1. Chapter 10 Specimen Collection

2. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Guidelines for Specimen Collection Apply principles of standard precautions Avoid environmental contamination Place lid on the table –Inner side up Avoid touching inside of container

3. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Guidelines for Specimen Collection Transport specimen in a plastic bag with biohazard label –Attach the requisition Do not put specimens in a refrigerator with food or medications

4. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Enemies of Specimen Collection Three enemies of specimen collection: 1.Time (transporting the specimen) 2.Temperature (avoid extremes) 3.Desiccation (drying; do not let the specimen dry out)

5. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Culture and Sensitivity Testing Culture determines if a pathogen is present –If so, whether the growth is heavy or light Sensitivity shows which antibiotics will best eradicate the pathogen

6. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Culture and Sensitivity Testing Cultures are always collected in sterile containers. It takes approximately 3 days to get results –Preliminary results available within 24 hours

7. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Culture and Sensitivity Testing Use good technique –Prevents picking up normal body flora and environmental contaminants

8. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Culture and Sensitivity Testing Collect an adequate amount of specimen Identify the specimen source and specific body collection site Make sure specimen is properly labeled Package properly if a pneumatic tube is used to transport to lab

9. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Swab Cultures Use a culturette After collecting the specimen –Squeeze bottom of outer plastic tube to break the inner ampule of transport medium When collecting a swab for Group A Streptococcus –Swab must be Dacron

10. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Swab Cultures Rotate swab so all surfaces contact the wound bed or other area If swabbing a wound, use a zigzag stroke

11. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Wound Infection Colonization is multiplication of a microbe after it has invaded the wound If wound is colonized, the microbe has successfully reproduced Signs or symptoms of infection are absent

12. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Wound Infection All Stage II, III, and IV pressure ulcers become colonized with bacteria A colonized wound will heal –Infected wound will not

13. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Sputum Culture Sputum is a secretion from the mucous membranes lining the trachea and lungs –It is not saliva from the mouth Collect early in the morning –Instruct patient to rinse mouth with water before collecting the specimen

14. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Gastric Specimen Gastric analysis checks for acid in the stomach Nasogastric tube must be inserted –Patient must be fasting Multi-step procedure that is collected over several hours

15. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Midstream Urine Specimen Midstream (clean-catch) urine specimen –Collected from the middle of the urinary stream Cleanse perineum according to facility policy prior to collecting the specimen Collect in a sterile container

16. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 24-Hour Urine Collection Tests for hormones, electrolytes, and proteins in urine over a 24-hour period Collection period starts when the patient has an empty bladder

17. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.17 24-Hour Urine Collection Collection container is refrigerated or stored on ice If a specimen is accidentally discarded –Stop test and begin again

18. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Renal Calculi Also called kidney stones –May develop anywhere in the urinary tract –May result from mineral salts collecting around bacteria, blood clots, or other particles –Stones are tiny, but very painful

19. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.19 Renal Calculi Renal colic is flank pain caused by obstructed urine –Sharp and severe in the lower back –Radiates around the body into the groin and testicles

20. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.20 Stool Specimen Hemoccult ® or guaiac test done bedside –Determines presence of occult blood in the stool Use a tongue blade –Collect two tablespoons of stool from bedpan

21. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.21 Stool Specimen Use a culturette to collect a rectal swab –Insert 1 ½ inches –Use normal saline to moisten the swab –Avoid lubricants

22. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.22 Blood Glucose Two-hour post prandial blood sugar –Collected 2 hours after a patient eats Fingerstick blood sugar (FSBS) –Checked by collecting capillary blood

23. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.23 Blood Glucose Blood glucose meters –Calibrated daily Nosocomial infection can be spread by a community blood glucose meter –Issuing an individual meter to each patient is best

24. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.24 Glycated Hemoglobin Glycated hemoglobin (A1C) –Blood sugar average over a three-month period Persons without diabetes –Normal A1C value is approximately 5.0% ADA –Goal of therapy should be less than 7%