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COLLECTION AND TRANSPORT
      OF SPECIMENS


JITENDRA KUMAR PANDEY
MGM medical college ,mumbai
PG,MEDICAL MICROBIOLOGY 3yr
INTORDUCTION:
Specimen    collection and
 transportation are critical
 considerations , because any results
 the laboratory generates is limited by
 the quality of the specimen and its
 condition on arrival in the laboratory.
Specimens should be obtained to
 minimize the possibility of introducing
 contaminating microorganisms that
 are not involved in the infectious
 process.
General guidelines for
specimen        collection:
 Depending   on the type of infection
  e.g. blood
 Aseptic precautions
 Anatomic sites and locations
 Adequate amount/volume
 Tissue or other body fluids should be
  preferred over swabs, to get quality
  material
 Proper timing
 Clinical laboratory form
An Ideal Request form

   Name     xxxx      Age         Sex
   IP/ OP No xyz     Time        Date
   Ward      xx123      Urgent / Routine
   Nature of specimen
   Investigation needed

                           Doctor/Staff
                          Contact No
                          1234567

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 Use of transport media
 Proper handling ,labelling and
  transportation




 Use of proper container
 Instruction to the patient
 Before the administration of antibiotics
 Avoid contamination of specimens
SPECIMEN TRANSPORT:
 Within 2 hours of collection
 Containers should be leak-proof
 Separate section for paperwork
 Special preservatives or holding
  media
 Biohazard label
   Triple packaging system
Criteria for rejection of
specimens:
Several criteria can be considered by a laboratory on
  the basis of which the processing of a specimen
  may not be done by the laboratory. Such a decision
  must be made in light of the specific requested
  investigation. Laboratory investigations of a sample
  are a waste of time and resources if following
  criteria are not fulfilled :
     Missing or inadequate identification
     Insufficient quantity
     Specimen collected in an inappropriate
  container
     Contamination suspected
     Inappropriate transport or storage

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Containers and swab for
the collection of
specimens:
Containers:

For faeces:-
• Universal container
• Spoon attached to the
 inside of the screw cap
For       urine:-
   Universal container for small
    quantities
   For larger quantities 250 ml wide
    mouthed screw-capped bottles are
    convenient

For       sputum:-
• Universal container should
  not be used
• Squat ,wide-mouthed disposable
  containers should be used
For       blood:-
•   Without anticoagulant for
    serological examination
•   With EDTA for parasitological
    examination


   BLOOD CULTURE BOTTLE:
•   This must be at least large
    enough to hold 50ml of liquid
    medium ,with which it is issued
    from laboratory ,plus 5-10ml of
    patient’s blood
For       serous fluids:-
•   Universal container
•   Addition of 0.3ml of 20% solution
    sodium citrate to the container prior
    to autoclaving (with the cap fitted)
    is recommended for collection of
    fluids that may coagulate on standing

•   This avoids difficulty in performing
    cell counts or centrifuging procedure
    with such fluids

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Swabs:-
Swabs suitable for taking Specimens
of exudates from the throat, nostril ,
ear , skin, wounds and other accessible
lesions consist of a sterile pledget of
absorbent material, usually cotton-wool
or synthetic fiber, mounted on a thin wire
 of stick

 Swabs      for special purpose:
 Baby swabs
 Pernasal swabs
 Post-nasal swabs
 Laryngeal swabs
 High vaginal and cervical swabs
 Serum coated cotton wool swab
      Containers of anaerobic
       specimens:
   Syringe and needle for aspiration.




 Tube or vial contains semi-solid holding medium an
  atmosphere of 5% CO2 ,a reducing agent, tube used for
  putting up the swab.
 Readymade swabs in a plastic tube or jacket and
  containing either Cary-Blair , Amies transporter pre-
  reduced (PRAs) medium id used.
 Plastic pouch or Bio-bag (transparent) containing a CO2
  generating system, palladium catalyst and an anaerobic
  indicator can also be used.
EYE:
Various specimens collected are:
A. specimens:
1.Conjunctival:-
 Container:
•   Aerobic swab moistened with
    Stuart’s or Amie’s medium
   Collection:
•   Obtained from superior and inferior tarsal conjunctiva
•   Specimen of both eyes with separate swabs by rolling swab
    over each conjunctiva
•   If a viral culture is requested ; a second
    specimen is collected
•   For Chlamydia culture swabs are taken
     with a dry calcium alginate swab
   Transport :
•   Within 24hrs/RT
•   For viral culture place in viral transport media and deliver
    promptly to laboratory or refrigerated
    for a short time and then transport on wet ice
•   For Chlamydia place in 2-Sp transport medium

