UNIT 1: Specimen Collection and Handling Flashcards
Types of UTIs (5)
Cystitis
Urethritis
Pyelonephritis
Pyelitis
Glomerulonephritis
Etiologic Agents
Enterics (3)
Proteus
Enterobacter
Klebsiella
Etiologic Agents in Urine (6)
E. coli
Enterics
Enterococcus faecalis
Pseudomonas aeruginosa
Staphylococcus aureus
S. saprophyticus
Preferred specimen used in Urine
Clean catch midstream
Other specimens used in urine (3)
Straight catheterized urine
Suprapubic aspirates
Collection during cystoscopy
Avoid collecting these 2 specimens in urine:
Random voided urine
Foley catheters
They are prone to contamination
T/F: The first portion of the urine stream in clean catch method is the most concentrated, thus it is the preferred portion
False
It contains organisms in the urethra; Midstream is preferred
UTIs
Inflammation of the bladder
Cystitis
UTIs
Inflammation of the kidney
Pyelonephritis
UTIs
Inflammation of the renal pelvis
Pyelitis
UTIs
Inflammation of the glomeruli
Glomerulonephritis
Specimens collected for urine (6)
First Morning
Random
Clean Catch Midstream Urine Specimen
Catheterized
Plastic Bag Collection
Suprapubic Aspiration
Urine specimen collection method for newborns
Plastic Bag Collection
T/F: First Morning Urine Specimen is the most concentrated
True
Urine
The direct collection of uncontaminated urine from the bladder with the use of a syringe
Suprapubic Aspiration
T/F: Suprapubic Aspiration is used for aerobic culture
False
Anaerobic culture
The amount of urine left in the bladder after urination
Residual urine
T/F: Females are less prone to bladder infections
False
Colony count that indicates UTI
100,000 CFU/ml and above
Urine culture
Incubation temperature and duration
35° for 18-24 hours
Specimen used for the diagnosis of lower respiratory tract infections
Sputum
Specimen used to diagnose bacterial pneumonia and pulmonary tuberculosis (PTB)
Sputum
Essential volume of collected sputum specime
5-10 ml
Sources of sputum sample (3)
Expectorated
Induced
Gastric contents
Source of sputum sample for children
Gastric contents
How many sputum samples should be collected for PTB?
2
Other specimens for PTB (3)
Besides sputum
Trastracheal aspirate
Bronchioalveolar Lavage (BAL)
Bronchial washings
Sputum sample for other infections
Early morning specimen
T/F: Prior to culture and sensitivity examination, pre-examine the submitted sputum
True
Stain used in th microscopic examination of sputum
Gram Stain
Used to assess the quality of sputum as it takes into account the ratio of WBCs to squamous epithelial cells as well as the presence of mucus in the specimen
Bartlett’s Classification
Bartlett’s Classification for sputum (2)
…> 25 leukocytes/LPF
…< 10 epithelial cells/LPF
The specimen of choice for the diagnosis of gastrointestinal pathogens
Stool
T/F: Rectal swabs may be used if stool is present on the swab during sample collection
True
Stool pathogens (9)
C. jejuni
Salmonella
Shigella
E. coli (EHEC, ETEC, EPEC, EIEC)
Vibrio
Y. enterolitica
L. monocytogenes
C. difficile
Mycobacterium Avium Complex (MAC)
Stool
EHEC stands for
Enterohemorrhagic Escherichia coli
Stool
ETEC stands for
Enterotoxigenic Escherichia coli
Stool
EPEC stands for
Enteropathogenic Escherichia coli
Stool
EIEC stands for
Enteroinvasive Escherichia coli
T/F: E. coli is a non-pathogenic normal flora
True
Stool pathogen detected in water analysis for fecal contamination
E. coli
Blood is used in the diagnosis of (5)
Fever of unknown origin (FUO)
Septicemia
Bacteremia
Typhoid Fever
Subacute Bacterial Endocarditis (SBE)
Blood should be collected before or after fever spike?
Both (before AND after)
T/F: Blood is used in both aerobic and anaerobic culture
True
Collection method for blood sample
Venipuncture
How many sites are used in blood collection?
2-3 different sites
Left and right hands/feet
Volume of blood that should be collected in adults
20 ml
Volume of blood that should be collected in pediatrics
1-20ml (1-5ml)
Blood:Media Ratio
1:10
1 blood:9 medium
Media of choice for blood samples (2)
Broth (Brain Heart Infusion, Biphasic Media, Thioglycollate Broth, Commercially available bottles)
Isolator system
Preferred anticoagulant for blood samples
Sodium polyanethole sulfonate (SPS)
(0.025-0.030%)
Other anticoagulants used for blood samples (3)
Heparin
Sodium amylosulfate
Sodium citrate
T/F: EDTA is antibacterial and should not be used in blood cultures
T
Body fluids include (7)
Abdominal fluid
Amniotic fluid
Ascitic fluid
Bile
Synovial fluid
Pleural fluid
Pericardial fluid
Body fluids are collected by?
