Collection and transportation of sputum

Question 1

what are the container specifications for sputum collections

Answer 1

1. wide mouth 50 ml capacity
2. Graduated specimen contaner (labeled)
3. translucent or clear material
4. sides and walls that allow easy labelling
5. leak proof with screw cap

Question 2

difference between spot specimen and early morning specimen

Answer 2

1. spot morning sample collected at the initial visit to the clinic
2. Early morning specimen: First sputum in the morning

Question 3

advantages of spot specimen

Answer 3

1. Requires only 2 visits
2. A spot specimen is available in case the patient does not return with the morning specimen

Question 4

Disadvantages of spot specimen

Answer 4

1. One of the two specimens may be of poor quality
2. High risk of missing the case if only the first specimen is examined

Question 5

2 sputum collection safety measures

Answer 5

1. Instruct the patient to cover his or her mouth when coughing
2. Never collect sputum in an enclosed room

Question 6

what are the guide lines that should be explained to the patient clearly

Answer 6

1. Why sputum is needed
2. How many samples are required
3. What is a good sample and how to obtain it
4. How opening and closing of containers should be done
5. Not to soil the exterior of the container
6. How specimen containers should be transported
   The need to return to the clinic

Question 6

What is the recommended volume of sputum to be collected for an Xpert MTB/RIF test, and why is this volume important

Answer 6

At least 3 ml of sputum should be collected for an Xpert MTB/RIF test. This volume is important to ensure there is enough sample to accurately detect the presence of Mycobacterium tuberculosis and assess rifampicin resistance.

Question 7

Explain why additional sputum specimens might be needed despite a single specimen recommendation for Xpert MTB/RIF testing.

Answer 7

Additional sputum specimens may be needed in case of an error or invalid Xpert MTB/RIF result. This ensures that the test can still be completed accurately even if the initial sample is compromised.

Question 8

Discuss the implications of using multiple sputum specimens for testing in terms of cost and diagnostic yield

Answer 8

Using multiple sputum specimens can increase the diagnostic yield, improving the chances of detecting tuberculosis. However, this also increases the cost of testing, which can be a significant factor in resource-limited settings

Question 9

Why is it important to avoid using pooled sputum specimens in tuberculosis testing?

Answer 9

Pooled sputum specimens can dilute the sample, leading to inaccurate results. Mixing samples from different patients can also introduce cross-contamination, potentially leading to false positives or negatives.

Question 9

What additional tests might require sputum specimens, and how does this affect the collection process?

Answer 9

Additional sputum specimens may be needed for microscopy, culture, and drug susceptibility testing (DST). This affects the collection process by necessitating multiple samples, ensuring enough material is available for all required tests according to the NTP’s guidelines.

Question 10

Why is supervision important during sputum collection?

Answer 10

Supervision during sputum collection ensures that the sample is collected properly, reducing the risk of contamination and ensuring that an adequate volume of sputum is obtained. This is crucial for accurate diagnostic results.

Question 11

Explain why Xpert MTB/RIF is not recommended for monitoring patients’ treatment.

Answer 11

Xpert MTB/RIF is designed for initial diagnosis and detection of rifampicin resistance but is not recommended for monitoring treatment because it does not quantify bacterial load or assess the progress of treatment effectively over time.

Question 12

How do the NTP’s guidelines on sputum collection enhance the accuracy and reliability of tuberculosis testing?

Answer 12

The guidelines ensure that adequate and uncontaminated samples are collected, specify volumes, and recommend conditions like supervision, thereby enhancing the accuracy and reliability of the tests conducted.

Question 13

which steps should the patient follow to produce the best specimen

Answer 13

1. Wash your mouth with clean water to remove food and other particles
2. Inhale deeply 2–3 times and breathe out strongly each time
3. Cough deeply from your chest to produce sputum
4. Place the open container close to your mouth to collect the specimen; do not get sputum on the outside of the container
5. Wash your hands after collecting the sample.