2. Corneal scrapings:
   Container:
    Bedside inoculation of BA,CA,SDA,7H10,Thio
   Patient preparation:
    Clinician should instill local anesthetic before collection
   Collection:
    By using heat sterilized platinum spatula or calcium alginate-
    tipped swab dipped in sterile trypticase soya broth
   Transport:
    Immediately/RT

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3. Anterior chamber and vitreous cultures:
 Collection:




Aspiration is carried out with a tuberculin
  syringe fitted with a
• 25-27 gauge needle for the aqueous
• 20-21 gauge needle for vitreous
  aspiration
 Transport:
Immediately/RT
EAR:
1. Inner ear:
   Container:
•   Sterile , screw-cap tube
    or anaerobic transporter
   Patient preparation:
•   Clean ear canal with mild
    soap solution before puncture
    of the ear drum
   Collection:
   Aspirate material behind drum with syringe if ear drum
    is intact; use swab to collect material from ruptured
    eardrum
   Transport:
•   Immediately/RT
2. Outer ear:
 Container:
•   Aerobic swab
    moistened with
    Stuart's or Amie’s
    medium
 Patient    preparation:
•   Wipe away crust with
    sterile saline
 Collection:
•   Firmly rotate swab in outer canal
 Transport:
•   Within 24hrs/RT
RESPIRATORY
TRACT(RT):
 Collection of specimen in the case of
  RTI poses a number of problems
  because , there is enormous
  commensal flora that colonizes this
  tract.
 Therefore, the specimen collection is
  very crucial and specially in case of
  viral infections of RT.
 One has to avoid contamination of the
  specimens.
 RT is broadly divided into:

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A . Upper RT:
 Container:
•   Swab moistened with Stuart’s or Amie’s medium
 Collection:
1.Oral swab:
•    Remove the oral secretions or debris
     from the surface of lesion with swab and discard
•    Using 2nd swab ,vigorously specimen the
     lesion avoiding any areas of normal
      tissue
2. Nasal swab:
•    Use swab moistened with sterile
     saline.
•    Insert approx. 2cm into nares
•    Rotate swab against nasal mucosa
3. Nasopharyngeal:
A. Swabs:
•   To collect nasopharyngeal cells, all mucus is
    removed
•   Small flexible nasopharyngeal swab is inserted
    along the nasal septum to the posterior pharynx
•   Rotate slowly for 5 sec. against the mucosa
    several times
B. Aspirate :
•   Is collected with a plastic tube attached to 10 ml
    syringe or suction catheter
C. Washings:
•   Is obtained with a rubber suction bulb by instilling
    and withdrawing 3-7 ml of sterile buffer saline
4.Laryngeal swab:
• Before use the swab is moistened with sterile
  D/W
• Patient is made sit and holding the tongue
  fully protruded
• with help of a piece of gauge, pass the swab
  back through the mouth wire mid-line and
  downwards over the epiglottis into larynx
  where it should induce reflex coughing that
  will expel sputum onto swab
• Withdraw the swab and replace it in its tube
  for delivery to the laboratory
5. Throat swab:
• Depress the tongue with
  a tongue depressor
• Introduce the swab between
  the tonsillar pillars and behind
  the uvula without touching the
  lateral walls of the buccal cavity
• Swab back and forth across
  the posterior pharynx
• Any exudates or membrane should be taken for
  specimen


 Transport:
•   Within 24hrs/RT

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Specimen collection and transport are critical for accurate laboratory results. Proper guidelines include using appropriate containers and transport media, adequate labeling, and timely delivery. Key points are minimizing contamination, ensuring sufficient sample quantity and quality, and following instructions for different specimen types like blood, urine, stool and respiratory samples. Adherence to protocols helps produce reliable diagnostic test results.