Needle aspiration
(done by doctors only)
Gastric tubes used in collection of gastric specimens (2)
Levine Tubes
Rehfuss Tubes
Specimen used in the diagnosis of meningitis or meningoencephalitis
Cerebrospinal Fluid (CSF)
T/F: CSF specimen must be placed in a biosafety cabinet
T
Because meningitis can be airborne (in droplets)
T/F: CSF specimen must be processed ASAP
T
Causative agents of Meningitis (5)
H. influenzae
N. meningitidis
S. pneumoniae
S. agalactiae
Listeria
Collection method for CSF specimen
Lumbar Tap
3rd-4th Lumbar Vertebra
CSF is placed in how many sterile tubes?
3
CSF
Which tube is used for microbiology if there are 3 sterile tubes?
2nd tube
CSF
Which tube is used for microbiology if there are 4 sterile tubes?
4th tube
Volume of CSF sample that should be collected
≥ 1 ml
T/F: If there is only 1 sterile tube of CSF collected for testing, then the sample must be rejected.
F
T/F: If there is 1 sterile tube of CSF collected for testing, you must use it for C&S first before other sections
T
CSF
Accidental tapping of artery can lead to
RBC contamination
Tissue Specimens
2 Types of biopsy
Excisional
Incisional
Collection method for tissue specimens
Biopsy
Tissue biopsy where the entire lesion is removed
Excisional biopsy
Tissue biopsy where only a portion of the lesion is removed
Incisional biopsy
T/F:
Aspirates - Anaerobic bacteria
Swabs - Aerobic bacteria
F
Transport of specimen to the laboratory is ideally:
30 minutes
Transport of specimens to the laboratory is preferably up to how many hours?
2 hours
Except for CSF specimens
T/F: If specimens cannot be transported to the lab immediately, specimens must be added with preservatives, anticoagulants, or placed in transport/culture media
T
2 preservatives for specimen preservation
Boric Acid
Refrigeration
Preservatives
Boric Acid and Refrigeration are bacteriostatic/bactericidal
Bacteriostatic
Maintains the viability of the specimen during transport to the lab
Transport Media/Holding Media
Transport Mediums (4)
Cary Blair
Stuart’s or Amie’s
JEMBEC Media
Gonopak
Antiphagocytic, anticomplementary anticoagulant that may inhibit some antimicrobials and certain bacteria
Sodium polyanethol sulfonate (SPS)
Sodium polyanethol sulfonate (SPS) inhibits certain bacteria, such as: (4)
Neisseria
Gardnerella vaginalis
Streptobacillus moniliformis
Peptostreptococcus anaerobius
2 anticoagulants used in preservation, storage, and transport of specimens
0.025%-0.03% Sodium polyanethol sulfonate (LIQUIOID)
Heparin
Storage Temperature and Application
CSF for viruses
Refridgerator temperature
Refridgerator temperature
4 degree Celcius
Ambient/Room temperature
22 degree Celcius
Body temperature
37 degree Celcius
Freezer temperature
-20 or -70 degree Celcius
Storage temperature and Application
Outer ear swab
Refridgerator temperature
Storage temperature and Application
Feces for isolation of Clostridioides difficile toxin
Refridgerator temperature
Storage temperature and Application
Sputum
Refridgerator temperature
Storage temperature and Application
Catheter tips
Refridgerator temperature
Storage temperature and Application
CSF for bacteria
Ambient/Room temperature
Storage temperature and Application
Abcess, lesion, wounds
Ambient/Room temperature
Storage temperature and Application
Body fluids
Ambient/Room temperature
Storage temperature and Application
Preserved urine and stool
Ambient/Room temperature
Storage temperature and Application urine and stool
Unpreserved urine and stool
Refridgerator temperature
Storage temperature and Application urine and stool
Nasal specimens
Ambient/Room temperature
Storage temperature and Application urine and stool
Tissue samples
Refridgerator temperature
Storage temperature and Application urine and stool
CSF
Body temperature
Storage temperature and Application urine and stool
Serum for Serology
Freezer temperature
(-20 C)
Storage temperature and Application urine and stool
Long term storage
Freezer temperature
(-70 C)
T/F: Difficult samples can be rejected
F
Confirm with the physician first
Examples of difficult specimens (2)
CSF
Surgical biopsies
Specimen Priority
Critical/Invasive
Level 1
Specimen Priority
Unpreserved
Level 2
Specimen Priority
Quantitation required
Level 3
Specimen Priority
Preserved
Level 4
Specimen Priority
Batch Processing
Level 5
Specimen Priority
Level 1 (4)
CSF
Amniotic fluid
Blood
Pericardial fluid
Specimen Priority
Level 2 (3)
Feces
Sputum
Tissue
Specimen Priority
Level 3 (2)
Urine
Tissue for quantification
Specimen Priority
Level 4 (3)
Feces in preservative
Urine in preservative
Swabs in holding/transport medium
Specimen Priority
Level 5
Sputum/AFB culture
Which specimen level should be the priority?
