Académique Documents
Professionnel Documents
Culture Documents
Prepared by: Lovelle Easter C. Macaraan Ma. Eloisa A. Alcantara Justine C. Sales Angelou H. Brinas
Introduction
The proper diagnosis of disease requires: 1. Taking a complete patient history 2. Conducting through physical examination of the patient. 3. Carefully evaluating the patients sign and symptoms 4. implementing the proper selection, collection, transport and processing of clinical specimen
Clinical Specimen
It is the various types of specimens (e.g. blood, urine, feces and cerebrospinal fluid) that are collected from patients and used to diagnose or follow the progress of infectious disease.
Type of Specimen
Type of Specimen
scotch tape prep Skin scrapping Skin snip Sputum Synovial (joint) fluid Throat Swabs Tissue specimen Urethral discharge material
Bronchial and V bronchoalveolar washes Cerebrospinal fluid Cervical & Vaginal Swab Conjunctival Swab or scraping Feces and Rectal Swab Hair clippings B, F, P, V B, B, V B, P, V
F
F
B B
Urine
B, P, V
B, P V
Urogenital secretion
Vesicle fluid or scraping
According to the Clinical and Laboratory Standards Institute All Specimens should be collected or transferred into a leakproof primary container with a secure closure. Care should be taken by the person collecting the specimen not to contaminate the outside of the primary containerWithin the institution, the primary container should be placed into a second container, which will contain the specimen if the primary container breaks or leaks in transit to the laboratory
Laboratory Policies and Procedures Manual or lab P&P (manual for short).Copies of the Lab P&P Manual must be available to every ward, floor, clinic, and department. Often it accessible through the hospitals computer system. However, the person who collects the specimen is ultimately responsible for its quality.
When clinical specimens are improperly collected and handled: 1. The etiologic(causative) agent may not be found or may be destroyed 2. Overgrowth by indigenous microflora may mask the pathogen 3. Contaminants may interfere with the identification of pathogens and the diagnosis of the infectious disease.
Specimen collection should be performed with care and tact to avoid harming the patient, causing discomfort, or causing undue embarrassment. A sufficient quantity of the specimen must be obtained to provide enough material for all required diagnostic tests. All specimens should be placed or collected into a sterile container to prevent contamination of the specimen by indigenous microflora and airborne microbes. Specimens should be protected from heat and cold and promptly delivered to the laboratory so that the results of the analyses will validly represent the number and types of organisms present at the time of collection. Hazardous specimens must be handled with even greater care to avoid contamination of the courier, patients and healthcare professionals.
Whenever possible, sterile, disposable specimen containers should be used. The specimen container must be properly labeled and accompanied by appropriate request slip containing adequate instructions. Specimens should be collected and delivered to the laboratory as early in the day as possible to give the technologist sufficient time to process the material especially when the hospital or clinic does not have 24-hour laboratory service.
Urine Urine is ordinarily sterile while it is in the urinary bladder. However during urination, it becomes contaminated by indigenous microflora of the distal urethra. Contamination can be reduced by collecting a clean-catch, midstream urine (CCMS urine). Clean-catch refers to the fact that the area around the external opening of the urethra is cleansed by washing with soap and rinsing with water before urinating. This removes the indigenous microflora that live in the area. Midstream refers to the fact that the initial portion of the urine stream is irected into a toilet or bedpan, and then the urine stream is directed into a sterile container.
There are actually three parts to urine culture: 1. A colony count 2. Isolation and identification of the pathogen 3. Antimicrobial susceptibility testing.
The colony count is a way of estimating the number of viable bacteria that are present in the urine specimen. A calibrated loop is a bacteriologic loop that has been manufactured so that it contains a precise volume of urine. The mere presence of bacteria in the urine (bacteriuria) is not significant, as urine always becomes contaminated with bacteria during urination (voiding).
Cerebrospinal Fluid Meningitis, encephalitis and meningoencephalitis are rapidly fatal diseases that can be caused by a variety of microbes, including bacteria, fungi, protozoa and viruses. Meningitis is inflammation or infection of the membranes that surround the brain and spinal column. Encephalitis is inflammation or infection of the brain.