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B. Lower RT:
 Container:
• Sterile screw-top container
 Collection:
1.Sputum:
 Patient preparation:
Ask patient to brush teeth
and then rinse or gargle with
water before collection
• Collected early in the
  morning before eating
• make collection in a
  disposable wide mouthed
  screw-capped sterile plastic
  container of about
  100ml capacity
• Instruct to wait until he/she feels material
  coughed into his/her throat
• Then work it forward into mouth and spit
  it directly into container
• Should be collected before starting
  antimicrobial chemotherapy
2.Transtracheal aspiration(TTA):
• Obtained by inserting a small plastic
  catheter into the trachea via a needle
  previously inserted through the skin and
  cricothyroid membrane
• This technique is rarely used any more
3.Bronchioalveolar lavage (BAL):
•   30-50 ml of physiological saliva
     is injected through a fiberoptic
     bronchoscope .
•   the saliva is then aspirated
4.Bronchial brush:
•   Is collected via a protected
    catheter bronchial brush as part
    of a bronchoscopy examination
5.Gastric lavage:
•   In the morning before the
     patient has taken anything
    but after a bout of coughing
     and swallowing , aspirate the
    fasting stomach contents with
    a Ryle’s tube
   Transport:
•   Within 24hrs/RT
BODY FLUIDS:
1.Cerebrospinal fluid:
 Container:
•   Sterile screw-cap tube
 Patient   preparation:
•   Disinfect skin before aspirating specimen
 Collection:
•   Lumbar puncture to collect the CSF for
    examination to be collected by Physician
    trained in procedure with aseptic
    precautions to prevent introduction of
    Infection.

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•   The trained physician
    will collect only 3-5 ml
    into a labeled sterile
    container
•   The fluid to be
    collected at the rate
    of 4-5 drops per second.
   The best site for puncture is inter
        space between 3 and 4 lumbar
        vertebrae
•    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,
e.g. 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.

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This document provides guidelines for collecting, transporting, and testing various clinical specimens for microbiological analysis. It discusses sample types including body fluids, cerebrospinal fluid, blood, urine, respiratory samples, gastrointestinal samples, ear swabs, eye swabs, and abscess or wound samples. For each sample type, it provides information on containers, transport times and temperatures, and appropriate microbiological tests. The document aims to ensure proper specimen collection and handling to optimize pathogen recovery and identification.

2.Pleural/Peritoneal/Pericardial/
        Synovial fluid:
 Container:
•   Sterile screw-cap tube or anaerobic
    transporter
 Patient    preparation:
•   Disinfect skin before aspirating with 2%
    iodine tincture
 Collection:
•   Obtained via percutaneous needle
    aspiration or surgery
 Transport:
•   Immediately/RT
BLOOD:
 Container:
• Blood culture media set(aerobic and anaerobic
  bottle)
or vacutainer tube with SPS


 Patient   preparation:
• Disinfect venipuncture site
with 70% alcohol and
disinfectant such as betadine
 Collection:
•   Select the vein from which blood is
    to be drawn
•   Disinfect the venipuncture site
•   Allow it to dry
•   With precautions to avoid
    touching and recontaminating the
    venipuncture Site , take the
    specimen of blood and put it
    immediately through the hole in the cap of bottle
 Volume      of blood:
• In adult 5-10ml
• In children 1-5ml
Transport:
•   Within 2hrs/RT
Gastrointestinal tract(GIT):
1.Stool:
 Container:
•   Clean leak-proof container
 Collection:
    •Pass stool directly into a sterile, wide-mouth, leak proof
    container     with a tight fitting lid.
    •Pass stool into a clean, dry bedpan, and transfer into a
    sterile leak proof container with a tight fitting lid.
   Stool for ova and parasites should be placed in preservative
    immediately after collection.
 Transport:
•   Within 24hrs/4 °C
•   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

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Transport media for stool specimens



Cary-Blair          All enteric organisms
Stuart              All enteric organisms
Amies               All enteric organisms
Buffered glycerol   All enteric organisms
saline              except
                    Vibrios
                    Campylobacter
Alkaline peptone    Vibrios
water
V-R fluid           Vibrios
2.Rectal swab:
Container:
•   Swab placed in enteric transport
    medium
Collection:
 Pass the tip of a sterile swab
  approximately 1 inch beyond the anal
  sphincter.
 Carefully rotate the swab to sample
  the anal crypts and withdraw the
  swab. Place the swab in transport
  medium.
Transport:
3.Duodenal aspirates:
 Container:
•   Sterile, screw-cap tube
 Patient    preparation:
•   Collect in early AM before patient eats or gets out
    of bed.
 Collection:
•   Ask the patient to swallow a weighted gelatin
    capsule containing a tightly wound length of string,
    which is left protruding from the mouth and taped to
    the cheek
•   After a predetermined period , during which the
    capsule reaches the duodenum and dissolves, the
    string now covered with duodenal contents is
    retracted .
 Transport:
URINARY TRACT INFECTION(UTI):

  1.Urine:
   Container:
  •   Sterile, screw-cap container
   Patient    preparation:
  Females:
  •   Clean area with soap and water, then rinse with
      water, hold labia apart and begin voiding in
      commode; after several ml have passed, collect
      midstream
  Males:
  •   Clean glans with soap and water, then rinse with
      water, retract foreskin; after several ml have

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This document provides information about specimen collection and processing in a medical laboratory. It discusses key steps like collecting specimens aseptically, proper labeling and documentation, safe transport, and timely analysis. Common specimens include blood, urine, sputum, and swabs from various body sites. The document outlines procedures for collecting different types of specimens, appropriate containers, transport and storage conditions. It emphasizes the importance of aseptic technique and quality control.

