Specimen collection LAB

• Genital tract specimen


  Accurate diagnosis of genital infections depends on separation of pathogens from normal flora
• Female genital tract


  • Colonized by a wide array of organisms
  • Many infections arise from normal flora upon activation by the patient condition and history, and other organisms
  • It is important to identify the carrier state, regardless of patient symptoms
• Group B streptococcus


  • Isolated from the vagina during late pregnancy is considered a risk factor for the successful outcome of the newborn
• Male urethra


  Contains just a few organisms normally found on the skin
• Non-culture methods of detecting some genital infections or syndromes are available and, in some instances, are actually the best choice for diagnosis
• Recovery of specific pathogenic organisms

  Culture of the proper specimen, with special care taken to exclude normal flora
• Guidelines in collecting a Genital Tract Specimen

  1. Use specimen collection system appropriate for suspected pathogen

  2. Squeeze sponge in the bottom of the culturette to moisten the swab after sampling

  3. For Neisseria gonorrhoeae, use sterile swab and media warmed to room temperature should be inoculated at the bedside

  4. Vaginal specimens are not acceptable for anaerobic culture and any specimen collected from higher in the female genital tract should be collected through a catheter to avoid contamination with vaginal flora

  5. For Chlamydia and/or viral, use sterile swab placed in a viral transport media at the bedside

  6. Every genital culture should be accompanied by a separate swab or smear for gram stain

  7. Indicate any specific organism suspected, as well as any pertinent clinical history

  8. Any growth from a specimen collected with a syringe will be considered significant

  9. Specimens collected for group B streptococcus screening must be specifically identified
• To detect the infection in genital specimen

  1. Microscopy

  2. Group B Strep Screen

  3. Gen-Probe Test
• Microscopy


  Some infections can be diagnosed immediately by simple microscopy
• Microscopy for

  • Syphilis
  • Neisseria gonorrhoeae
  • Trichomonas vaginalis and/or Yeast
• Group B Strep Screen

  1. The later in pregnancy that cultures are performed, the closer the correlation with intra-partum conditions

  2. The optimal method is the collection of two separate swabs from the distal vagina and the anorectum

  3. Cervical-cultures are not acceptable

  4. Insert culturette swab into the rectum, hold in place for a few seconds to absorb fluid, withdraw, remove plastic cap and place swab in the plastic sleeve

  5. The vaginal swab should be collected without the use of a speculum
• Gen-Probe Test

  1. GEN-PROBE collection device is unisex for female endocervical and male urethral specimens

  2. Unisex collection device contains transport media and a swab

  3. Use enclosed swabs only

  4. Transport and store at 2-30 degrees C

  5. Testing must occur within 60 days of specimen collection
• Procedures in collecting Endocervical Specimen

  1. Use white shaft swab labeled "cleaning swab - not for specimen collection" to remove excess mucus from cervix and discard

  2. Insert second swab (blue shaft) from collection kit about 1 to 1.5 cm into endocervical canal

  3. Rotate swab clockwise for 10-30 seconds to ensure adequate sample

  4. Withdraw swab carefully to avoid contact with vaginal mucosa

  5. Insert swab into transport tube and snap off shaft at the score line

  6. Recap tightly, label with patient name and DOB, and transport specimen to lab
• Males - urethral collection procedure


  1. Patient should not have urinated for at least one hour prior to sample collection

  2. Insert the swab (blue shaft) provided in the kit 2 to 4 cm into the urethra

  3. Rotate clockwise for 2 to 3 seconds to ensure contact with all mucosal surfaces

  4. Withdraw swab and insert into transport tube. Snap off shaft at the score line

  5. Recap tightly, label with patient name and DOB, and transport specimen to lab
• GEN-PROBE collection device


  Available for Chlamydia / Gonorrhoea detection from a urine specimen
• Collection Process for GEN-PROBE urine specimen

  1. Patient should not have urinated for at least one hour prior to specimen collection

  2. Female patients should NOT cleanse the labia prior to specimen collection

  3. Instruct patient to collect only the first 20-30 ml of initial urine stream into a urine collection cup

  4. Transfer 2 ml of urine into the urine specimen transport tube using the disposable pipette provided in the package

  5. Alternatively, urine in the original specimen collection container may be transported to the lab either refrigerated or at room temperature

