1. Sending Samples Kim Wilson, Matron, Infection Prevention UHMB] 12/03/2012

2. Introduction What kind of samples do you send? WHY?

3. Use of the Laboratory Blood Culture CSF Aspirates Sputum Swabs Urines Enterics Doctor “ Nurse “

4. A Few Myths The laboratory diagnoses infection The specimen always gets to the lab Microbiology is instantaneous –Things take time to grow –Useful information before formal report All laboratory reports are right All laboratory reports require action

5. A Few Truths We can easily grow bacteria from any body surface, but what does it mean? The microbiology report only says what’s there, not what it means

6. What Can We Look For? 2 important concepts: INFECTION Bacteria are causing harm Antibiotics MAY be required COLONISATION Bacteria are NOT causing harm Antibiotics are NOT required These are CLINICAL concepts that are assessed at the bedside, not in the laboratory. Treat patients not bits of paper

7. How Does Infection Arise? Contact with organism Organism overcomes body defences (virulence, impaired defences) –Malnutrition –Immunocompromised –Debility –Diabetes –Surgery –Devices –Antibiotics

8. Defining Infection SYSTEMIC SIGNS Fever Shock Markers Neutrophilia, ESR, CRP LOCAL SIGNS Pain Swelling Heat Red Inflammation is not necessarily infection

9. Using the Laboratory Blood Culture –Confirmation of sepsis - Not diagnosis –Care in collection - Contamination Sputum –Invariably contaminated - Limited value –Aspirates / Endoscopy Urine –Contamination Common –Bacteriuria is very common – and is not significant Swabs –Colonisation

10. Collecting a Sample Blood Culture ANTT Urine MSU Sputum Fresh Swab From the wound bed

11. Why are samples not tested? Mainly Labelling – either or both label and pot incomplete (or blank) Mismatched form and pot (2 people) No clinical indication identified Other issues Wound swabs no identified location DOB /NHS number/RTX do not match

12. The sooner we get it the better!

13. Thank you