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The document outlines principles for proper collection and submission of specimens to the microbiology lab in order to obtain accurate test results. It discusses 9 key principles: 1) collecting specimens with minimal contamination close to site of infection, 2) collecting at optimal times, 3) obtaining sufficient quantity, 4) using appropriate collection devices and containers, 5) collecting before antibiotics, 6) proper labeling for transport, 7) minimizing transport time, 8) following special handling instructions, and 9) collecting the proper specimen for the ordered test. Specific guidelines are provided for various specimen types like blood, urine, sputum etc. to ensure specimens are of high quality for microbiological analysis.

 Collection:
•   after several ml have
    passed, collect midstream
    in a urine container
 Transport:
•   Within 24hrs/4°C


2.Catheter specimen of urine (CSU):
 Container:
•   Sterile, screw-cap container
 Patient    preparation:
•   Clean urethral area (soap and water) and rinse
    (water)
 Collection:
•   Insert catheter into bladder
•   Allow first 15ml to pass
•   Then collect remainder
 Transport:
• Within 24hrs/4°C

3.Suprapubic bladder aspiration:
•   It is used primarily for neonates and small
    children but may be safely used in adults
•   A full bladder is required for this
•   Overlying skin id disinfected
•   Bladder is punctured above the symphysis
    pubis with a 22-gauge needle on a syringe
•   About 10ml of urine is aspirated
HAIR,NAILS, OR SKIN SCRAPINGS
   (FOR FUNGUS CULTURE)
 Container:
•   Clean, screw-top tube
 Patient     preparation:
•   Nails or skin: wipe with 70% alcohol
 Collection:
•   Hair: Collect hair with intact shaft
•   Nails: Send clippings of affected area
•   Skin: Scrape skin at leading edge of lesion
 Transport:
•   Within 24hrs/RT
ABSCESS:
(also lesions, wounds, pustule, ulcer)
A . Superficial:
   Container:
• Anaerobic swab
moistened with Stuart’s or
Amie’s medium
   Patient preparation:
•   Wipe area with sterile saline
 or 70% alcohol
   Collection:
•   Swab along the leading edge of wound
   Transport:
•   Within 24hrs/RT

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This document provides guidelines for collecting, handling, transporting, and labeling microbiological samples for laboratory testing. It discusses appropriate collection methods and media for different sample types including blood, cerebrospinal fluid, stool, respiratory, and post-mortem samples. Guidelines are also provided on biosafety procedures, case investigation forms, and criteria for rejecting samples. The key aspects covered are collection of adequate samples, use of appropriate transport media, maintaining proper transport conditions, completing necessary documentation, and following biosafety protocols.

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For correct diagnosis and then to start the suitable therapy collection of required sample and then its testing is of utmost importance.

laboratory diagnosisabstanimal
B . Deep:
   Container:
•   Anaerobic transporter
   Patient preparation:
•   Wipe area with sterile saline or 70%
    alcohol
   Collection:
•   Aspirate material from wall or excise
    tissue
   Transport:
•   Within 24hrs/RT
Genital tract
A . Females:
1.Cervical swab:
 Container:
•   Swab moistened with
    Stuart’s or Amie’s medium
 Patient    preparation:
•   Remove mucus before
•   collection of specimen
 Collection:
•   Swab deeply into
    endocervical canal
 Transport:
•   Within 24hrs/RT
2 . High vaginal swab:
 Container:
•   Swab moistened with Stuart’s or Amie’s medium
•   Or JEMBEC transport system
 Patient     preparation:
•   Remove exudates
 Collection:
•   Swab secretions and mucous membrane of vagina
 Transport:
•   Within 24hrs/RT
3 . Urethral swab:
 Container:
•   Swab moistened with Stuart’s or Amie’s medium
 Patient      preparation:
•   Remove exudates from urethral opening
•   Collection:
•   Collect discharge by massaging
    urethra against pubic symphysis
•   Or insert flexible swab 2-4cm into
    urethra and rotate swab for 2 sec.
•   Collect at least 1 hr after patient
    has urinated
 Transport:
•   Within 24hrs/RT

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This document provides guidelines on standard operating procedures for microbiology laboratory diagnosis. It discusses the proper collection, transport, and processing of various clinical specimens like blood, cerebrospinal fluid, sputum, urine, stool, and others. Key points emphasized include collecting specimens before antimicrobial administration, using appropriate containers, minimizing delays in transport and storage, and preventing contamination. The document also outlines procedures for staining techniques, sterilization, waste disposal, and quality control. Following standardized protocols helps ensure accurate laboratory diagnosis of infectious diseases.

