BACTE SPECIMEN MANAGEMENT Flashcards
The goal of the collector in specimen collection
maintain the viability of
organisms with minimal contamination
collect the specimen in the ______________ of the infection _________________________ and _________________________________
acute (early) phase, or within 2-3 days for viral infections, before antibiotics are administered
Collect the specimen using the proper technique and
supplies with minimal contamination from ____________________
normal biota
Label the specimen accurately with the specific
anatomic site and the patient information—_______________________________________________________
patient’s
name and unique identification number, as well as
date and time of collection.
collection medium for upper respiratory tract, and genitourinary tract
Pre-moistened Swab
collection medium for Stool
Clean Leak-proof
Container
collection medium for corneal scrapings
Bedside Plating
collection medium for Hair, Nails, Skin scrapings
Clean Screw Top-tube (for
fungal culture)
Bags should be marked with ______________________________
BIOHAZARD LABEL
when using swabs ________________ should be summited
Two swabs, (direct smear and culture)
Wound fibers
may trap
specimens and
prevent the
efficient release
Regular Fiber Swab
Perpendicular
arrangement of fibers
and solid swab head
aid in the release of
specimen
Nylon Flocked Swab
preferred material for the tip of swabs
Dacron, rayon, or Calcium alginate
contain excessive fatty acids
which are inhibitory and toxic to some bacteria
Cotton-tipped swabs
To counteract fatty acids, ___________________ can be added to media to absorb fatty acids present
in the specimen
charcoal
_______________________
are not recommended for viral collection (SARS-CoV-2)
Calcium alginate swabs or swabs with wooden shafts
is not an appropriate specimen source when the exact
anatomic site is not provided.
WOUND
swab recommended for viral collection
Use synthetic fiber swabs with thin or wire shafts (nylon flocked swabs)
The specimen for wound should be collected by _______________________ rather than by swab from the advancing
margin of the lesion
needle aspiration
Specimen that can be collected by patients
Urine, sputum, stool
specimen should be Transported ideally within __________ of collection, preferably within _____
30 mins, 2 hrs
specimens that must immediately be transported
Bone, Prostatic samples tube
specimens that must transported in less than 15 mins
Body fluids, CSF, Gastric wash or lavage
specimens that must transported within 1 hour
Gastric biopsy, Stool
specimens that must transported within 24 hours
Bone marrow aspirate, preserved clean-voided midstream urine
fungal culture, hair, nail scrapings must be transported within ________
● 72 hrs
unpreserved urine must be transported within __________
30 mins
If transport is delayed, the specimen can be
maintained by storage under certain conditions or with
the use of
Preservatives
○ Anticoagulants
○ Transport or holding medium or culture
medium
used to maintain urine colony counts
Boric Acid
preservation for
stool for ova and parasite examination ( maintain the
integrity of trophozoites and cysts)
Polyvinyl Alcohol (PVA) and Buffered Formalin
__________ for Clostridium difficile toxin assay should be
collected without a preservative and can be
refrigerated
Stools
Preservatives (fixatives) should NOT be ADDED to
fecal specimens for _________________
bacteriological testing
Stool specimens for bacterial culture that are
not transported immediately can be _________________, at around ___________________
refrigerated, -70 deg C
f the delay is longer than 2 hours, the specimen can be added to ___________________________
Cary-Blair transport medium
Contains substances that do not promote the
multiplication of microorganisms but ensure their
preservation and are available in swab collection
systems
TRANSPORT OR HOLDING MEDIA
Commercial transport
system used for N.
gonorrhoeae
JEMBEC (John E. Martin
Biologic Environmental
Chamber)
Contains selective agar
(Modified Thayer-Martin)
and carbon dioxide
generating tablet (sodium
bicarbonate and citric
acid)
JEMBEC (John E. Martin
Biologic Environmental
Chamber)
● Recovery of aerobic and
anaerobic bacteria
● For respiratory samples
Amie’s transport media
● For stool pathogens
(Salmonella, Shigella,
Vibrio, or Campylobacter)
Cary-Blair
Multi-purpose transport
media
Stuart’s
● Neisseria
Transgrow
● For vaginal swab (S.
