Specimen Requirements

Acceptable Specimens:

 

Abscess,  lesion, ulcer,  vesicle, or wound: 1 ESwab per test request in sterile transport tube or  ≥1 mL in leakproof screw-capped, sterile container or syringe (needle removed)

 

Note: If #LAB7000/7001 Mycobacteriology (AFB) culture, or LAB7009 Mycology (fungal) culture is also requested, collect an additional specimen per test using a second BD ESwab Collection Kit or Minitip Collection Kit.

 

Biopsy, bone, heart valve, lymph node, stone, or tissue: ≥1 g in leakproof screw-capped, sterile container

 

Catheter tip:  leakproof screw-capped, sterile container

 

Ear: External - 1 ESwab per test request in sterile transport tube.  Internal - 1 ESwab per test request in sterile transport tube or ≥1mL fluid in leakproof, screw-capped, sterile container.

 

Eye: ocular swab (conjunctiva and cornea swab) - 1 BD ESwab Minitip Collection Kit; cornea or corneal scraping - any amount of specimen in leakproof, screw-capped, sterile container. 

 

Sterile body fluids (CSF, pleural, synovial, pericardial, peritoneal, paracentesis, donor storage solution): >1 mL of fluid in leakproof screw-capped, sterile container or syringe (needle removed)
 

Other Body Fluids (bile, aspirate, drainage, cyst fluid, etc.): ≥0.5 mL of fluid in leakproof screw-capped, sterile container or syringe (needle removed)
 

Genital (cervical, endocervical, penile, urethral, vaginal, etc.): 1 ESwab per test request in sterile transport tube.

 

Hardware: any amount in leakproof, screw-capped, sterile container.

 

Placenta: >1g in leakproof, screw-capped, sterile container.

 

Respiratory: (BAL, bronchial washing, sinus aspirate, sputum, tracheal, etc.) - ≥5 mL in leakproof screw-capped, sterile container; (airway donor, airway recipient, deep throat) - 1 ESwab per test request; (bronchial brush) - brush in leakproof, screw-capped, sterile container with sterile saline.

 

Stool or rectal swab: 0.3g to 2g of fresh stool in Cary-Blair transport media or 1 rectal ESwab per test request in sterile transport tube.

Note: Hospital Patients: Collect only 1 stool for routine culture as soon as possible after admission.

 

Throat: 1 ESwab per test request in sterile transport tube

 

Urine: ≥5 mL of urine in a BD VACUTAINER grey-top C & S Preservative Tube or a leakproof screw-capped, sterile container.

Unacceptable Specimens:

Catheter tips that do not have an accompanying blood culture drawn within 24 hours

 

Fluids, other than peritoneal dialysis fluid, inoculated into blood culture bottles

 

Saliva

 

Specimen received in container containing additive (EDTA, sodium citrate, etc.)

 

Urinary catheter tip

 

Specimen collected with ESwab Collection Kit is unacceptable if received without fluid or swab in the transport tube.

 

Collection Procedure:

Note: Specimen source is required.

 

Abscess,  lesion, ulcer,  vesicle, or wound

1. Disinfect surface of site to be cultured.
2. Aseptically collect purulent material by aspiration (preferred) or by using an ESwab Collection Kit. Frequently, viable organisms are only associated with abscess wall, so adequately sample this area.
   1. If material is aspirated, aseptically inject specimen into a leakproof screw-capped, sterile container.
   2. If collected by ESwab, return ESwab into transport tube following instructions on kit.
3. Maintain sterility and forward promptly.
   Note: Indicate specimens collected for possible Brucella, Francisella, or anthrax in the "Suspected Pathogen" field upon order.

Biopsy, bone, heart valve,  lymph Node, stone, or tissue
1. Aseptically collect ≥1 g of specimen.
2. Place specimen in a leakproof screw-capped, sterile container.
3. Maintain sterility and forward promptly.

4. If an anaerobic work-up is required, see LAB7035/7382 Culture, Aerobe and Anaerobe for instructions.

Note: Indicate specimens collected for possible Brucella, Francisella, or anthrax in the "Suspected Pathogen" field upon order.

 

Catheter Tip
1. Aseptically collect catheter tip.
2. Place specimen in a leakproof screw-capped, sterile container.
3. Maintain sterility and forward promptly.

4. When sending catheter tip for culture, also collect and send a set of blood culture bottles; see LAB462 - Blood culture.

 

Ear

1. External
A. Cleanse external canal with mild antiseptic. Avoid topical ointments or drugs in or on site to be cultured.
B. Swab, scrape, or aspirate specimen from active margin, preferably including fresh secretion from deeper areas.
C. Return ESwab into transport tube following instructions on kit. Place aspirated specimen in a leakproof screw-capped, sterile container.
D. Maintain sterility and forward promptly at ambient temperature only.

2. Internal
A. Cleanse external canal with mild antiseptic. Avoid topical ointments or drugs in or on site to be cultured.
B. Insert sterile funnel and swab or aspirate specimen from eardrum or beyond.
C. If eardrum is not perforated, specimen should be collected by a physician trained in this procedure.
D. Return ESwab into transport tube following instructions on kit. Place aspirated specimen in a leakproof screw-capped, sterile container.
E. Maintain sterility and forward promptly at ambient temperature only.

