled Wipe off any spilled material on its material on its outside with tissue outside with tissue paperpaper

Deliver the specimen Deliver the specimen quickly to laboratoryquickly to laboratory

Sputum Examination for Sputum Examination for TuberculosisTuberculosis

Specimen should Specimen should be collected with be collected with biosaftey biosaftey precautions.precautions.

Several specimens Several specimens should be collected should be collected before coming to before coming to negative negative conclusions.conclusions.

Specimens for Urinary Specimens for Urinary Tract InfectionsTract Infections

Collecting Urine for Collecting Urine for examinationexamination

Collect the Mid Collect the Mid stream specimens stream specimens of Urineof Urine

Do not collect Do not collect spontaneously spontaneously passed urine passed urine without without instructions, which instructions, which can lead to can lead to contamination with contamination with commensals commensals bacteria Colonized bacteria Colonized on urethral orifice on urethral orifice and perineumand perineum

Specimen CollectionSpecimen Collection

The urine collected in The urine collected in a wide mouthed a wide mouthed container from container from patientspatients

A mid stream A mid stream specimen is the most specimen is the most ideal for processingideal for processing

Female patients Female patients passes urine with a passes urine with a labia separated and labia separated and mid stream sample is mid stream sample is collectedcollected

How Urine Specimens How Urine Specimens collected in young and collected in young and

infantsinfants Non invasive methods are Non invasive methods are

safe and idealsafe and ideal Follow the Broom hall Follow the Broom hall

method,method, By tapping just above By tapping just above

the pubis with two the pubis with two fingers placed on supra fingers placed on supra pubic region after 1 pubic region after 1 hour of feed, tapping hour of feed, tapping on at the rate of 1 on at the rate of 1 tap/second for a period tap/second for a period of 1 minute, if not of 1 minute, if not successful tapping is successful tapping is repeated once again.repeated once again.

The child spontaneously The child spontaneously pass the Urine and to be pass the Urine and to be collected in a sterile collected in a sterile containercontainer

Transport of Urine for Transport of Urine for Culturing Culturing

All collected specimens All collected specimens of urine to be of urine to be transported to transported to laboratory with out laboratory with out delaydelay

Delay of 1 – 2 hour Delay of 1 – 2 hour deter the quality of deter the quality of diagnostic evaluations.diagnostic evaluations.

If the delay is If the delay is anticipated the anticipated the specimens are at specimens are at preserved at 4preserved at 400cc

In field conditions Boric In field conditions Boric acid can be added at a acid can be added at a concentration of 1.8 %concentration of 1.8 %

Genital Tract InfectionsGenital Tract Infections

Genital Infections in Genital Infections in womenwomen

Genital infections Genital infections present with, present with, arthritis, arthritis, vaginosis, genital vaginosis, genital ulceration, ulceration, cervicitis, uterine cervicitis, uterine sepsis, salphingits, sepsis, salphingits, oophoritis, and oophoritis, and pelvic pelvic inflammatory inflammatory disease.disease.

Collection of specimensCollection of specimens The specimen The specimen

commonly collected commonly collected for the diagnosis of for the diagnosis of vaginiti’s, vaginosis vaginiti’s, vaginosis or uterine sepsis is or uterine sepsis is high vaginal swabhigh vaginal swab

The swab is inserted The swab is inserted into upper part of the into upper part of the vagina and rotated vagina and rotated there before there before withdrawing it.withdrawing it.

Specimen collection in Specimen collection in GonorrhoeaGonorrhoea

An endocervical swab An endocervical swab must be collected for must be collected for examination for examination for gonococci.gonococci.

A vaginal speculum A vaginal speculum must be used to must be used to provide a clear sight of provide a clear sight of the cervix and swab is the cervix and swab is rubbed in and around rubbed in and around the introitus of the the introitus of the cervix and withdrawn cervix and withdrawn without contamination without contamination from vaginal wall.from vaginal wall.

Specimens from other Specimens from other genital areasgenital areas

Other swabs should Other swabs should be collected from any be collected from any exduate discharged exduate discharged from the meatus of from the meatus of the urethra or a the urethra or a Bartholin's gland.Bartholin's gland.

Rectal or pharyngeal Rectal or pharyngeal swabs should be swabs should be considered depends considered depends on sexual habits of on sexual habits of the patientthe patient

Transportation of Transportation of specimensspecimens

All the swabs to be promptly All the swabs to be promptly transported to laboratory, in cases transported to laboratory, in cases of delay or in cases of delicate of delay or in cases of delicate microbes to be transported in microbes to be transported in Amie's transport medium.Amie's transport medium.

If possible two swabs to be If possible two swabs to be collected and submitted for each collected and submitted for each site.site.

Specimen collection in Specimen collection in MenMen

The infection in The infection in men are mostly men are mostly caused by the same caused by the same organism as in organism as in women.women.

Urethritis is Urethritis is commonest commonest presentation may presentation may be caused by be caused by Gonococci or Non-Gonococci or Non-gonococcal.gonococcal.

May present with May present with Genital Ulcers.Genital Ulcers.

