Update of Sample Handling for Microbiology Specimen
Perhimpunan Dokter Spesialis Patologi Klinik dan Laboratorium Indonesia Palembang, 10 Mei 2018 Preanalytic process : • Patuent identification • Preparation tools and materials / medium • Collecting • Handling • Labelling • Storage • Transportation Basic principles of specimen collection:
1. A culture specimen should be taken in the acute phase of
infection (likelihood of recovering the suspected agent is greatest) and before antibiotics are administered 2. The collection process is initiated by written order followed by selection of a site to culture Failure to select an appropiate site, leads to misleading culture results and may adversely affect patient management 3. It is important to culture the infecting agents while avoiding the usual flora and colonizing organism 4. Should be obtained from the site of infection with minimal contamination from adjacent tissues and organ secretions Basic principles of specimen collection: 5. Test result must always be compared with suspected diagnosis carefully. Failure to recover organism could be due to a true absence of the organism or to inadequate sampling of the site 6. The volume of specimen must be adequate 7. All specimens except stool should be collected in a sterile container, labeled with: the name, identification number of the patient, the source, the time of collection. 8. After collection, specimen should be placed in a biohazard bag and transported to the laboratory ASAP 9. If delay unavoidable, urine, sputum other respiratory specimens, stool should be refrigerated to prevent overgrowth of normal flora Factors that affect the reliability and reproducibility of laboratory results Sources of error may include the following: • Personnel. • Environmental factors. • Specimens. • Laboratory materials. • Test method. Some methods are more reliable than others. • Equipment. Lack of equipment or the use of substandard or poorly main- tained instruments will give unreliable results. • Examination and reading. Hurried reading of results, or failure to examine a sufficient number of microscope fields, can cause errors. • Reporting. Transcription errors, or incomplete reports, cause problems. Note • The volume of specimen collected must be adequate for performance of the microbiologic studies requested. • Calcium Alginate should be avoided for collection of samples for viral culture because it could inactivate Herpes Simplex Virus. • Cotton maybe toxic to Neisseria Gonorrhoeae • Wooden shaft should be avoided because the wood maybe toxic to Chlamydia Trachomatis. Note • Swabs are not optimal for detection of anaerobes, mycobacteria, or fungi, and their use when these organisms are suspected should be discouraged. • Specimens should be obtained from the site of infection with minimal contamination from adjacent tissues and organs secretions. • All specimens except stool should be collected in a sterile container, and all should be labeled with the name and identification number of the person from whom the specimen was collected, the source of the specimen, and the time the specimen was collected. Note • After collection, specimen should be placed in a biohazard bag and transported to the laboratory as soon as possible. • If delay is unavoidable, urine, sputum and other respiratory specimens, stool, and specimens for detection of Chlamydia Trachomatis or Viruses should be refrigerated to prevent overgrowth of normal flora. • CSF and other body fluids, bloods and specimens collected for recovery of Neisseria Gonnorrhoeae should be stored at room temperature, because refrigeration adversely affects recovery of potential pathogens from these sources. Note • Policies should be established for handling unlabeled or mislabeled specimens. • Universal precaution (UP) must be followed when handling all specimens. • Optimally, all specimens containers, but at minimum those containing respiratory secretion and those submitted specifically for detection of mycobacteria or fungi, should be opened in a biologic safety cabinet. criteria for rejecting specimens unsuitable for culture, e.g : – Any specimen received in formalin. – 24-hour sputum collections. – Specimens in containers from which the sample has leaked/ opened – Specimen contaminated with Barium, chemical dyes, or oily chemicals. – Specimens from foley catheters – Duplicate specimens (except blood culture) received in a 24-hour period. The following specimens should be rejected for anaerobic culture : – Gastric washings – Midstream urine – Stool – Oropharyngeal specimens – Sputum – Swabs of ileostomy or colostomy sites – Superficial skin specimens Wounds GOOD QUALITY SPECIMENS ARE NEEDED FOR RELIABLE MICROBIOLOGIC DIAGNOSES thank you