Question 14

what is the recomended volume of sputum collection

Answer 14

3-5 ml of purulent/mucoid sputum

Question 15

what are sputum specimen guidelines

Answer 15

1. Bloody specimens and food particles inhibit PCR amplification.
2. Samples stayed over days at room temperature not viable for testing
3. Sputum sample less than 1 ml is not adequate for Xpert MTB/RIF examination
4. Poorly labelled specimen
5. Incomplete and incorrect filled forms

Question 15

what to do when receiving sputum specimens in the lab

Answer 15

1. Check the quantity and quality of specimens:
   -Check the volume (ideally 3-5 ml; a minimum of 3 ml is required for Xpert MTB/RIF testing)
   -Record sputum consistency (mucoid, purulent, bloody or watery) on the report form
   -Ensure that specimens do not contain food or other particulates.
2. Check that the patient’s information is complete, and that Xpert MTB/RIF testing has been requested in accordance with the NTP’s guidelines.
3. Follow the NTP’s guidelines for rejecting samples.
4. Ensure that the patient’s information is complete on both the request form and the specimen container, and ensure that the information matches.
5. Record the specimen in the laboratory register and allocate a laboratory serial number to the specimen

Question 15

what information should be included on the sputum examination request form

Answer 15

Name of the treatment unit
Date of the request
Patient’s information (that is, name, sex, age, address and the register number of the patient or suspected case)
Number of specimens and types of specimens sent for testing
Date the specimens were collected
Reason for examination (for example, Hospitalised, HIV positive/smear negative, Presumptive MDR etc.)
Name and Signature of the person requesting the examination.

Question 16

advantages of patient referral systems

Answer 16

1. Sputum collection can be monitoredand collection can be repeated if the first specimen is not satisfactory.
2. Treatment can be initiated faster.

Question 17

disadvantages of patient referral systems

Answer 17

Requires patients to travel which might be un affordable to some distant patients

Question 18

disadvantages of specimens are referred

Answer 18

1. Requires systems for safe transport and shipment.
2. Requires efficient system for transmitting results.
3. Specimen transport may require cold-chain or preservatives.
4. Due to inefficient transportation and poor storage conditions, samples may be un viable upon reaching the GeneXpert testing area

Question 19

advantages if specimen are reffered

Answer 19

Patient does not have to travel

Question 20

Why is it important to transport sputum specimens to the laboratory as quickly as possible?

Answer 20

Transporting sputum specimens quickly prevents degradation and contamination, ensuring the accuracy and reliability of the Xpert MTB/RIF test results.

Question 21

What should be done if there is a delay in transporting the sputum specimen to the laboratory?

Answer 21

If there is a delay, the specimen can still be used for Xpert MTB/RIF testing. However, it should be refrigerated at 2–8°C for a maximum of 10 days or stored at a maximum of 35°C for up to 3 days before refrigeration.

Question 22

Explain the importance of refrigerating sputum specimens and the specific temperature requirements

Answer 22

Refrigerating sputum specimens at 2–8°C helps preserve the sample by slowing bacterial growth and enzymatic activity. This ensures the specimen remains viable for testing up to a maximum of 10 days.

Question 22

Why must the identification number on each sputum container correspond to the number on the request form?

Answer 22

This correspondence ensures that each specimen is correctly linked to the right patient, preventing errors in diagnosis and treatment.

Question 23

What information should be included on the accompanying forms for each sputum specimen?

Answer 23

The accompanying forms should include patient identification details, the date and time of specimen collection, the type of test requested, and any relevant clinical information

Question 24

Explain why using pooled sputum specimens should be avoided in tuberculosis testing

Answer 24

Pooled sputum specimens can dilute the sample, leading to inaccurate test results, and can introduce cross-contamination, increasing the risk of false positives or negatives

Question 25

What steps should be taken if an error or invalid Xpert MTB/RIF result is encountered?

Answer 25

If an error or invalid result occurs, collect an additional sputum specimen and repeat the test to ensure accurate diagnosis.

Question 26

Discuss the potential consequences of not following proper sputum specimen handling and transport guidelines

Answer 26

Not following proper guidelines can lead to degraded or contaminated samples, inaccurate test results, delayed diagnosis, inappropriate treatment, and increased risk of transmission of tuberculosis.