Level 1 - Critical/Invasive
Selection of Appropriate Culture Medium
Isolation of gram-positive and gram-negative anaerobes
Anaerobic phenylethyl alcohol agar
Selection of Appropriate Culture Medium
Isolation of gram-negative anaerobes
Anaerobic kanamycin-vancomycin agar
Selection of Appropriate Culture Medium
Isolation of Bordetella pertussis (2)
Bordet-Gengou media
Regan-Lowe agar
Selection of Appropriate Culture Medium
Enrichment used to isolate Legionella
Buffered charcoal yeast extract (BCYE)
Selection of Appropriate Culture Medium
Isolation of Campylobacter
Campy blood agar
Selection of Appropriate Culture Medium
Enriched, nonselective medium to isolate fastidious organisms
Chocolate agar
Selection of Appropriate Culture Medium
Isolation of Neisseria and Haemophilus
Chocolate agar
Selection of Appropriate Culture Medium
Isolation of Yersinia species
Cefsulodin-Irgasan-novobiocin agar (CIN agar)
Selection of Appropriate Culture Medium
Isolation of gram-positive bacteria
Colistin-nalidixic acid agar
Selection of Appropriate Culture Medium
Differential: isolation of gram-negative bacilli and differentiation of lactose fermenters from non-lactose fermenters (2)
Eosin-methylene blue agar
MacConkey agar
Selection of Appropriate Culture Medium
Enrichment broth to enhance recovery of stool pathogens and inhibit normal flora coliforms (3)
Gram-negative broth
Selenite broth
Tetrathionate broth
Selection of Appropriate Culture Medium
Selective: isolation of stool pathogens through inhibition of normal flora coliforms (2)
Hektoen enteric agar
Salmonella-Shigella agar
Selection of Appropriate Culture Medium
Primary isolation medium for Mycobacterium
Löwenstein-Jensen medium
Middlebrook medium
Petragnani’s medium
Incubation Conditions
Usual incubation time for most bacteria
18-24 hours
37 degrees C
Incubation Conditions
Pseudomonas aeruginosa
Campylobacter jejuni
42 degrees C
Listeria monocytogenes
Yersinia enterocolitica
4 degrees C
(Cold enrichment medium)
Incubation Conditions
Aerobic bacteria e.g. P. aeruginosa
Ambient air
(21% oxygen)
Incubation Conditions
Anaerobic bacteria e.g. Fusobacterium, Bacteroides, Clostridium
Use of anaerobic jars
(Gas-Pak, Brewer Jar, Glove Box method, Biobag System)
Incubation Conditions
Enterics
Facultative anaerobes
Incubation Conditions
Capnophiles
Candle Jar
Incubation Conditions
Requires 5-10% carbon dioxide to grow
Capnophiles
Incubation Conditions
Requires reduced oxygen (5-6%)
Microaerophiles eg. Campylobacter jejuni, Helicobacter pylori
Incubation Conditions
21% Oxygen, 0.03% CO2
Aerobic Bacteria
Incubation Conditions
0% oxygen
Anaerobe
Incubation Conditions
5-10% CO2; 15% Oxygen
Capnophiles
Incubation Conditions
5-6% or 5-10% Oxygen
Microaerophiles
Critical results that should be reported immediately
Panic Values
Enumeration
Panic Values
Positive:
Blood Culture
CSF Gram Stain or Culture
S. pyogenes in surgical wound
Gr Staining suggestive of gas gangrene
Blood Smear for Malaria
Cryptococcal Antigen Test
AFS
Detection of select agents such as Brucella or other significant pathogen
A protein that can only be killed via incineration; causes CJD
Prions
Selection of Appropriate Culture Medium
Isolation and differentiation of Vibrio
Thiosulfate-citrate-bile salts-sucrose agar
Selection of Appropriate Culture Medium
Isolation of Neisseria gonorrhoeae (2)
Martin-Lewis medium
Modified Thayer-Martine agar
Selection of Appropriate Culture Medium
All-purpose isolation media; subculture from primary plate
Trypticase soy agar
Selection of Appropriate Culture Medium
Enriched broth that permits growth at various oxygen levels
Thioglycolate broth