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Bacte LEC > Specimen Collection: BLOOD > Flashcards

Specimen Collection: BLOOD Flashcards

1
Q

Types of specimen

A

Feces
Anaerobic sample
Blood
Urine
Tissue biopsy
Sputum
Swab

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2
Q

Test selection

A

Microscopy
Culture
Serologic
Genetic

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3
Q

This is done to identify antimicrobial drugs that will be best used to control or kill the organisms.

All the information gathered through the tests will be utilized by the clinician to come up with the ideal treatment regimen for the patient.

A

antimicrobial susceptibility testing

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4
Q

GENERAL SPECIMEN COLLECTION GUIDELINES

A

Obtain specimen before treatment;

Collect material from the appropriate site and avoid contamination.

Obtain material during the acute stage of the illness and ensure correct timing of specimen collection;

Collect using sterile collection method;

Collect sufficient quantity.

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5
Q

LABEL:

A

Patient’s full name

Identification number of the patient

the type of specimen

date and time of collection

Collector’s signature

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6
Q

Incorrect Labelling

A

• Label too high (on cap)
• Label too low (started on bottom)
• Labels exposed to adverse conditions: heat, cold, moisture
• Two labels should not share the same tube
• Double label cover epic label completely
• Twisted label
• Label upside down - Accession number belongs under cap
• Folded/ bubbled label
• Wrong color tube for test requested

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7
Q

SPEICMEN TRANSPORT GUIDELINES

A

All specimen must be sent to the laboratory on the day of collection with as little delay as possible.

Bacteria are vulnerable to delay in processing

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8
Q

DELAY IN TRANSPORT AND PROCESSING

Refrigeration
Ex: URINE ->

A

refrigerate (24 hrs)

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9
Q

DELAY IN TRANSPORT AND PROCESSING

Maintain viability of bacteria and slows down all 3 processes

A

Transport Medium

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10
Q

Transport media

Slows down: 3

A

• Growing process
• Reproducing process
• Dying process

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11
Q

TRANSPORT OF SPECIMEN (REFERRAL TESTING)

A

• Volume

• Packing

• Paperworks

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12
Q

TRANSPORT OF SPECIMEN (REFERRAL TESTING)
• Volume: must not exceed______
Bacteria and fungi ->_______

A

40 mL

tubed solid media

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13
Q

TRANSPORT OF SPECIMEN (REFERRAL TESTING)

• Packing: leak-proof, tightly sealed containers with________

DOH Manual on ______of Laboratory Specimen for Referral

______Dangerous Goods Shipping
Guidelines

A

Biohazard label

Packaging & Transport

IATA’s

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14
Q

TRANSPORT OF SPECIMEN (REFERRAL TESTING)

Paperworks: ______that are enclosed in the container, identified and marked properly

A

itemized content

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15
Q

IATA- DOH TPS

Patient specimens or culture isolates must be______ before being shipped.

The material is placed into a primary receptacle that must be watertight.

______material is placed around the primary receptacle, and it is then placed into a secondary container that is also watertight.

The secondary package is sealed and placed into a sturdy outer container constructed of______.

Specific instructions must be followed for labeling the container as “________.” Specimens that are shipped by air require specific labeling and shipping documents.

A

triple packaged

Absorbent

fiberboard

Hazardous Material

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16
Q

Triple Package System

A

Watertight Primary Receptacle
Glass, Metal, or Plastic*

Watertight Secondary Packaging

List of Contents

Rigid Outer Packaging

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17
Q

made of glass tubes/metal tubes/ mostly plastic (safer)

there should be an absorbent packing material (especially for liquids) that should keep the tubes from shaking around

A

Inner Container/Primary Receptacle

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18
Q

Placed in a second packaging that would contain the Itemized List of Contents

Inserted into a rigid cardboard that has an Infectious Substance Label, Shipping name, shipper’s name and Identification, data or information, UN number/UN package certification mark

A

Watertight Secondary Packaging

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19
Q

SHIPPING LABELS

WHAT’S PRESENT:

A

Information from the sender
Information for the receiver
Package and content
Laboratory & contact number
UN Number is present
‘Infectious substance’ sticker

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20
Q

Infectious substance’ sticker

If the infectious substance is_______, UN2814 is the number

If the infectious substance contains a biologically______ organism, it belongs to Biological Substance Category B, UN3373