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Specimen quality is important for accurate diagnosis and treatment. Laboratories must develop good relationships with healthcare providers to ensure high quality specimens. Sputum is the preferred respiratory specimen for tuberculosis testing and should be thick, mucopurulent, and at least 3 mL in volume. Extrapulmonary specimens can also be tested for tuberculosis from sterile and non-sterile sites. All mycobacteria specimens require special handling and transport according to regulations to maintain specimen integrity and prevent exposure. Processing involves digestion, decontamination, and concentration to reduce normal flora and recover mycobacteria for testing.

B . Males:
1.Prostrate:
 Container:
•   Swab moistened with Stuart’s or Amie’s medium
•   Or sterile screw-cap tube
 Patient     preparation:
•   Clean glans with soap and water
 Collection:
•   Collect secretion on swab or
•   In tube
 Transport:
• Within 24hrs/RT for swabs
• Immediately/RT if in tubes
2 . Urethra:
 Container:
•   Swab moistened with Stuart’s or Amie’s medium
•   Or JEMBEC transport system
 Collection:
•   Insert flexible swab 2-4cm into urethra and rotate
    for 2 sec.
•   Or collect discharge on JEMBEC transport system
 Transport:
•   Within 24hrs/RT for swab
•   Within 2hrs for JEMBEC transport system
REFRENCES:
   Specimen Collection In Clinical
    Microbiology
     Dr. V. L.Malhotra, Dr. Neelam Khandpur
   Bailey And Scott's Diagnostic Microbiology
    (12th Edition)
   Koneman’s Colour Atlas Of Diagnostic
    Microbiology (6th Edition)
   Textbook Of Microbiology- Ananthanarayan
    And Paniker’s(8th Edition)
   Mackie And McCartney Practical
    Microbiology(14th Edition)
   Internet
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This document provides guidance on proper specimen collection, transport, and aseptic technique in microbiology. It discusses the importance of collecting the right specimen from the right patient at the right time and transporting it properly to the laboratory. It provides details on proper collection and transport of various specimen types from different sites of infection, including respiratory, urinary, genital, and others. Proper labeling, containers, transport media, and aseptic technique are also covered to ensure sample quality and viability.