agalactiae)
Todd-Hewitt and LIM
(Modified Todd-Hewitt)
● Viral Transport Media
(VTM)
Leibovitz-Emory media
● Suspected bacillary
dysentery (stool)
Sach’s buffered glycerol
saline
● Suspected Cholera
Venkatraman
Ramakrishnan (VR)
medium
To prevent clotting of specimens, including blood,
bone marrow, and synovial fluid ( if the specimen is
clotted, organisms are trapped in clotted material an
difficult to isolate)
ANTICOAGULANTS
commonly used and is the most
appropriate/common anticoagulant used for
microbiology specimens
Sodium polyanethol sulfonate (SPS) at 0.025%
blood to sps ratio
10:1
______________ - counteracts the action of SPS
Addition of 1% gelatin
often used for viral cultures and isolation of
Mycobacterium spp. from blood and may inhibit the
growth of gram-positive bacteria and yeast
Heparin
specimen storage for Body Fluids, Bone
IUD (Intrauterine Device)
IV catheters
Prostatic Fluid in TUBES
Suprapubic Aspirate
Must be plated as
soon as received
specimen storage for Blood, Corneal Scrapings
Must be incubated at
37 deg C on
specimen storage for blood
Less than or equal to
2 hrs at ROOM TEMP
specimen storage for Abscess, Bone Marrow Aspirate,
Body fluids, Inner Ear, CSF for
bacteria (15th edition), Conjunctiva,
Aqueous Fluid, Corneal Scraping,
Rectal Swab, Genital Tracts,
Prostate fluid SWAB, Urethra,
Upper Respiratory Tract, Tissues
Within 24 hrs at
ROOM
TEMPERATURE
specimen storage for Pericardial Fluid and other fluids
(fungal culture), External Ear, IV
Catheters, Gastric Wash/Lavage,
Gastric Biopsy, Stool (Routine),
Unpreserved stool for E. coli toxin
assays, BAL, Endotracheal
aspirate, BW/BB, Sputum,
Clean-voided midstream urine and
Straight catheter
Within 24 hrs at 4 deg C
specimen storage for C. difficile culture or nucleic acid
detection
2 days at 4 deg C
specimen storage for CSF for viruses detection
3 days at 4 deg C
specimen storage for Stool for O&P Examination, Hair,
Skin and Nails (for Fungal Culture)
INDEFINITELY at
Room Temperature
Layers of triple package
PRIMARY RECEPTACLE
SECONDARY CONTAINER
THIRD RECEPTACLE
- contains the infectious
substance and the receptacle should be
watertight, leak-proof, and labeled properly
including the contents of the sample
Primary receptacle
s watertight,
leakproof packaging, and is used to enclose
and protect the primary receptacle(s)
Secondary container
protects the secondary
container from physical damage during
transport (rigid outer packaging)
Third receptacle
a material known or
suspected to contain a pathogen (bacteria, viruses,
rickettsiae, parasites, fungi, or prions) that causes
disease in humans or animals.
infectious substances
Critical/Invasive
- Potentially
life-threatening and
from an invasive
source
- Require immediate
processing
LEVEL 1 SPECIMEN
Amniotic fluid,
Blood, Brain,
CSF, Heart
valves,
Pericardian fluid
LEVEL 1 SPECIMEN
Unpreserved
- Unprotected and
may quickly
degrade or have
overgrowth of
contaminating biota
LEVEL 2 SPECIMEN
Body fluids (not
listed for Level 1).
Bone, Drainage
from wounds,
Feces, Sputum,
Tissue
LEVEL 2 SPECIMEN
specimen with Quantitation required
LEVEL 3 SPECIMEN
Feces and urine
in preservative,
swabs in holding
medium
LEVEL 4 SPECIMEN
Preserved specimen
LEVEL 4 SPECIMEN
Proper identification of each specimen includes a
label firmly attached to the container with the following
information:
Name
○ ID number
○ Room number
○ Physician
○ Culture Site
○ Date of Collection
○ Time of Collection
The ____________________ must contain sufficient
information for the specimen and requisition to be
matched up when received in the laboratory
specimen label
Blood should be drawn during the time of _______________
febrile (fever) episode.