F. Topical ointments or drugs in or on site to be cultured must be avoided.

 

Eye

1. Ocular swab (conjunctiva or cornea)
Call Barnes-Jewish Hospital Laboratory Customer Service at 314-362-1470 to obtain BD ESwab Minitip Collection Kit.
A. Collect specimen before application of topical anesthetics because topical anesthetics possess antimicrobial activity.
B. Cleanse skin around eye with mild antiseptic.
C. Gently remove makeup and ointment with sterile cotton and saline.
D. Collect specimen by passing ESwab 2 times over lower conjunctiva or over cornea. Avoid eyelid border and lashes.
E. Return ESwab into transport tube following instructions on kit. 
F. Maintain sterility and forward promptly.

2. Cornea (corneal scraping)

A. Using a sterile spatula, scrape ulcers or lesions into small, leakproof, screw-capped sterile container or Eswab collection kit.

B. Moisten specimen with minimum amount of sterile saline.

C. Maintain sterility and forward promptly.

Additional information on ocular specimen collection instructions can be found here.

 

Sterile body fluids (CSF, pleural, synovial,  pericardial, peritoneal, paracentesis, donor storage solution)

1. Aseptically collect >1 mL of fluid.
2. Place specimen in a leakproof screw-capped, sterile container.
3. Maintain sterility and forward promptly.
4. Requests for anthrax (cerebrospinal fluid):  specimens must be carefully collected, labeled as “Possible anthrax,” and delivered directly to the Microbiology Laboratory. Indicate on request form or in "Suspected Pathogen" field on electronic order entry.
5. If an anaerobic work-up is required, see LAB7035/7382 Culture, Aerobe and Anaerobe for instructions.

 

Other body fluids (bile, aspirate, drainage, cyst fluid, etc.)
1. Aseptically collect ≥0.5 mL of fluid using a sterile syringe.
2. Place specimen in a leakproof screw-capped, sterile container. Smaller amounts of fluid may be kept in the syringe (needle removed).
3. Maintain sterility and forward promptly.
4. If an anaerobic work-up is required, see LAB7035/7382 Culture, Aerobe and Anaerobe for instructions.

 

Genital
1. Cervical, endocervical, and vaginal
A. Do not use lubricant on speculum.
B. Remove cervical mucous first before inserting ESwab into endocervical canal.
C. Insert swab into vagina or endocervical canal and move swab from side-to-side.
D. Return ESwab into transport tube following instructions on kit.
E. Maintain sterility and forward promptly at ambient temperature only.

 

2. Penile and urethral
A. If using a mini-tip ESwab, gently scrape anterior urethral mucosa and place in a screw-capped, sterile container.
B. Use an ESwab to collect urethral discharge.
C. Return ESwab into transport tube following instructions on kit.
D. If fluid is collected, submit it in a leakproof screw-capped, sterile container.
E. Maintain sterility and forward promptly at ambient temperature only.

F. Requests for Haemophilus ducreyi: Call Laboratory Medicine resident at digital pager 314-747-1320 for approval and collection technique before obtaining specimen. Indicate on request form or in computer order “Look for Haemophilus ducreyi.” 

 

Placenta

1. Aseptically collect >1g of specimen.

2. Place specimen in a leakproof, screw-capped, sterile container.

3. Maintain sterility and forward promptly.

 

Respiratory (bronchial, sputum, tracheal, etc.)
1. Bronchial washing, bronchial alveolar lavage (BAL), and tracheal aspirate
A. Aseptically collect ≥5 mL.
B. Place specimen in a leakproof screw-capped, sterile container.
C. Maintain sterility and forward promptly.

2.  Bronchial brush

A. Obtain a sterile container with 1 mL of sterile saline.  If tubes are not available, contact the laboratory.

B. Aseptically collect the bronchial brush and place in the container with 1 mL of sterile saline.

C. Maintain sterility and forward promptly.

3. Sputum
A. Aseptically collect early-morning specimens free of oral contamination in a leakproof screw-capped, sterile container.
B. Instruct patient to brush his/her teeth and rinse mouth well with water.
C. Have patient remove dentures.
D. Instruct patient to take a deep breath, hold it momentarily, and then cough deeply and vigorously into container. Collect 3 mL to 5 mL of discharged material.
E. Maintain sterility and forward promptly.

F. Sputum specimens contaminated with excessive normal oropharyngeal flora will be rejected for culture.
Note: Indicate specimens collected for possible Francisella, or anthrax in the "Suspected Pathogen" field upon order.

 

Stool or rectal swab

1. Stool
A. Select portions of fresh stool containing blood or mucous.
B. Submit in Cary-Blair transport media
C. Maintain sterility and forward promptly at ambient temperature only.

2. Rectal swab
A. Pass ESwab beyond rectal sphincter.
B. Rotate ESwab and withdraw.
C. Return ESwab into transport tube following instructions on kit.
D. Maintain sterility and forward promptly at ambient temperature only.
E. Stool is routinely screened for Campylobacter, Escherichia coli O157, Salmonella, Shigella, Edwardsiella, Aeromonas,  Pleisiomonas, Yersinia, and Shiga-like toxin.
F. Vibrio will be cultured upon request. Indicate on request form or in "Suspected Pathogen field upon electronic order entry.

 

Throat
1. Depress tongue and rub ESwab over each tonsillar area and posterior pharynx.
2. Collect any exudate on swab.
3. Avoid touching tongue and uvula.
4. Return ESwab into transport tube following instructions on kit.
5. Maintain sterility and forward promptly at ambient temperature only.

6. Specimen screened for group A beta-hemolytic Streptococcus and Arcanobacterium haemolyticum.

 

Urine
1. Aseptically collect ≥3 mL of specimen in a BD VACUTAINER grey-top C & S Preservative Tube or a leakproof screw-capped, sterile container.
2. Maintain sterility and forward promptly.