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Collection and transport

  • 1. COLLECTION AND TRANSPORT OF SPECIMENS JITENDRA KUMAR PANDEY MGM medical college ,mumbai PG,MEDICAL MICROBIOLOGY 3yr
  • 2. INTORDUCTION: Specimen collection and transportation are critical considerations , because any results the laboratory generates is limited by the quality of the specimen and its condition on arrival in the laboratory. Specimens should be obtained to minimize the possibility of introducing contaminating microorganisms that are not involved in the infectious process.
  • 3. General guidelines for specimen collection:  Depending on the type of infection e.g. blood  Aseptic precautions  Anatomic sites and locations  Adequate amount/volume  Tissue or other body fluids should be preferred over swabs, to get quality material  Proper timing  Clinical laboratory form
  • 4. An Ideal Request form  Name xxxx Age Sex  IP/ OP No xyz Time Date  Ward xx123 Urgent / Routine  Nature of specimen  Investigation needed Doctor/Staff Contact No 1234567
  • 5.  Use of transport media  Proper handling ,labelling and transportation  Use of proper container  Instruction to the patient  Before the administration of antibiotics  Avoid contamination of specimens
  • 6. SPECIMEN TRANSPORT:  Within 2 hours of collection  Containers should be leak-proof  Separate section for paperwork  Special preservatives or holding media  Biohazard label
  • 7. Triple packaging system
  • 8. Criteria for rejection of specimens: Several criteria can be considered by a laboratory on the basis of which the processing of a specimen may not be done by the laboratory. Such a decision must be made in light of the specific requested investigation. Laboratory investigations of a sample are a waste of time and resources if following criteria are not fulfilled :  Missing or inadequate identification  Insufficient quantity  Specimen collected in an inappropriate container  Contamination suspected  Inappropriate transport or storage
  • 9. Containers and swab for the collection of specimens: Containers: For faeces:- • Universal container • Spoon attached to the inside of the screw cap
  • 10. For urine:-  Universal container for small quantities  For larger quantities 250 ml wide mouthed screw-capped bottles are convenient For sputum:- • Universal container should not be used • Squat ,wide-mouthed disposable containers should be used
  • 11. For blood:- • Without anticoagulant for serological examination • With EDTA for parasitological examination  BLOOD CULTURE BOTTLE: • This must be at least large enough to hold 50ml of liquid medium ,with which it is issued from laboratory ,plus 5-10ml of patient’s blood
  • 12. For serous fluids:- • Universal container • Addition of 0.3ml of 20% solution sodium citrate to the container prior to autoclaving (with the cap fitted) is recommended for collection of fluids that may coagulate on standing • This avoids difficulty in performing cell counts or centrifuging procedure with such fluids
  • 13. Swabs:- Swabs suitable for taking Specimens of exudates from the throat, nostril , ear , skin, wounds and other accessible lesions consist of a sterile pledget of absorbent material, usually cotton-wool or synthetic fiber, mounted on a thin wire of stick  Swabs for special purpose:  Baby swabs  Pernasal swabs  Post-nasal swabs  Laryngeal swabs  High vaginal and cervical swabs  Serum coated cotton wool swab
  • 14. Containers of anaerobic specimens:  Syringe and needle for aspiration.  Tube or vial contains semi-solid holding medium an atmosphere of 5% CO2 ,a reducing agent, tube used for putting up the swab.  Readymade swabs in a plastic tube or jacket and containing either Cary-Blair , Amies transporter pre- reduced (PRAs) medium id used.  Plastic pouch or Bio-bag (transparent) containing a CO2 generating system, palladium catalyst and an anaerobic indicator can also be used.
  • 15. EYE: Various specimens collected are: A. specimens: 1.Conjunctival:-  Container: • Aerobic swab moistened with Stuart’s or Amie’s medium  Collection: • Obtained from superior and inferior tarsal conjunctiva • Specimen of both eyes with separate swabs by rolling swab over each conjunctiva • If a viral culture is requested ; a second specimen is collected • For Chlamydia culture swabs are taken with a dry calcium alginate swab
  • 16. Transport : • Within 24hrs/RT • For viral culture place in viral transport media and deliver promptly to laboratory or refrigerated for a short time and then transport on wet ice • For Chlamydia place in 2-Sp transport medium 2. Corneal scrapings:  Container: Bedside inoculation of BA,CA,SDA,7H10,Thio  Patient preparation: Clinician should instill local anesthetic before collection  Collection: By using heat sterilized platinum spatula or calcium alginate- tipped swab dipped in sterile trypticase soya broth  Transport: Immediately/RT
  • 17. 3. Anterior chamber and vitreous cultures:  Collection: Aspiration is carried out with a tuberculin syringe fitted with a • 25-27 gauge needle for the aqueous • 20-21 gauge needle for vitreous aspiration  Transport: Immediately/RT
  • 18. EAR: 1. Inner ear:  Container: • Sterile , screw-cap tube or anaerobic transporter  Patient preparation: • Clean ear canal with mild soap solution before puncture of the ear drum  Collection:  Aspirate material behind drum with syringe if ear drum is intact; use swab to collect material from ruptured eardrum  Transport: • Immediately/RT