  6. Transfer to the GEN-PROBE transport tube must be within 24 hrs. of specimen collection

  7. Processed urine (urine in transport tube) must be tested within 30 days of collection
• Special considerations in specimen collection by site for female

  1. Vagina: Use a speculum without lubricant, collect mucosal secretions from high in the vaginal canal

  2. Cervix: Do not use lubricant, wipe the cervix clean of vaginal secretions and mucus, rotate a sterile swab to obtain exudate from the endocervical glands

  3. Bartholin gland: Decontaminate the skin and aspirate material from the duct

  4. Endometrium: Collect by transcervical aspiration through a telescoping catheter

  5. Fallopian tube: Swab or preferably an aspirate obtained during surgery

  6. Amniotic fluid: Aspirate by catheter, amniocentesis, or at C-section

  7. Vulvular lesion: Clean lesion with saline and remove crust, if present, scrape lesion until serous fluid emerges, then wipe away fluid and debris, press base of lesion until fluid is expressed, aspirate with a fine gauge needle or unroof the vesicle and collect fluid with a sterile swab for viral culture

  8. Urethra: Wait at least 1 hour after urination to collect specimen, collect discharge with a sterile swab by gentle massage of urethra against the pubic symphysis through the vagina, if no discharge is obtained, cleanse external urethra with betadine soap and rinse with water, insert a female urogenital swab 2-4 cm into the urethra, gently rotate and leave in place for 1-2 seconds before withdrawing
• For Male

  1. Urethra: Wait at least 2 hours after urination to collect specimen, cleanse head of penis and then collect discharge with sterile swab by gently squeezing penis with a milking motion, if no discharge is present, insert a male urogenital swab 2-4 cm into the urethra, gently rotate, leave in place 1-2 seconds, and withdraw

  2. Prostate fluid: Perform digital massage through rectum and collect fluid in a sterile tube or swab

  3. Epididymis: Needle and syringe aspirate

  4. Penile lesion: Cleanse lesion surface with saline, and remove crust if present, scrape lesion until serous fluid is obtained, then wipe away fluid and debris, press lesion base until fluid is expressed, aspirate with a fine gauge needle or unroof the vesicle and sample with a sterile swab for viral culture
• Stool Culture Purpose

  Identify the causative agent of diarrhea<|>Detect the bacterial carrier state in a patient
• Stool Culture for Pathogens

  Routine stool culture screening for Salmonella, Shigella, Arizona, Edwardsiella, Campylobacter, shiga toxin producing E. coli, and for a predominance of Staphylococcus aureus, Pseudomonas, or yeast<|>Screening for E. coli by culture methods has been replaced by testing for E. coli shiga-like toxin<|>Enterohemorrhagic E. coli produce a toxin capable of causing bloody diarrhea and can lead to hemolytic uremic syndrome as a result of toxin damage to the kidneys<|>An order for isolation of a single specific organism, such as Yersinia, Vibrio, Clostridium difficile or Neisseria gonorrhoeae must be requested separately, over and above an order for routine stool culture
• Stool Culture


  A test on a stool sample to find germs such as bacteria or gingus that can cause an infection by smearing a sample the sample onto plates containing gel that encourage bacterial growth<|>If no germs grow, the culture is negative
• Guidelines In stool Specimen Collection


  1. A single properly collected specimen is usually enough to identify the cause of acute bacterial diarrhea, to detect a carrier state, single specimens for three consecutive days are recommended

  2. All stool specimens for culture should be submitted in a transport media

  3. Stool specimens should be collected in a clean, dry container, not contaminated with water, urine, barium, or mineral oil

  4. Transfer specimen from the collection container into a transport vial ASAP, use the "spork" in the cap lid to sample the stool, particularly areas of blood or mucous, do not overfill the transport vial

  5. Tighten the cap and shake well to mix

  6. Please note any mention of a specific organism on the request form and/or request specific culture type in the computer
• Alternative Collection Methods

