Specimen Type 

Collection Instructions

Abscesses, aspirates and wound

Decontaminate the surface site with 70% alcohol.

Collect purulent material aseptically from an undrained abscess using a sterile needle and syringe. For open abscess (after incision and drainage)  collect the expressed material with a needle and syringe.

Transfer 5-10 ml (Minimum 2 ml) of aspirated fluid abscess material or Pus aspirate in 50 ml sterile conical tube (leak proof without fixative).

Pus aspirate is always superior to a swab specimen.

Swab is strongly discouraged unless it is the only specimen available.
Specify anatomic Site.

Body Fluids

Disinfect site with 70% alcohol if collecting by needle and syringe. Aspirate fluid as much as possible optimal volume (10 ml desirable) in a 50 ml sterile conical tube leak proof container without fixative.

Specify anatomic site (Plural, Pericardial, Peritoneal, Abdominal, Amniotic, Ascites, Bile, Synovial, and OTHERS).

Since many of these fluids may contain fibrinogen, it may be necessary to add anticoagulant (SPS) to collection containers.

Bone marrow

Prepare the surgical site as for surgical incision. Use a blood collector tube and mix content of tube after collection in either BD MGIT  tube obtained from TB lab.(Discards half of the media and add the sample).
Alternatively, 10 ml yellow top collectors containing sodium polyanethol sulfonate (SPS).

Cerebrospinal fluid (CSF)

Lumbar puncture:
CSF must be collected prior to antimicrobial therapy. Place CSF into leak-proof tubes. Submit the most turbid tube to Microbiology section.

Reservoir/shunts:
Disinfect reservoir collection site before collection of CSF.

Submit specimen in sterile tube with appropriate volumes.

Gastric wash or lavage

Collect three consecutive days in early morning before patients eat and while are still in bed.

Perform lavage with 25 to 50 mL of chilled, sterile distilled water. Recover sample and place in 50 mL conical sterile tube.

(Comments: The specimen must be processed promptly, since mycobacteria die rapidly in gastric washing, neutralize with 100 mg sodium bicarbonate if transport is delayed more than one hour,)

Sputum (expectorated or induced)

Rinse mouth with water to remove food particles, debris, mouthwash, or oral drugs, which may inhibit the growth of Mycobacteria and remove excess oral biota.

Collect sputum (for two consecutive days), have patient breathe deeply and cough several times to achieve a deep lower reparatory specimen (not postnasal fluid).

For induced sputum, use sterile hypertonic saline.  Avoid sputum contamination with nebulizer reservoir water.  Saprophytic Mycobacteria in tap water may produce false-positive culture or smear results.

Indicate on test order if specimen is induced sputum, as these watery specimens resemble saliva and risk rejection as inadequate.
Induced sputum to be collected by trained staff.

Lower Respiratory:

•  Bronchoalveolar lavage
•  Bronchoalveolar wash
•  Endotracheal secretion
•  Transtracheal secretion 

Lower Respiratory Endo-tracheal, Trans-tracheal secretions, Bronchoalveolar Lavage or Bronchial wash in a 50 ml sterile conical tube leak proof container without fixative.

Collect washing or aspirate in a 50 ml sterile conical tube leak proof container without fixative.

Avoid contaminating bronchoscope with tap water when collecting Bronchoalveolar Lavage or Bronchial washing.

Stool

Pass specimen directly into sterile leak-proof 50ml conical tube.

Do not use holding or transport medium or preservatives

Do not submit feces contaminated with urine or toilet water

Tissue / Biopsy.

Aseptically collect tissue in 50 ml sterile containers without fixatives or preservatives during surgery or cutaneous biopsy procedure

Tissue collection is an invasive procedure and requires a trained physician. Include material from both the center and the edge of the lesion.

Add 2 to 3 ml of sterile saline for transport.

Urine

Collect approximately 40mL of urine in 50 ml sterile containers without fixatives (midstream is never advised). A first morning specimen is preferred

Comments: Organisms accumulate in bladder overnight, so first void morning specimen provides best yield. Specimens collected at other times are dilute and are not optimal.

Collect one specimen per day on three consecutive days.

1. Collect specimen before administration of antimicrobial agents when possible. Collect sufficient quantity of specimen. Too little may yield false negative results.
2. Collect with as little contamination from normal flora as possible to ensure that the specimen represents the infected site. If collection is through intact skin, cleanse the skin first.

3. Collect specimen at the most active stage of the disease to increase chances of isolation and identification of the causative organisms. Sample the body area, lesion, exudate, or drainage most likely to contain the suspected pathogen (i.e. the leading edge of a skin lesion; depth of a wound, not the surface; sputum, not saliva).

4. Request and encourage the active cooperation of the patient in collection of the specimen. Make sure the patient has adequate instructions and the proper equipment to provide a satisfactory specimen.

5. Use appropriate collection devices, sterile equipment, and aseptic technique. Use only the standard equipment recommended by the laboratory. Do not substitute makeshift containers, bottles, or tubes.

6. Use 50 ml sterile conical tube for all TB specimen collections except for CSF and bone marrow.

7. Minimize transport time; maintain an appropriate environment for specimen transportation.

8. Refrigerate the specimen at 2-8°C (except bone marrow and CSF), if a delay of more than one hour is anticipated.

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3. Forbes BA, Sahm DF, Weissfeld AS (Eds). Specimen Management. In: Bailey & Scott's Diagnostic Microbiology, 12th ed, Mosby, Elsevier, St. Louis, 2007.
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