Guidelines on Specimen Collection

Order Of Draw

Blood culture tubes (applying full aseptic technique)

Blue cap (sodium citrate)

Yellow cap (Serum Separator Tube)

Green Cap (Heparinized tube)

Purple cap (EDTA tube)

Royal Blue cap

Grey cap (fluoride tube)

Unless indicated samples should be stored in room temperature (air conditioned) and away from sunlight until pick up.

Tubes must be labeled with patient’s full name.

Microbiology

SPECIMEN TYPE	COLLECTION GUIDELINES	CONTAINER & STORAGE	COMMENTS
Abscess/Wound Open Closed	Remove surface exudate by wiping with sterile saline Aspirate if possible. Place fluid or tissue in sterile container Syringes are acceptable if delivered promptly Aspirate abscess wall with needle and syringe Syringes are acceptable if delivered promptly Disinfect surface of the wound (if not broken) with 70% alcohol or wipe with sterile saline (if broken). Aspirate if possible. If swab used, obtain at the time of incision, drainage or debridement of wound.	Sterile container/ swab transport medium/ sterile syringe/ Room Temperature	Tissue or fluid samples are preferable to swabs. Sampling of the surface area may contaminate the sample with flora not involved in the infection.
Biopsy/Bone/Tissue	Submit in sterile container without formalin Specimen may be kept moist with 0.85% sterile saline	Sterile container Room Temperature	Sampling of the surface area may contaminate with normal flora not involved in the infection.
Sterile Body Fluids Abdominal Ascites, Bile, Synovial, Pericardial, Peritoneal, Pleural	Disinfect overlying skin with iodine tincture Generally, specimens are obtained via percutaneous needles aspiration or surgery Transfer fluid to sterile container or blood culture bottles with syringe.	Sterile container/blood culture bottle Room Temperature	Fluid samples are preferable to swabs dipped in fluid
CSF	The physicians generally obtains these samples	Sterile container Room Temperature	Nil
Blood Culture	ASEPTIC TECHNIQUE IS CRITICAL TO PROPER BLOOD CULTURE COLLECTION Clean venipuncture site using 70% alcohol then with 10% iodine. Draw blood from the cleaned site : 8-10ml blood for adults, 1-3 ml blood for children	Blood culture bottle Room Temperature	A blood culture set consists of an aerobic and anaerobic bottle for adults and older children. For children, a set is a single pediatric bottle. Blood volume must be 8-10ml for adults and 1-3ml for children.
Ear swab	Use a moistened swab to remove any debris or crust from the ear canal. Discard swab. Obtain sample by firmly rotating the routine culture swab in the outer canal.	Sterile gel swab/VTM Room Temperature Refrigerate	Nil If otitis externa is suspected, vigorous swabbing is needed as simple surface swabbing may miss a streptococcal infection.
Eye , conjunctiva	Roll swab over the Conjunctiva The clinician may opt to inoculate culture plates directly at time of collection May submit sample on routine culture swab. Bacterial/Fungus : routine culture swab Viral Culture: Viral Transport Media (VTM) available from HQ.	Sterile gel swab Room Temperature	Nil
Eye, Cornea (scrapings)	The physicians usually obtain these samples May opt to inoculate directly onto culture plates A swab may also be submitted for routine culture	Sterile gel swab Room Temperature	Nil
Respiratory Tract, Upper Nasal Swab Oral	Insert swab into nares Rotate swab against the nasal mucosa Remove oral secretions or debris from the surface of the infected area with a swab and discard. Using the swab appropriate for tests ordered, sample site vigorously avoiding areas of normal tissue. Bacterial/Fungus : routine culture swab Viral : viral transport media (VTM)	Room Temperature	Nil
Throat	Depress tongue down with sterile tongue depressor Firmly sample inflamed areas, exudate and / or lesions with the swab appropriate for the test ordered. Bacterial/Fungus : routine culture swab Viral : viral transport media (VTM)	Refrigerate Sterile Gel Swab/VTM Room Temperature Refrigerate	Nil
ERespiratory Tract, Lower Sputum, expectorated Tracheal aspirate	Have patient gargle or rinse mouth with water. Instruct patient to cough deeply to produce a sample from the lower respiratory tract and not saliva. Collect sample in sterile Container Please aspirate or washing into sputum trap container	Sterile gel swab/VTM Room Temperature Refrigerate	Specimens must be brought to the laboratory as soon as possible after collection.
Skin Scrapping	Cleanse the area with 70% alcohol Scrape area at the active margin of the lesion. Do not draw blood Place scrapings into sterile container	Sterile container Room Temperature	Nil
Nail	Wipe nail with 70% Alcohol Clip away the affected area and collect material or debris from under the nail Place in sterile container	Sterile gel swab/VTM Room Temperature Refrigerate	Nil
Gastrointestinal Tract	Roll swab over the Conjunctiva The clinician may opt to inoculate culture plates directly at time of collection May submit sample on routine culture swab	Sterile container Room Temperature Refrigerate	All stool specimens must be brought to laboratory as soon as possible.
Rectal swab	Bacterial/Fungus : routine culture swab Viral Culture: Viral Transport Media (VTM) available from HQ.	Room Temperature Room Temperature Refrigerate	Nil
Urine	Collect 20ml of mid-stream urine (MSU) in sterile specimen container.	Sterile urine container Refrigerate	Nil

Cytology

General Instructions on Specimen Fixation

Smears

Rapid fixation of smears is necessary to preserve cytological detail. If smears are allowed to dry on the slides prior to fixation, marked distortion of cells occurs.

Smear preparation such as vaginal, cervical, endometrial aspirations and aspiration cytology specimens should be fixed immediately in a solution of 95% ethyl alcohol or a coating fixative such as Cytofix; other commercial spray fixatives may be used. A minimum of fifteen to twenty minutes fixation is required in the case of ethyl alcohol fixation (although prolonged fixation will not materially alter the cytology). In the case of spray fixatives, the smear should be allowed to dry for 10 minutes prior to placing into slide holders for dispatch to the laboratory.

The slide MUST be labeled with the patient name and identification number (last 6 digits), passport or MRN.

Histology

A Request Form must accompany all specimens. When more than one specimen is sent from the same patient at the same operation, use only one form. Specimens from different anatomical sites should be sent in separate containers and must be itemized in the same Request Form. The containers of such samples must be similarly itemized and labeled with patient’s identification such that they can be cross-referenced to the patient and the anatomic site and side of origin of the sample.

Special Instructions

Frozen sections will be done without fixative. Advance notice is required. Kindly contact the laboratory for specific appointment
Routine specimens should be sent in containers with 10% buffered formalin unless otherwise stated.
Appropriate containers are available from the laboratory on request. To prevent leakage it is advised to double wrap the specimen container.
Multiple small specimens, such as gastrointestinal biopsies, should be mounted on a piece of filter paper and properly labeled.
Large specimens such as colon must be completely immersed in formalin. Containers must be tightly secured.
Do not crush specimens with forceps, hemostats or other instruments. Avoid using cautery.
Do not force a large specimen into a small container. Large specimens must be completely surrounded by formalin for proper fixation.
URGENT REPORT” request has to be clearly indicated on the request form; otherwise they will be processed as per according to queue.
For specimens where orientation is important, mark or tag the specimen e.g. Axillary tail of mastectomy specimens, orientation of surgical margin.