Specimen Requirements

Abscess

1.  Optimal Volume-Collect as much as possible.

2.  Remove surface exudate by wiping with sterile saline or 70% alcohol.  Collect fluid abcess material with syringe.  For open lesions/abcesses, aspirate material from under the margin of the lesion/abcess.  Remove needle and cap syringe.

3.  Label syringe with patient's name (first and last), date and actual time of collection, and type of specimen.

4.  Maintain sterility and forward promptly refrigerated.

Note:  Specimen source is required on request form for processing.

Blood

1.  10 mL (minimum 5 mL adult, 1 ml pediatric) collected in a SPS (yellow-top), or sodium heparin (green top)tube.

2.  Clotted specimens will be rejected.

3.  Label specimen tube with patient's name (first and last), date and actual time of collection, and type of specimen.

4.  Send to the laboratory at room temperature.

Specimen source is required on the request form for processing.

Body Fluid

1. 10 mL (minimum volume: 1 mL) of body fluid in a screw-capped, sterile container.
2. If submitting specimen in syringe, remove needle and cap syringe.

3. Label container/syringe with patient’s name (first and last), date and actual time of collection, and type of specimen.
4. Maintain sterility and forward promptly at refrigerated temperature only.

Note:  Specimen source is required on request form for processing.

Bone Marrow

1.  10 mL (minimum 1 mL) bone marrow aspirate collected in SPS (yellow top) or sodium heparin (green top ) tube.

2.  Label the tube with the patient's name (first and last), date and actual time of collection, and specimen source.

3.  Send to the laboratory at room temperature.

Specimen source is required on the request form for processing.

Bronchoalveolar Lavage or Bronchial Washings
1. Aseptically collect a minimum of 5 mL of bronchoalveolar lavage or bronchial washings in a screw-capped, sterile container.

2. Avoid contaminating bronchoscope with tap water.
3. Saprophytic mycobacteria may produce false-positive culture or smear results.
4. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
5. Maintain sterility and forward promptly at refrigerated temperature.
Note:  Specimen source is required on request form for processing.

Bronchial Brushings

1. Submit bronchial brushings in a screw-capped, sterile container or in sterile saline.
2. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
3. Maintain sterility and forward promptly.
Note:  Specimen source is required on request form for processing.

Gastric Lavage Fluid

1. Gastric lavage specimens should be reserved for those circumstances where specimens cannot be obtained by other methods, such as pediatric patients.
2. Collect a fasting, early-morning (soon after patient awakes in order to obtain sputum swallowed during sleep) specimen at least 8 hours after patient has eaten or taken oral drugs as follows:
A. A disposable gastric tube is inserted and gastric contents aspirated. Place specimen in a screw-capped, sterile container.

B. Patient then ingests 20 mL to 30 mL of sterile water. This is aspirated and added to first specimen.

3. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
4. Maintain sterility and forward promptly at room temperature.
Note:  Specimen source is required on request form for processing.

Spinal Fluid
1. Submit maximum amount of spinal fluid available in a screw-capped, sterile vial. (Less than 0.5 mL of spinal fluid is not acceptable.)
2. Label vial with patient’s name (first and last), date and actual time of collection, and type of specimen.

3. Forward promptly to the laboratory at refrigerated temperature.
Note:  Specimen source is required on request form for processing.

Sputum
Sputum, Expectorated

1. Collect an early-morning specimen on at least 3 consecutive days in a screw-capped, sterile container as follows:
A. Instruct patient to brush his/her teeth and/or rinse mouth well with water to minimize contaminating specimen with food particles, mouthwash, or oral drugs which may inhibit the growth of mycobacteria.
B. Have patient remove dentures.
C. Instruct patient to take a deep breath, hold it momentarily, then cough deeply and vigorously into container, and collect 5 mL to 10 mL of discharged material. (Nasal secretion, saliva, or 24-hour collection is not acceptable.)
2. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
3. Maintain sterility and forward promptly at refrigerated temperature.
Note:  Specimen source is required on request form for processing.

