EXERCISE 9 Flashcards
(245 cards)
1
Q
The collection time is best when the [?] the suspected agent is greatest.
A
likelihood of recovering
2
Q
If the patient is for antimicrobial therapy, samples must be collected [?] is administered
A
before the antimicrobial agent
3
Q
This is for the recovery of organisms that are usually highly susceptible to antibiotics like:
- beta-hemolytic Streptococcus from a
- Neisseria gonorrhoeae from
- Haemophilus influenzae or Neisseria meningitidis from
A
- throat swab
- genitourinary samples
- CSF
4
Q
The administration of antibiotics does not necessarily preclude the recovery of other microorganisms from clinical samples. Therefore, one should always attempt to [?], although the result must be interpreted accordingly or qualified in the written report.
A
culture
5
Q
Recovery of suspected agents is also greatest during the [?] phase of the illness. In the case of viral infection, it is best to collect the sample from 2 to 3 days of infection.
A
acute (early)
6
Q
In many cases, specimen collection should also be based on the [?] of infectious disease.
A
history and pathophysiology
7
Q
In suspected cases of typhoid fever, a [1] is preferred during the first week of infection and [2] during the second and third weeks of infection.
A
blood sample
urine or feces
8
Q
The collection site is from an [?] with minimum contamination from adjacent tissues, organs, or secretions.
A
actual infection site
9
Q
Specimen containers for microbiologic processing must be [3 answers]. However, for stool samples [2 answers] container is acceptable.
A
sterile, sealable, and leak-proof
clean, and leakproof
10
Q
Samples must be transported within sealable, leak proof, plastic bags with a separate section for paperwork; marked with a [?].
A
biohazard label
11
Q
Specimen volume should be [?] to perform the microbiologic studies requested
A
adequate
12
Q
As a general rule, at least [?] of material should be received for routine bacterial culture, and more is necessary for additional studies.
A
0.5 ml or 0.5 g
13
Q
If the sample is insufficient, notify the nurse/ doctor. If possible collect additional samples. If an additional sample is not possible and scientific, ask the doctor to [?] the test.
A
prioritize
14
Q
[?] are inferior in the collection of most specimens since it does not provide sufficient quantity, are easily contaminated, and can become dried out, leading to a loss of organisms.
A
Swabs
15
Q
Swabs are appropriate when a [?] of sample is not necessary like samples from the oropharyngeal, upper respiratory tract, external ear, eye, and genital tract.
A
large volume
16
Q
A swab from wound swab is acceptable only when the organism load is [?]
A
high
17
Q
[?] is recommended.
A
Polyester tipped on a plastic shaft
18
Q
should be avoided for viral culture (inactivate HSV). It may emit toxic products that may inhibit fastidious bacteria.
A
calcium alginate
19
Q
tends to have excessive fatty acid which may be toxic to certain bacteria like Neisseria gonorrhoeae
A
cotton-tipped swab
20
Q
is toxic to Chlamydia trachomatis
A
wooden shaft
21
Q
Organism recovery from swabs may be enhanced by placing the swab in [?] and vertexing for 20 seconds before inoculation
A
0.5 to 1.0 mL of saline or tryptic soy broth
22
Q
use of [?] are encouraged
A
aspiration needles and catheters
23
Q
maintain the sample as near its original state as possible with minimum deterioration and to minimize hazards to specimen handlers by using [?] that are confined within proper protective containers
A
tightly fitting collection devices
24
Q
[?] between the collection of specimens and inoculation of media to a minimum
A
reduce the time delay
25
– material should be inoculated directly onto MAC or GN broth
Shigella species from a patient with bacillary dysentery
26
- inoculated directly onto CAM or selective media
Neisseria gonorrhoeae from urethral or cervical secretion
27
- inoculated directly onto fresh Bordet-Gengou agar
Bordetella pertussis from respiratory specimen
28
are also especially sensitive to ambient condition
Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and anaerobes
29
Samples must be transported to the laboratory within [?] (ideal) from collection because many microorganisms are susceptible to environmental conditions
30 minutes to 2 hours
30
• presence of oxygen (O2) -
anaerobes
31
• changes in temperature
Neisseria meningitides
32
• changes in pH
Shigella
33
Small volumes of fluid (<1 ml) or tissue (<1 cm3) should be submitted within [?] to avoid evaporation, drying, and exposure to ambient conditions. A few drops of no bacteriostatic saline may be added for hydration
15 to 30 min
34
Larger volumes and those specimens in the holding medium may be stored for as long as
24 h
35
▪ Samples must be placed in a
biohazard bag
36
transport containers for anaerobic specimen
1. Syringe and needle for aspiration
2. Tube or vial
3. Swab/ plastic jacket system
4. Bio-bag or plastic pouch
37
[?] or liquid specimens can be transported to the laboratory after bubbles are carefully expelled from the syringe and the tip of the needle is inserted into a sterile stopper.