The venipuncture site should be disinfected with
______________________________
chlorhexidine-alcohol. (70 % Alcohol then 2%
clorhexidine then 2% tincture of iodine)
is the
recommended skin antiseptic for blood
cultures, infants 2 months and older and for
patients with iodine sensitivity.
Chlorhexidine gluconate
A set of blood culture bottle is composed of two
bottles - _____________________, Fill _________ first before _____________
one each of aerobic and anaerobic culture bottles, Aerobic, anaerobic
Disinfect the cap of blood culture bottles with _______________________ and wait ______
70%
isopropyl alcohol or chlorhexidine, 30 secs
Recommended blood-to-broth-ratio is ______________________ to
negate antibacterial activity
1:5 to 1:10
________________________ will satisfy the required volume of the sample to detect\ bacteremia
Three sets of blood cultures
At least ______ of blood collected per day
60ml
Collect samples before patient receive ____________________
antimicrobial therapy-
Do NOT draw more than ____________ in a 24-h period
four sets
specimen of
choice for urine culture
Clean-voided midstream (CVS) (Minimum volume: 2-3 mL)
preferred as it provides
more concentrated sample (specimen of choice for
molecular studies)
First morning specimen -
clean urethral area and
insert catheter into bladder, allowing first 15 ml to
pass then collect remainder
Catheterized specimen
specimen of choice for
anaerobic culture (needle aspiration above the
symphysis pubis through the abdominal wall into the
full bladder)
Suprapubic aspirate
aspirate 5-10 ml with needle
and syringe
Indwelling catheter
formula for colony count
Colony count = No. of colonies x Factor
1ul (0.001 ml) - Factor to be used: __________
1000
10ul (0.01 ml) - Factor to be used: _______
100
Values ____________________ indicate infections
greater than 1.0 X10^5
Values between __________________
colonies/ml are considered contaminants.
1.0 X 10^3 and 1.0 X10^5
Specimen of choice for the detection of
gastrointestinal pathogens
STOOL
Stool specimens should be ________________ to the
container; not be contaminated with urine or water.
excreted directly
How many specimens for Bacterial infection: ________________________
3 specimens (once a day for 3 days)
How many specimens for Parasitic infection: ________________________
3 specimens within 10
days
Ratio of Stool to Preservative -
1:3
In case of microscopy, use ________________ to
observe fecal WBCS.
methylene blue
If a patient has received antiparasitic drugs, the
specimen collection should be done after ______________
7 to 10
days
If a patient is undergoing barium studies, the
patient must delay specimen collection until the
_______________________________
barium has cleared (4 to 5 days)
appears as a white chalky
substance in the specimen and masks the
appearance of parasites under the
microscope
Barium
Do not perform routine stool cultures for patients
whose length of stay in the hospital ____________
and whose admitting diagnosis was _________________;
these patients should be tested for __________________
exceeds 3 days, not diarrhea, Clostridiodes difficile
Used to diagnose bacterial pneumonia
SPUTUM
is the preferred sputum (AFB microscopy)
First early morning specimen
specimens are required for mycobacterial infections
Two to three consecutive early morning specimens
Patients are allowed to breath aerosolized droplets of
solution containing _________________________ for approximately ________________ or until________________ is initiated
15% sodium chloride and 10%
glycerin, 10 minutes, cough
_____________________ is used to collect sputum for pediatric and “uncooperative” patients
induced sputum
Patients should gargle their mouth with water and
expectorate with the aid of a deep cough directly into
a sterile container
expectorated sputum
Sputum is rejected if it
represents the saliva and not the lower respiratory tract secretions
Bartlett’s Criteria
For sputum samples to be accepted
for cultivation, there should be _________________________ and
________________________ per LPO
<10 SQUAMOUS epithelial cells, >25 pus cells (PMNs)
Collected through lumbar puncture
CEREBROSPINAL FLUID
CSF specimen
