Asep Zainuddin, dr SpPK

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