A

known or identified

unknown

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21
Q

Respiratory
Gastrointestinal
Blood Culture
Urine
Fungal
Mycobacterial
Chlamydia

A

1 hr

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22
Q

Anaerobic DT

A

30mins

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23
Q

Wound, skin & soft tissue DT

A

30mins

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24
Q

CSE and Other fluids DT

A

Immediately

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25
Q

Certain bacteira, such as _____ and _____ are very susceptible to drying and changes in temperature

A

Neissera and Haemophilus

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26
Q

CRITERIA FOR SPECIMEN REJECTION

A
  1. Unlabelled specimen
  2. Incorrectly labelled specimens (Mismatch Specimen and Form)
  3. Specimen sent in wrong container; Inappropriate container; Wrong preservative for test
  4. Broken Leaking container; Spilt sample
  5. Insufficient sample volume (Volume not to the mark) e.g Citrated blood
  6. Specimen received in syringe
  7. Contaminated sample or Contaminated request form
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27
Q

REJECTED SPECIMEN: ANAEROBIC CULTURE

A
  1. Gastric washings
  2. Voided urine
  3. Stool
  4. Oropharyngeal samples
  5. Sputum
  6. Swabs of ileostomy or colostomy sites
  7. Superficial skin specimen
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28
Q

UNIVERSAL PRECAUTIONS

General rule:

A

Treat any specimen as infectious

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29
Q

Appropriate barriers (PPE)

A

Gloves
Lab coat
Masks
Goggles
Impermeable gowns or aprons

30
Q

CLINICAL SPECIMEN

A

• Blood
• respiratory tract (upper, lower)
• Urine
• Cerebrospinal fluid
• Gastrointestinal Tract
• Genital Tract
• Wound & Abscess

31
Q

Blood culture purpose

A

Confirm the infectious etiology
Identify the etiologic agent
Guide antimicrobial therapy

32
Q

BLOOD CULTURE -> determines (3)

• Aims to grow pathogenic microorganisms for diagnosis of above-mentioned diseases

A

bacteremia, fungemia & septicemia

33
Q

FACTORS THAT AFFECT RECOVERY OF ETIOLOGIC AGENT IN THE BLOOD

A

Specimen Collection
Culture Medium
Incubation Requirement

34
Q

Volume of blood is critical; yield affects isolation of the infectious agent - collect more than_____, minimum is_____ for adults (2 containers)

A

10mL

20mL

35
Q

Temperature for incubation

A

35-37C

36
Q

Frequent blood culture contaminants but also true pathogens:

A

• Coagulase-negative staphylococci
• viridans Streptococci
• Corynebacteria A
• Bacillus species
• Propionibacterium species

37
Q

VOLUME OF BLOOD
• 1 set=

A

2 tubes
Aerobic & anaerobic

38
Q

Adult

One set in one arm, the other in another arm, last set is from the leg vein

The more blood volume to be examined, the greater chances for you to be able to isolate organisms

A

20-60 mL (adult)

39
Q

(pediatric patient)
(neonates)
(1 month - 2 years old)
(children below 10 years old)

A

5-10 mL

1-2 mL

2-3 mL

3-5 mL

40
Q

NUMBER OF BLOOD CULTURE SETS

Collect______ sets of bottles (aerobic + anaerobic) for each septic episode

If culture is negative after _____ incubation and patient is still
potentially septic without an identified source

Collect______additional sets of bottles (aerobic + anaerobic)

If culture is negative after 24 h incubation…….

A

2 to 3

24-48 h

2 to 3

Repeat protocol if necessary
Prolong incubation
Investigate non-microbial etiology

41
Q

= watch out for the times where the
patient’s temperature would spike up, this is a telltale sign that the organisms or are in their generation time period

A

Septic episode

42
Q

= it could be viral.

Viral organisms do not respond very well on culture media used for bacteria.

They do not just grow on any environment.

A

Investigate non-microbial etiology

43
Q

= sometimes, there are organisms that would be present after 21 days of incubation; if not, call and inform the physician, and ask if they could repeat process for the third time around (2-3 sets per septic episode)

A

Prolong incubation

44
Q

If there’s one tube that turns out to be positive, what should we do?

• If the pathogenic organism identified in that bottle is

Listeria, Staphylococcus, Brucella, Haemophilus or Enterobacteriaceae…

A

This is a probable bloodstream infection

45
Q

If there’s one tube that turns out to be positive, what should we do?