  • 19. 2. Outer ear:  Container: • Aerobic swab moistened with Stuart's or Amie’s medium  Patient preparation: • Wipe away crust with sterile saline  Collection: • Firmly rotate swab in outer canal  Transport: • Within 24hrs/RT
  • 20. RESPIRATORY TRACT(RT):  Collection of specimen in the case of RTI poses a number of problems because , there is enormous commensal flora that colonizes this tract.  Therefore, the specimen collection is very crucial and specially in case of viral infections of RT.  One has to avoid contamination of the specimens.  RT is broadly divided into:
  • 21. A . Upper RT:  Container: • Swab moistened with Stuart’s or Amie’s medium  Collection: 1.Oral swab: • Remove the oral secretions or debris from the surface of lesion with swab and discard • Using 2nd swab ,vigorously specimen the lesion avoiding any areas of normal tissue 2. Nasal swab: • Use swab moistened with sterile saline. • Insert approx. 2cm into nares • Rotate swab against nasal mucosa
  • 22. 3. Nasopharyngeal: A. Swabs: • To collect nasopharyngeal cells, all mucus is removed • Small flexible nasopharyngeal swab is inserted along the nasal septum to the posterior pharynx • Rotate slowly for 5 sec. against the mucosa several times B. Aspirate : • Is collected with a plastic tube attached to 10 ml syringe or suction catheter C. Washings: • Is obtained with a rubber suction bulb by instilling and withdrawing 3-7 ml of sterile buffer saline
  • 23. 4.Laryngeal swab: • Before use the swab is moistened with sterile D/W • Patient is made sit and holding the tongue fully protruded • with help of a piece of gauge, pass the swab back through the mouth wire mid-line and downwards over the epiglottis into larynx where it should induce reflex coughing that will expel sputum onto swab • Withdraw the swab and replace it in its tube for delivery to the laboratory
  • 24. 5. Throat swab: • Depress the tongue with a tongue depressor • Introduce the swab between the tonsillar pillars and behind the uvula without touching the lateral walls of the buccal cavity • Swab back and forth across the posterior pharynx • Any exudates or membrane should be taken for specimen  Transport: • Within 24hrs/RT
  • 25. B. Lower RT:  Container: • Sterile screw-top container  Collection: 1.Sputum:  Patient preparation: Ask patient to brush teeth and then rinse or gargle with water before collection • Collected early in the morning before eating • make collection in a disposable wide mouthed screw-capped sterile plastic container of about 100ml capacity
  • 26. • Instruct to wait until he/she feels material coughed into his/her throat • Then work it forward into mouth and spit it directly into container • Should be collected before starting antimicrobial chemotherapy 2.Transtracheal aspiration(TTA): • Obtained by inserting a small plastic catheter into the trachea via a needle previously inserted through the skin and cricothyroid membrane • This technique is rarely used any more
  • 27. 3.Bronchioalveolar lavage (BAL): • 30-50 ml of physiological saliva is injected through a fiberoptic bronchoscope . • the saliva is then aspirated 4.Bronchial brush: • Is collected via a protected catheter bronchial brush as part of a bronchoscopy examination 5.Gastric lavage: • In the morning before the patient has taken anything but after a bout of coughing and swallowing , aspirate the fasting stomach contents with a Ryle’s tube  Transport: • Within 24hrs/RT
  • 28. BODY FLUIDS: 1.Cerebrospinal fluid:  Container: • Sterile screw-cap tube  Patient preparation: • Disinfect skin before aspirating specimen  Collection: • Lumbar puncture to collect the CSF for examination to be collected by Physician trained in procedure with aseptic precautions to prevent introduction of Infection.
  • 29. The trained physician will collect only 3-5 ml into a labeled sterile container • The fluid to be collected at the rate of 4-5 drops per second.
  • 30. The best site for puncture is inter space between 3 and 4 lumbar vertebrae • 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.
  • 31. Transportation to Laboratory:  The collected specimen of CSF to be dispatched promptly to Laboratory , delay may cause death of delicate pathogens, e.g. Meningococci and disintegrate leukocytes
  • 32. 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.
  • 33. 2.Pleural/Peritoneal/Pericardial/ Synovial fluid:  Container: • Sterile screw-cap tube or anaerobic transporter  Patient preparation: • Disinfect skin before aspirating with 2% iodine tincture  Collection: • Obtained via percutaneous needle aspiration or surgery  Transport: • Immediately/RT
  • 34. BLOOD:  Container: • Blood culture media set(aerobic and anaerobic bottle) or vacutainer tube with SPS  Patient preparation: • Disinfect venipuncture site with 70% alcohol and disinfectant such as betadine
  • 35.  Collection: • Select the vein from which blood is to be drawn • Disinfect the venipuncture site • Allow it to dry • With precautions to avoid touching and recontaminating the venipuncture Site , take the specimen of blood and put it immediately through the hole in the cap of bottle  Volume of blood: • In adult 5-10ml • In children 1-5ml Transport: • Within 2hrs/RT