Meningoencephalitis is inflammation or infection of both the brain and the meninges. To diagnose these diseases, cerebrospinal fluid must be collected into a sterile tube by a lumbar puncture under surgically aseptic conditions. Preliminary reports are laboratory reports that are communicated to the requesting physicians before the availability of the final report. Preliminary reports containing CSF Gram Stain observation frequently enable physicians to make diagnoses and initiate therapy and often save patients lives. Sputum
Sputum is pus that accumulates deep within the lungs of a patient with pneumonia, tuberculosis, or other lower respiratory infection. Unfortunately many of the sputum specimens that are submitted to the CML are actually saliva. A laboratory workup of a patients saliva will not provide clinically relevant information about the patients lower respiratory infection. This situation can be avoided if someone takes a moment to explain to the patient what is required.
Throat Swabs
Routine throat swabs are collected to determine whether a patient has strep throat. If any other pathogen is suspected by the physicians to be causing the patients pharyngitis, a specific culture for that pathogen must be noted on the request slip, so that the appropriate culture media will be inoculated. Wound Specimens Whenever possible, a wound specimen should be an aspirate, rather than a swab specimen. Specimens collected by swab are frequently contaminated with indigenous microflora and often dry out before they can be processed in the CML.
GC Cultures The initials GC represent an abbreviation for gonococci, a term referring to Neisseria gonorrhoeae. As mentioned earlier, N. gonorrhoeae is a fastidious bacterium that is microaerophilicc and capnophilic. Only Dacron, calcium alginate, or nontoxic cotton swabs should be used to collect GC specimens.
Fecal Specimen Ideally fecal specimens (stool specimen) should be collected at the laboratory and processed immediately to prevent a decrease in temperature, which allows the pH to drop, causing the death of many Shigella and Salmonella species. Alternatively, the specimen may be places in a container with a preservative that maintains a pH of 7.0.
Organization
Pathology Department
of typical Pathology
Department
Anatomical Pathology
Clinical Pathology
Morgue
Histopathology Laboratory
Cytology Laboratory
Immunology Laboratory
Blood Bank
Responsibilities The primary mission of the CML is to assist clinicians in the diagnosis and treatment of infectious diseases. To accomplish this mission, the four major, day-to-day responsibilities of the CML are to:
-Process the various clinical specimens that are submitted to the CML -Isolate pathogens from those specimens. -Identify (speciate) the pathogens. -Perform antimicrobial susceptibility testing when appropriate to do so.
The exact steps in the processing of clinical specimens vary from one specimen type to another and also depend on the specific section of the CML to which the specimen is submitted, In general, processing includes the following steps: -Examining the specimen macroscopically and recording pertinent observations(e.g cloudiness or the oresence of blood, mucus or an unusual odor) -Examining the specimen microscopically and recording pertinent observations( e.g the presence of white blood cells or microorganisms) -Inoculating appropriate culture media in an attempt to isolate the pathogens from the specimen and get them growing in pure culture in the laboratory.
Bacteriology Section
Mycology Section
Immunology Section
Virology Section
Parasitology Section
Bacteriology Section The overall responsibility of the Bacteriology Section of the CML is to assist clinicians in the diagnosis of bacterial diseases.
The various phenotypic characteristics (clues) useful in identifying bacteria include the following: > Gram reaction > Cell shape > Morphologic arrangement of cells > Growth or no growth on various types if plated media > Colony morphology > Presence or absence of a capsule > Motility > Number and location of flagella
> Ability to sporulate > Location of spores > Presence or absence of various enzymes > Ability to catabolize various carbohydrates and amino acids > Ability to reduce nitrate > Ability to produce indole from tryptophan > Atmospheric requirements > Type of hemolysis produced
Mycology Section The overall responsibility of the Mycology Section of the CML is to assist clinicians in the diagnosis of fungal infections. In the Mycology section, various types of clinical specimens are processed, fungal pathogens are isolated and tests are performed to identify the fungal pathogens. Parasitology Section The overall responsibility of the Parasitology Section of the CML is to assist clinicians in the diagnosis of parasitic diseases-specially, infections caused by endoparasites, such as parasitic protozoa and helminthes (parasitic worms).
Virology Section The overall responsibility of the Virology Section of the CML is to assist clinicians in the diagnosis viral diseases. Mycobacteriology Section The primary responsibility of the Mycobacteria Seciton of the CML is to assist clinicians in the diagnosis of tuberculosis. In the mycobacteriology section, various types of specimens are processed, acid fast staining is performed.