Sputum, Induced
1. Collect an early-morning specimen on at least 3 consecutive days in a screw-capped, sterile container as follows:
A. Induce cough by inhalation of sterile, hypertonic saline. Collect 5 mL to 10 mL of expectorated material.
2. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
3. Maintain sterility and forward promptly at refrigerated temperature.
Note:  1. Avoid sputum contamination with nebulizer reservoir water.
2. Saprophytic mycobacteria in tap water may produce false-positive culture or smear results.
3. Indicate on request form if specimen is induced sputum, as these watery specimens resemble saliva and risk rejection as inadequate.
4. Specimen source is required on request form for processing.

Tissue
1. Aseptically collect 1 g of tissue, if possible, in a screw-capped, sterile container without fixative or preservative avoiding indigenous microbiota. (Specimen submitted in formalin is not acceptable.) Select caseous portion if available.
2. Do not immerse in saline or other fluid or wrap in gauze.
3. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
4. Maintain sterility and forward promptly at refrigerated temperature only. Freezing decreases yield.
Note:  Specimen source is required on request form for processing.

Urine

Collect first-morning specimen on 3 consecutive days for either clean-catch specimen or catheterized specimen. Only 1 specimen/day will be accepted. Organisms accumulate in bladder overnight, so first-morning void provides the best yield. Specimens collected at other times are dilute and are not optimal.

Catheterized
1. Avoid sending urine that has remained stagnant in catheter tubing for any length of time, do not send catheter bag urine, and avoid sending urine from catheters that have been in place longer than 5 to 9 days.
2. Clean catheter with an alcohol sponge, puncture with sterile needle, and collect in sterile syringe.
3. Pour 40 mL of urine into a screw-capped, sterile container. Mix well.
4. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
5. Send specimen refrigerated. Maintain sterility and forward promptly.
Note:  Specimen source is required on request form for processing.

Clean-Catch, Midstream
1. Collect a clean-catch, midstream urine specimen (10 mL of urine) as follows:
 
Males
A. Prepare obstetrical Towelette® by opening packages (do not remove Towelette® until ready to use), and place on sink. Take top off of plastic urine container, and set on edge of sink. Set Towelettes® and container so they can be reached while urinating.
B. Holding back foreskin with 1 hand, if necessary, use first Towelette® to wash end of penis. Discard Towelette® in wastebasket.
C. Continue holding back foreskin and gently rinse end of penis using second and third Towelette®, discarding them in wastebasket when done.
D. Continue holding back foreskin and begin to urinate into toilet.
 
Females
A. Prepare obstetrical Towelette® by opening packages (do not remove Towelette® until ready to use), and place on sink. Take top off of plastic urine container, and set on edge of sink. Set Towelettes® and container so they can be reached while urinating.
B. With 2 fingers of 1 hand, hold outer folds of vagina apart. With other hand, gently wash vaginal area from front to back, using first Towelette®. Discard Towelette® in wastebasket.
C. Still holding outer vaginal skin away from opening through which urination takes place, rinse area from front to back using Towelette® #2, discard, and repeat with Towelette® #3.
D. Continue holding outer vaginal folds apart and begin to urinate into toilet. Lean slightly forward so that urine flows directly down without running along skin.

2. After first few teaspoons, place screw-capped, sterile urine container under stream of urine and collect as much urine as possible (minimum volume:  40 mL). (Specimen <40 mL, unless larger volume is not obtainable, or 24-hour urine specimen is not acceptable.)
3. After finishing, tighten cap on container securely, and wash any spilled urine from outside of container.
4. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
5. Send specimen refrigerated. Maintain sterility and forward promptly.

Note:  Specimen source is required on request form for processing.

Suprapubic Aspirate
1. Be sure at least 4 to 6 hours have elapsed since last urination.

2. Clean suprapubic skin with iodine followed by alcohol.

3. Insert 22-gauge needle attached to a 20-mL syringe into skin at about a 30° angle to abdominal wall, immediately superior to the symphysis in midline.
4. Aspirating as one penetrates, stop as urine is obtained. Fill syringe with 10 mL to 15 mL of urine (infants may require a smaller syringe and needle).

5. Place specimen in a screw-capped, sterile container.
6. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
7. Send specimen refrigerated. Maintain sterility and forward promptly.
Note:  Specimen source is required on request form for processing.