Essentials of specimen management

in diagnostic microbiology
Dr.T.V.Rao MD
Aim of Microbiologic evaluations
The goal of
microbiologic
evaluation is to provide
accurate, clinically
pertinent results in a
timely manner. The
quality of the
specimens submitted
to the microbiology
laboratory is critical for
optimal specimen
evaluation
Scientific SPECME! C"##ECT"! for
valid interpretation
Valid interpretation of the results of culture
can be achieved only if the specimen
obtained is appropriate for processing. As a
result, care must be taken to collect only
those specimens that may yield pathogens,
rather than colonizing flora or
contaminants. Specific rules for the
collection of material vary, depending upon
the source of the specimen, but several
general principles apply
$iosafety a concern in specimen
collection
Wear gloves,
gons, masks,
and!or goggles,
hen appropriate,
hen collecting
specimens from
sterile sites. "se
strict aseptic
technique.
Specimen Management a !e% Concept
The impact of proper specimen management on
patient care is enormous. #t is the key to
accurate laboratory diagnosis and confirmation,
it directly affects patient care and patient
outcomes, it influences therapeutic decisions, it
impacts hospital infection control, and it impacts
patient length of stay, hospital costs, and
laboratory costs, and influences laboratory
efficiency. Today it is essential the clinicians
should change the attitude toards the
$aboratory and to be more empoered ith
interaction ith laboratory specialists.
Collect t&e Specimens at optimal times
%ollect the
specimen at
optimal times
&for e'ample,
early morning
sputum for A()
culture*.
Collect sufficient 'uantity
%ollect a sufficient
quantity of material.
"se appropriate
collection devices+
sterile, leak,proof
specimen containers.
"se appropriate
transport media
&anaerobe transport
vials, %ulturette for
bacterial culture, %ary,
)lair for stool culture,
Decontaminate t&e area of specimen
collection
#f appropriate,
decontaminate the skin
surface. "se -.,/01
alcohol &A$%* and 21
chlorhe'idine or 3,21
tincture of iodine &T#4*
to prepare the site.
Allo a contact time of
to minutes to
ma'imize the
antiseptic effect.
Minimise t&e Transport time
5inimize transport
time. 5aintain an
appropriate
environment
beteen collection
of specimens and
delivery to the
laboratory.
Clinician interaction improves t&e
laboratory performance
Today it is essential
the clinicians
should change the
attitude toards
the $aboratory and
to be more
empoered ith
interaction ith
laboratory
specialists.
Try to collect t&e specimens before
antibiotic t&erapy
Most mportant criteria of
sample collection
continues to be a
specimen s&ould be
collected prior to
administration of
antibiotics. "nce
antibiotics &ave been
started( t&e f lora
c&anges( leading to
potentially misleading
culture results
Collecting specimens from Critical sites
5icrobiology
laboratories need
precise concepts to
collect the
specimens and use
of special skills and
selective media a
must for effective
methods in
6iagnosis
Appropriate labelling a must
Specimens must be labelled
accurately and completely so
t&at interpretation of results
%ill be reliable
#abels suc& as )eye* and
)%ound specimens* are not
&elpful to t&e interpretation of
results %it&out more specific
site and clinical information
+e.g.( surgical site infection
after laparotomy,.
-ollo% t&e #aboratory Manuals
The microbiology
laboratory policy manual
should be available at all
times for all medical
staff to revie or consult
and it ould be
particularly helpful to
encourage the nursing
staff to revie the
specimen collection and
management portion of
the manual
Poor 'uality specimens to be re.ected
Specimens of poor
quality must be
re7ected.
5icrobiologists
should act correctly
and ith responsibly
hen they call
physicians to clarify
and resolve problems
ith specimen
submissions.
Do not process commensals
These specimens processed and
many 7unior staff start reporting
commensals and oral flora as
pathogens, equally ignorant
clinician, 8hysicians should not
demand that the laboratory
report 9everything that gros,:
thus providing irrelevant
information that could result in
inaccurate diagnosis and
inappropriate therapy.
Do not culture normal microbiota
5any body sites have
normal microbiota that
can easily contaminate
the specimen.
Therefore, specimens
from sites such as
loer respiratory tract
&sputum*, nasal
sinuses, superficial
ounds, fistulae, and
others require care in
collection.
S%abs are not optimal specimens for
processing
;ever forget the sab is never
optimal, the laboratory requires
a true clinical specimen, not a
sab of a specimen. Actual
tissue, aspirates, and fluids are
alays specimens of choice,
especially from surgery. A sab
is not the specimen of choice for
many specimens because sabs
pick up e'traneous microbes,
hold e'tremely small volumes
of the specimen &...0 m$*,
/ave tec&nical policy
The laboratory
should be alloed to
set technical policy<
this is not the
purvie of the
medical staff. =ood
communication and
mutual respect ill
lead to collaborative
policies.
Appropriate microbiology s0ills reduce
superbugs
5icrobiology laboratory
results that are reported
should be accurate,
significant, and clinically
relevant, do not report S.
pneumonia from throat
sabs, Susceptibility
testing should be
performed on clinically
significant isolates, not
on all microorganisms
recovered in culture.
Appropriate microbiology s0ills reduce
superbugs
# ish you refer the 8eer
revieed 6iagnostic
5icrobiology te't books
or else you are
communicating the
commensal and
contaminants as
pathogens and ith
misuse of antibiotic as it
a concern in the >ra of
raise of S1PER $12S.
T&e Programme is Created and Designed
by Dr.T.V.Rao MD for /ealt& Care
Professionals in Developing 3orld
>mail
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