Sample collection guidelines for Patients

Sputum

1. Assure patient cooperation to get an adequate specimen.
2. Instruct the patient as follows:
   1. Rinse mouth with clean water to remove food particles and debris.
   2. Have patient breathe deeply and cough several times to achieve a deep specimen.
   3. Patient should expectorate into dry, sterile container.
   4. Tuberculosis patients should expectorate sputum in the early morning, into a sterile container with lid sealed tightly.
3. Transport immediately at ambient temperature. Refrigerate if a delay of more than one hour is anticipated.
4. Expectorated sputum is acceptable for bacterial, mycobacterial, and fungal cultures. . Micro Lab will determine the number of squamous epithelial cells present for specimen adequacy and reject samples for bacterial culture that are not indicative of deeply expectorated specimens.
5. Patients with clinical and chest x-ray findings compatible with TB should collect 3 first morning sputums (preferably on 3 separate days) for AFB culture.

Induced Sputum

• Sputum induction is a procedure to help a patient cough up secretions from the lungs more easily. The principle is to create extra moisture in the airways of the lungs. This will loosen and thin out secretions so they may be coughed up more easily.

The patient inhales nebulised hypertonic saline solution, which liquefies airway secretions, promotes coughing and allows expectoration of respiratory secretions.1 Sputum induction is simple and non-invasive, and if successful, often precludes the need for bronchoscopy.

The procedure produces coughing so it is likely that infectious droplets, if present, will be expelled into the room air. Strict airborne respiratory precautions should be observed whenever sputum induction is performed.

Urine for Bacterial, Fungal, AFB Cultures

1. Instructions for female patients to collect midstream urine for bacterial culture:
1. Wash hands thoroughly with soap and water, rinse them, and dry them.
2. Spread labia, with one hand, and keep them continuously apart.
3. Wash the urinary opening and the surrounding area .
4. Take the open sterile cup in the other hand without touching the rim or inner surface of the cup or lid.
5. Void 20 to 25 ml into the toilet and catch a portion of the rest of the urine in the container without stopping the stream. Do not touch the legs, vulva, or clothing with the cup.
6. Place the lid securely on the cup.
7. Immediately transport to the lab, refrigerate in case of delay.
2. Instructions for male patients to collect midstream urine for bacterial culture:
1. Wash hands.
2. Retract the foreskin completely.
3. Wipe head of penis in a single motion with clean water. If not circumcised, hold foreskin back before cleansing.
4. Void 20 to 25 ml into the toilet and catch a portion of the remaining urine in the cup without stopping the stream. Do not touch the cup with the penis.
5. Place the lid on the cup securely
6. Immediately transport to the lab, refrigerate in case of delay
3. Indwelling catheter urine:
1. Do not collect urine from the drainage bag because growth of bacteria outside the catheter may have occurred at this site.
2. Clean the catheter with an alcohol pad.
3. Use a sterile needle and syringe to puncture the tubing. Aspirate the urine directly from the tubing.
4. Transfer the urine to a sterile specimen container Immediately transport to the lab, refrigerate in case of delay.
4. Specimen handling:
1. Label the container immediately.

For AFB CULTURE: Entire first morning Urine specimen should be collected, on minimum three Consecutive days, in specially provided sterile containers

Stool, Faeces

• Collect specimen in a clean bed pan or use plastic wrap placed between the toilet seat and the bowl. Do not submit feces contaminated with urine or toilet water.
• Transfer specimen into a clean, dry container or the appropriate preservative.
• Transport at ambient temperature within two hours of collection.