  1. For diapers in children: If the quantity is sufficient to bring the transport fluid up to the fill-to-here line, scrape up the stool with the spork in the cap assembly of the transport vial, recap, shake well, and submit

  2. For children with watery diarrhea: Place a pedi urine collection bag over the child's anal area, monitor closely, so the bag can be removed ASAP after a bowel movement to preserve as much specimen as possible in the bag, cut a corner from the bottom of the bag and pour contents into a transport vial
• To sample the stool

  1. Pick up or pour a quantity of stool sufficient to bring the fluid volume up to the "fill-to-here" line

  2. Do not overfill the transport vial

  3. Tighten the cap and shake well to mix
• Please note any mention of a specific organism on the request form and/or request specific culture type in the computer
• Alternative Collection Methods - Diapers in Children


  1. If the quantity is sufficient to bring the transport fluid up to the fill-to-here line

  2. Scrape up the stool with the spork in the cap assembly of the transport vial, recap, shake well, and submit
• Alternative Collection Methods - Children with a Watery Diarrhea


  1. Place a pedi urine collection bag over the child's anal area

  2. Monitor closely, so the bag can be removed ASAP after a bowel movement to preserve as much specimen as possible in the bag

  3. Cut a corner from the bottom of the bag and pour contents into a transport vial
• Rectal Swabs


  1. Insert sterile culturette swab a short distance into the rectum

  2. Hold in place for a minimum of 30 seconds to allow the swab to absorb specimen and withdraw

  3. Remove cap and place swab in culturette sleeve

  4. Squeeze sponge to moisten swab
• Ova


  In stool, the worms look like small pieces of white cotton thread, because of their size and white color, pinworms and difficult to see
• Parasite exam

  The male worm is rarely seen because it remains inside the Intestine<|>It is best to search for pinworms at night when the female comes out to lay her eggs<|>Diagnosis of intestinal parasitic infection is dependent on laboratory demonstration of the diagnostic stage of the parasite<|>Identification is by gross and/or microscopic exam of feces for eggs, larvae, or protozoa<|>An order for Ova & Parasites (O& P) will result in a screen of the specimen for most parasites<|>Specific orders for Giardia antigen (GIAR), Cryptosporidium (CRYPTOSM), or pinworms (PIN), have special collection criteria and/or detection methods and so must be ordered as separate, distinct procedures
• How To Collect The Specimen for Ova & Parasites


  1. Three specimens collected on successive three days are recommended for optimum parasite detection

  2. Collect specimen in a clean, dry container

  3. Stool swabs are unacceptable for Ova & Parasites exams

  4. Interfering substances like substances and medications interfere with parasite detection

  5. Specimen should not contain water or urine

  6. Contamination with mineral oil, barium, bismuth, antibiotics, anti-malarials, or non-absorbable antidiarrheal agents can prevent parasite recovery for one to several weeks

  7. Purging or bowel prep agents must be cleared before the specimen can be submitted for Ova & Parasites exam, as they are crystalline in nature and obscure any parasitic elements that might be present

  8. Specimen collection should take place a minimum of 7 days after administration of any of the interfering agents mentioned above

  9. All specimens should be placed in fixative ASAP after collection
• Two-Vial System


  Currently in use for ova and parasite fixation and preservation<|>Both vials must be submitted for the complete OP exam<|>Pink Cap Vial contains formalin and is used in the procedure<|>Blue or Gray Cap Vial contains Polyvinyl Alcohol (PVA) and an iodine concentration, used to prepare a permanent stained smear
• Proper Use of Two-Vial System


  1. Pour over or use the "spork" provided in the cap lid to sample the specimen, in particular areas of blood or mucous

  2. Add specimen to each vial until fluid level reaches the fill-to-here line

  3. Do not overfill the vials

  4. Tighten caps and shake vigorously to mix

  5. Note specimen consistency on the outside of the vial and/or on the computer order

  6. Include recent travel history of the patient, if known

  7. Unpreserved liquid specimens may be submitted to the lab in a clean, dry container, immediately after passage, if amoebiasis is suspected