Gonococcus infection in Gonococcus infection in MenMen

The specimen is The specimen is collected by milking collected by milking the urethra and the urethra and urethral discharge urethral discharge is smeared on slides is smeared on slides and inoculated on and inoculated on warmed plates of warmed plates of heated blood agar heated blood agar or selective medium or selective medium for isolation of for isolation of GonococciGonococci

Other Genital infections Other Genital infections When prostatitis is When prostatitis is

suspected and there suspected and there is no spontaneous is no spontaneous discharge from discharge from urethra, massage of urethra, massage of the prostate per the prostate per rectum may express rectum may express some exduate for some exduate for examination, and examination, and culture.culture.

Collection of specimens Collection of specimens in Chancresin Chancres

TThe examination of he examination of chancre requires chancre requires the careful the careful collection of collection of exudates and its exudates and its preparation for preparation for dark ground dark ground microscopy.microscopy.

Many patients need Many patients need clotted blood for clotted blood for specific serological specific serological investigation.investigation.

Wound, Skin, and Wound, Skin, and Deep SepsisDeep Sepsis

Collection of Collection of specimensspecimens

PPus or exudates is us or exudates is often submitted on a often submitted on a swab for laboratory swab for laboratory investigation.investigation.

The swabs are The swabs are inefficient sampling inefficient sampling device and tends to device and tends to desiccate the specimen desiccate the specimen and trap the bacteria and trap the bacteria which are then not which are then not released on to culture released on to culture plateplate

Ideal samples from Ideal samples from woundswounds

The ideal sample is pus or The ideal sample is pus or exudates should be exudates should be submitted in a small submitted in a small screw-capped bottle in screw-capped bottle in firmly stoppered tube or firmly stoppered tube or syringe or a sealed syringe or a sealed capillary tube.capillary tube.

Fragments of excised Fragments of excised tissue removed at tissue removed at wound toilet or wound toilet or curettings from infected curettings from infected sinuses and other sinuses and other tissues should be sent tissues should be sent in a sterilein a sterile container. container.

Gastrointestinal Gastrointestinal InfectionsInfections

Collection of specimensCollection of specimens Whenever possible, Whenever possible,

a specimen of faeces a specimen of faeces should be collected.should be collected.

A rectal swab is A rectal swab is unsatisfactory, unsatisfactory, unless it is heavily unless it is heavily charged and visibly charged and visibly stained with faeces stained with faeces collected from collected from rectum, not anusrectum, not anus

Collection of FaecesCollection of Faeces

The specimen may be collected The specimen may be collected from faeces passed into a clean from faeces passed into a clean bed pan, not mixed with urine, bed pan, not mixed with urine, or disinfectant or from the or disinfectant or from the surface of heavily soiled toilet surface of heavily soiled toilet paper.paper.

The specimen is collected into The specimen is collected into 25 ml screw capped wide 25 ml screw capped wide mouthed disposable container.mouthed disposable container.

Transportation of Transportation of specimenspecimen

Collect 1-2 ml of faeces, and apply the Collect 1-2 ml of faeces, and apply the cap tightly.cap tightly.

Take care not to soil the rim or outside of Take care not to soil the rim or outside of the bottle.the bottle.

Transmit the container quickly to Transmit the container quickly to laboratory.laboratory.

If delay is unavoidable and particularly If delay is unavoidable and particularly when the weather is warm collect the when the weather is warm collect the specimens in a container holding 6 ml specimens in a container holding 6 ml buffered glycerol saline transport mediumbuffered glycerol saline transport medium

Specimen collection for Specimen collection for Virological diseasesVirological diseases

Direct virus diagnosis depends on the Direct virus diagnosis depends on the detection of virus particles, viral detection of virus particles, viral antigen or viral nucleic acid in antigen or viral nucleic acid in specimen taken from the site of specimen taken from the site of

infection.infection.

Specimens should be delivered Specimens should be delivered promptly to the laboratory so that no promptly to the laboratory so that no

deterioration in the quality of the cells deterioration in the quality of the cells occur.occur.

However the specimen collection However the specimen collection techniques alter depending on the techniques alter depending on the

Aetiological agent and site of Aetiological agent and site of involvement.involvement.

Training the Paramedical Training the Paramedical StaffStaff Nursing staff and Medical Assistants Nursing staff and Medical Assistants

are the strengths of specimen collection are the strengths of specimen collection in the Developing worldin the Developing world

All the progressive Medical All the progressive Medical Institutes should train their staff in Institutes should train their staff in proper and scientific methods in proper and scientific methods in

specimen collection and a fraction specimen collection and a fraction of Morbidity and Mortality can be of Morbidity and Mortality can be

reduced.reduced. Dr.T.V.Rao MDDr.T.V.Rao MD

Created for awareness on specimen Created for awareness on specimen collection in developing world among collection in developing world among

the Medical and Paramedical staffthe Medical and Paramedical staffDr.T.V.Rao MDDr.T.V.Rao MD

emailemaildoctortvrao@gmail.comdoctortvrao@gmail.com