  • 36. Gastrointestinal tract(GIT): 1.Stool:  Container: • Clean leak-proof container  Collection: •Pass stool directly into a sterile, wide-mouth, leak proof container with a tight fitting lid. •Pass stool into a clean, dry bedpan, and transfer into a sterile leak proof container with a tight fitting lid.  Stool for ova and parasites should be placed in preservative immediately after collection.  Transport: • Within 24hrs/4 °C • 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
  • 37. Transport media for stool specimens Cary-Blair All enteric organisms Stuart All enteric organisms Amies All enteric organisms Buffered glycerol All enteric organisms saline except Vibrios Campylobacter Alkaline peptone Vibrios water V-R fluid Vibrios
  • 38. 2.Rectal swab: Container: • Swab placed in enteric transport medium Collection:  Pass the tip of a sterile swab approximately 1 inch beyond the anal sphincter.  Carefully rotate the swab to sample the anal crypts and withdraw the swab. Place the swab in transport medium. Transport:
  • 39. 3.Duodenal aspirates:  Container: • Sterile, screw-cap tube  Patient preparation: • Collect in early AM before patient eats or gets out of bed.  Collection: • Ask the patient to swallow a weighted gelatin capsule containing a tightly wound length of string, which is left protruding from the mouth and taped to the cheek • After a predetermined period , during which the capsule reaches the duodenum and dissolves, the string now covered with duodenal contents is retracted .  Transport:
  • 40. URINARY TRACT INFECTION(UTI): 1.Urine:  Container: • Sterile, screw-cap container  Patient preparation: Females: • Clean area with soap and water, then rinse with water, hold labia apart and begin voiding in commode; after several ml have passed, collect midstream Males: • Clean glans with soap and water, then rinse with water, retract foreskin; after several ml have
  • 41.  Collection: • after several ml have passed, collect midstream in a urine container  Transport: • Within 24hrs/4°C 2.Catheter specimen of urine (CSU):  Container: • Sterile, screw-cap container  Patient preparation: • Clean urethral area (soap and water) and rinse (water)
  • 42.  Collection: • Insert catheter into bladder • Allow first 15ml to pass • Then collect remainder  Transport: • Within 24hrs/4°C 3.Suprapubic bladder aspiration: • It is used primarily for neonates and small children but may be safely used in adults • A full bladder is required for this • Overlying skin id disinfected • Bladder is punctured above the symphysis pubis with a 22-gauge needle on a syringe • About 10ml of urine is aspirated
  • 43. HAIR,NAILS, OR SKIN SCRAPINGS (FOR FUNGUS CULTURE)  Container: • Clean, screw-top tube  Patient preparation: • Nails or skin: wipe with 70% alcohol  Collection: • Hair: Collect hair with intact shaft • Nails: Send clippings of affected area • Skin: Scrape skin at leading edge of lesion  Transport: • Within 24hrs/RT
  • 44. ABSCESS: (also lesions, wounds, pustule, ulcer) A . Superficial:  Container: • Anaerobic swab moistened with Stuart’s or Amie’s medium  Patient preparation: • Wipe area with sterile saline or 70% alcohol  Collection: • Swab along the leading edge of wound  Transport: • Within 24hrs/RT
  • 45. B . Deep:  Container: • Anaerobic transporter  Patient preparation: • Wipe area with sterile saline or 70% alcohol  Collection: • Aspirate material from wall or excise tissue  Transport: • Within 24hrs/RT
  • 46. Genital tract A . Females: 1.Cervical swab:  Container: • Swab moistened with Stuart’s or Amie’s medium  Patient preparation: • Remove mucus before • collection of specimen  Collection: • Swab deeply into endocervical canal  Transport: • Within 24hrs/RT
  • 47. 2 . High vaginal swab:  Container: • Swab moistened with Stuart’s or Amie’s medium • Or JEMBEC transport system  Patient preparation: • Remove exudates  Collection: • Swab secretions and mucous membrane of vagina  Transport: • Within 24hrs/RT
  • 48. 3 . Urethral swab:  Container: • Swab moistened with Stuart’s or Amie’s medium  Patient preparation: • Remove exudates from urethral opening • Collection: • Collect discharge by massaging urethra against pubic symphysis • Or insert flexible swab 2-4cm into urethra and rotate swab for 2 sec. • Collect at least 1 hr after patient has urinated  Transport: • Within 24hrs/RT
  • 49. B . Males: 1.Prostrate:  Container: • Swab moistened with Stuart’s or Amie’s medium • Or sterile screw-cap tube  Patient preparation: • Clean glans with soap and water  Collection: • Collect secretion on swab or • In tube  Transport: • Within 24hrs/RT for swabs • Immediately/RT if in tubes
  • 50. 2 . Urethra:  Container: • Swab moistened with Stuart’s or Amie’s medium • Or JEMBEC transport system  Collection: • Insert flexible swab 2-4cm into urethra and rotate for 2 sec. • Or collect discharge on JEMBEC transport system  Transport: • Within 24hrs/RT for swab • Within 2hrs for JEMBEC transport system
  • 51. REFRENCES:  Specimen Collection In Clinical Microbiology Dr. V. L.Malhotra, Dr. Neelam Khandpur  Bailey And Scott's Diagnostic Microbiology (12th Edition)  Koneman’s Colour Atlas Of Diagnostic Microbiology (6th Edition)  Textbook Of Microbiology- Ananthanarayan And Paniker’s(8th Edition)  Mackie And McCartney Practical Microbiology(14th Edition)  Internet