1st tube: _____________________
2nd tube: ____________________
3rd tube: _________________
chemistry, microbiology, hematology
CSF Should be processed ___________________ but can be stored up to __________________________
immediately, 6 hours at 35-37 deg C
CSF needed for bacteria % virus, AFB & fungi
equal or greater than 1ml
equal or greater than 2ml
recommended method
for the CSF specimen
Rapid diagnostic testing (Direct Gram stain, Cryptococcal antigen test)
Never refrigerate CSF for _________________, but for
viruses, it can be held for _____________________
bacteriology, 4 deg C for 3 days
to collect sediment (used for staining or culture
Cytocentrifuge
Use ____________________ if there’s no cytocentrifuge
acridine orange
Add __________ for CSF collected from shunt
THIO
Specimen of choice for the recovery of Bordetella
pertussis
NASOPHARYNX SWAB
in nasopharynx swab A flexible swab is inserted through nose into __________________ and rotate for__________ and Must be transported within _______ (without transport medium)
posterior nasopharynx, 5 seconds, 15 minutes
A pre-moistened swab with sterile saline should be
inserted approximately 1-2 cm (1inch) nares and
rotate against nasal mucosa
NASAL SWAB
● Recommended specimen for the routine culture of
group A streptococci (S. pyogenes)
● Posterior pharynx and tonsils should be swabbed
without touching the palate and sides of the mouth
and tongue
GENITAL
THROAT/PHARYNX SWAB
● Used to diagnose STDs or Venereal diseases
● The mucus should be removed prior to collection.
GENITAL SPECIMEN: CERVIX
GENITAL SPECIMEN: CERVIX site of collection
● Endocervical canal
● Exudates should be removed before specimen
collection.
GENITAL SPECIMEN: VAGINA
Secretions from the_____________________ are swabbed.
mucous membrane of the
vagina
Perform Gram stain for bacterial vaginosis, especially
WBCs, clue cells
○ Gram-positive rods: _______________________
○ Gram-negative rods: ________________________
presence of Lactobacillus, presence of Mobiluncus
spp.
Traditional specimen of choice for Chlamydia trachomatis
GENITAL SPECIMEN: URETHRAL SWAB
GENITAL SPECIMEN: URETHRAL SWAB Collect __________ after the patient’s last urination.
1 hour
For microscopy, ____________ is utilized to observe fecal leukocytes
methylene blue
GASTROINTESTINAL: RECTAL SWAB, A swab should inserted ________________ in past anal
sphincter; feces should be visible on swab.
1-1.5 cm
______________________ medium can be utilized for rectal swabs.
Cary-Blair transport medium
Collected early in
the morning before
the patient rises
from the bed or
takes his/her first
meal
Gastric Aspirate
(Gastric Wash or
Lavage)
Best specimens for
infants and for AFB
examination
Gastric Aspirate
(Gastric Wash or
Lavage)
Gastric Aspirate (Gastric Wash or
Lavage) Must be neutralized
with ______________ within ___ of collection
sodium bicarbonate, 1h
Specimen of choice for
the detection (rapid
urease test, urea breath
test) and isolation of
Helicobacter pylori
Gastric Biopsy
Wipe area with sterile saline or 70% alcohol
ABSCESS
Swab along the outer edge
using swab moistened with transport
medium
Superficial abcess
Aspirate with needle and syringe and place in an anaerobic transport system. Wash any granules and emulsify in saline.
Deep abcess
Sample both eyes; use separate swabs moistened
with sterile saline
CONJUNCTIVA
Clinician should instill local anesthetic before collection.
Inoculate directly to the agar (bedside inoculation
with Brain Heart Infusion 10% [BHI] agar)
CORNEAL SCRAPINGS
Disinfect skin before removal.
IV CATHETER, PINS
Do not use _________________ for culture.
Foley catheters
IV catheters are inoculated for ______________________________
semi- quantitative Maki
Roll Plate
● Involves the preparation of samples for microscopy
and culture.
● Begins with a macroscopic observation
SPECIMEN PROCESSING
are examined for evidence of
blood, mucus and rice-watery appearance.
Stool specimens
The presence of a ___________________________ is one of the indicators of an
anaerobic infection.
necrotic tissue samples (black
discoloration)
A useful tool that provides rapid information
DIRECT MICROSCOPIC EXAMINATION
grinding of tissue (tissue biopsy)
Homogenization-