If viridans streptococci or coagulase-negative staphylococci and consistent with clinical setting (e-g-Indwelling catheter, prosthetic heart valve, immunocompromised patient)….

A

Probable bloodstream infection

46
Q

If there’s one tube that turns out to be positive, what should we do?

If normal skin flora is positive ONLY for Propionibacterium, corynebacterium, Bacillus, coagulase-negative Staphylococci….

A

Probable contamination

47
Q

What to do after if….

This is a probable bloodstream infection

Probable bloodstream infection

Probable contamination

A
  • Repeat collection / repeat procedure
  • Consider non-infecitous etiology
  • Investigate viral etiology or non-culturable microorganism
48
Q

SAMPLES FOR REJECTION

A

• Clotted specimens
• Specimens collected using only alcohol as antiseptic
• For adults: less than 20 mL of blood sample

49
Q

BLOOD TO BROTH RATIO

• Recommended:____
• dilute the antibacterial & inhibitory substances in the blood
• Commercial Continuously Monitoring Blood Culture System may use smaller blood to broth ratio of less than____

A

1:10 ratio

1:5

50
Q

CULTURE MEDIA

A

Glucose broth
Bile broth
Trypticase soy broth
Brain heart infusion broth
Thioglycollate broth
Columbia or Brucella broth

51
Q

o Ideal for endocarditis

A

Glucose broth

52
Q

Ideal for samples for patients with enteric fever

A

Bile broth

53
Q

NOT for samples that may contain
Neisseria and Streptococcus pneumoniae

Use BHI instead

A

Trypticase Soy Broth

54
Q

Multipurpose broth

For anaerobes

A

Brain Heart Infusion broth

Thioglycollate broth

55
Q

Anticoagulant, anti-phagocytic and anti-complementary action

Neutralizes bactericidal effect of serum

Inactivates certain antimicrobial agents

A

Sodium Polvathenol Sulfonate [SPS] (0.025 to 0.03%)

56
Q

EXAMPLES OF ANTIMICROBIAL AGENTS THAT CAN BE INACTIVATED RATHER BY SPS

A

Gentamicin
Kanamycin
Streptomycin
Polymyxin B

57
Q

Downside to SPS
• Quite toxic to certain fastidious organisms like

A

Neisseria, Mycoplasma, Peptostreptococcus, Streptobacillus moniliformis

58
Q

Use_______- used to inactive penicillin

A

1-2% gelatin or penicillinase

59
Q

Subculture on BAP (Blood Agar Plate) & CA (Chocolate Agar Plate): after _____hours, 3rd /5th /7th day

Usually incubated on____
enhanced atmosphere

A

14-17 hrs.

carbon dioxide

60
Q

Incubation

______days is sufficient
Not more than____ days; _____ = contamination

A

3-5

7

> 5 days

61
Q

7 DAYS INCUBATION IS USEFUL FOR

A

Fungemia
Bacteremia (HACEK group, Brucella, Legionella)

62
Q

Mycobacterial culture

A

> 4 weeks

63
Q

Manual Examination of bacterial growth

A

Turbidity
Hemolysis
Gas production
Pellicle formation or discrete colonies

64
Q

COMMERCIALLY DEVELOPED SYSTEM

A

Biphasic Septicheck System

Oxoid Signal Broth Displacement System

65
Q

Has an agar slant attached to the broth containing bottle

Allows the subculturing to be done in a closed system-we don’t need to open the container to subculture the agar.

Simply tilt the bottle to allow the broth to flow on the surface of the agar to allow the organism on the broth to grow on the culture media

A

Biphasic Septicheck System

66
Q

Comes with a cylindrical signal device that’s attached to the main bottle with a long needle extending to the surface of the broth.

Closed system as well

A

Oxoid Signal Broth Displacement System

67
Q

Automated Detection System

A

BACTEC 9240/ 9120/ 9050

BAC T/Alert

TREK ESP culture system

68
Q

• Alerts when the culture is positive
• You can process a lot at one time
Gram stain & subculture follows

A

Automated detection system

69
Q

CONTINUOUS MONITORING SYSTEMS
ADVANTAGES

A

•
•
•

Decrease the laboratory work

Decrease the pseudo bacteremia due to decrease in sampling and handling

Increase in the speed of detection and rate of recovery

70
Q

DISADVANTAGES OF CONTINUOUS
MONITORING SYSTEMS

A

Requires an instrument
Limited selection of medium
Expensive

Bacte LEC (29 decks)

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