  8. A direct wet mount procedure can be performed to look for motile protozoans
• Collecting Specimen for Giardia Antigen and Cryptosporidium


  Transfer the stool into the pink cap vial which has a formalin
• Detecting the pinworm in the stool

  1. Contact the laboratory for commercial collection kit or clear Scotch tape and a glass slide

  2. Opaque tape is unacceptable

  3. Collect the specimen first thing after patient awakens in the morning, before arising from bed

  4. Collect using a loop a strip of clear tape length-wise down a wooden tongue depressor, around the end and back up the other side of the stick, sticky side out

  5. Hold both ends of the tape securely against the tongue depressor

  6. Have the patient lie face down and spread the buttocks

  7. Press the sticky side of the tape against several areas of the perianal region

  8. Place the tape, sticky side down on a glass slide and smooth with cotton or gauze

  9. Transport to laboratory ASAP
• Fecal Occult Blood Test (FOBT)


  Also known as stool guaiac, the hemoccult test (OCCB)<|>A qualitative method for detection of blood in the stool (Examination of a sample of stool (feces) to check for blood)<|>Intended as a diagnostic aid during routine physical exams, monitor for bleeding patients with iron deficiency anemia, recuperating from surgery, peptic ulcer, ulcerative colitis, or other conditions and as a screen for colorectal cancer<|>Occult Blood means that it cannot seen with the naked eye<|>Presence of blood means there is likely some kind of bleeding in the digestive tract<|>It may be caused by a variety of conditions including polyps<|>By the use colonoscopy it can determine if the bleeding is coming from the stomach or small intestine
• How to collect the specimen for Fecal Occult Blood Test


  1. There are no restrictions on the number of times an occult blood test may be ordered

  2. If the first specimen is positive, the reason for testing should be evaluated before ordering additional tests

  3. If initially negative test, additional specimens may be required

  4. Since gastrointestinal lesions may bleed intermittently, the recommendation is a specimen from three consecutive bowel movements

  5. If patient preparation guidelines cannot be met, be advised that results may be falsely positive or falsely negative and evaluate your patient accordingly

  6. For females: Do not submit specimens during, or until three days after a menstrual period, do not submit specimens while the patient has bleeding hemorrhoids or blood in the urine, for 7 days prior to and during the collection period, avoid aspirin or other non-steroidal anti-inflammatory drugs, anticoagulants, or any substance which could irritate the gastro-intestinal tract, including alcohol, for 72 hours prior to and during the collection period, avoid vitamin C, or iron supplements containing Vitamin C, and other food likes Red meat, Artichokes, mushrooms, bean sprouts, apples, oranges, bananas, grapes

  7. If specimen is collected over a toilet bowl, remove toilet bowl cleaners from the tank and flush twice before proceeding

  8. Place stool specimen in a clean, dry container

  9. The Hemoccult test requires only a small amount of specimen, but submit enough of a quantity so that the stool does not dry out before reaching the lab
• Alternative Collection Method - Hemoccult Cards


  1. Specimen may be applied to the card at the bedside

  2. Flip open the cover of the card to expose the two areas of guaiac paper

  3. Use a wooden applicator to sample the stool and apply a thin smear to box A

  4. Use the same applicator to sample a second, different area of the stool specimen and repeat the thin smear for box B

  5. Discard the applicator and close the cover flap

  6. Label the card and return it to the laboratory

  7. Development of the test must take place in the laboratory or by the physician, if performed in a patient area
• Fecal Leukocytes


  A positive result means white blood cells (leukocytes) were found stool sample which indicate inflammation in the digestive tract<|>The more leukocytes found the higher the chance of bacterial infection<|>Chronic ulcerative colitis and chronic bacillary dysentery can cause passage of pus with the stool<|>Examination of stool for fecal leukocytes may also be requested as stool WBC, fecal leukocytes, or stool leukocytes
• Collecting specimen for Fecal Leukocytes

  1. Only liquid stools or those containing recognizable mucous should be submitted for microscopic examination of stool leukocytes

  2. Formed stool is an unacceptable specimen

  3. Collect specimen prior to procedures requiring administration of barium

  4. Specimen should be submitted in a clean, dry container