Fresh exudate
38
Syringe and needle for aspiration procedure is valid only if the specimen can be transported to the laboratory without [?]. This practice is under question because of the chance of HIV transmission from a needlestick injury.
delay
39
Tube or vial contains semisolid holding medium, an atmosphere of [?], a reducing agent, and [?]indicator to give visual indication of anaerobiosis.
5% CO2; reazurin
40
The tube is used primarily for the insertion of [?]; the vial is used for inoculation of the [?]
swab specimen; liquid specimen
41
is fitted with a swab and contain either Cary-Blair, Amies transport, or prereduced (PRAS) medium.
A plastic tube or jacket
42
The [?] also includes a vial or chamber separated by a membrane that contains chemicals resulting in the generation of CO2 catalysts and desiccants to “scavenger” any reduced O2 that may get into the system.
culturette system
43
[?] containing a CO2-generating system, palladium catalyst cups, and an anaerobic indicator.
Transport plastic bag
44
The bag is sufficiently large to enclose an inoculated petri dish containing prereduced media, or a biochemical identification microtube tray such as for performing [?].
Minitek tests
45
Bag or pouch is sealed after inoculated plates have been inserted and the CO2-generating systems is that the plates can be directly observed through the thin, clear [?] of the bag for visualization of early growth of colonies.
plastic
46
governed by guidelines
Shipping of infectious material
47
▪ goal of Shipping of infectious material: safeguard [?] in the transportation industry and the [?]
employees; general public
48
patient specimens and culture isolates must be [?] before being shipped
triple packaged
49
the primary [?] that must be watertight
receptacle
50
the [?] material is placed around the primary receptacle
absorbent
51
the secondary receptacle is also
watertight
52
patient specimens and culture isolates must be [?] before being shipped
triple packaged
53
the primary [?] that must be watertight
receptacle
54
the [?] material is placed around the primary receptacle
absorbent
55
the secondary receptacle is also [?]; sealed
watertight
56
sturdy outer container constructed of
fibreboard
57
specific instructions must be followed for labeling the container as
“Hazardous Material”
58
Shipping carton containing dry ice (hazardous material) as a refrigerant for a specimen must be marked [?] and package must allow the escape of carbon dioxide gas to prevent the build-up of pressure that can rupture the container.
“Dry Ice Frozen Medical Specimen”
59
The dry ice should be placed outside the [?] along with a shock-absorbent material in such a manner that the second container does not become loose inside the outer container as the dry ice sublimates.
secondary container
60
sputum samples for recovery of mycobacteria and fungi – without further treatment if collected in a
sterile propylene or polyethylene container
61
maintain appropriate colony count.
Specimen preservatives
62
maintain accurate urine colony counts
boric acid
63
essentially a solution of buffers with [3 answers] and growth factors excluded
carbohydrates, peptones, and other nutrients
64
maintain the [?] of microorganisms present in a specimen without supporting the growth of any other organisms
viability
65
absorb fatty acids present in the specimen that could kill fastidious organisms such as Neisseria gonorrhoeae or Bordetella pertussis
charcoal
66
Direct inoculation to culture media at the time of
| specimen collection is optimal for the isolation of certain pathogens
(bedside inoculation)
67
provides semi-solid consistency to prevent oxygenation and spillage
a small amount of agar
68
recommended as a preservative for specimens suspected of containing mycobacteria (distant transport)
sodium borate solution
69
transport buffered medium for recovery of viruses
sucrose-phosphate-glutamate
70
o blood, synovial fluids, and peritoneal fluids into a
blood broth culture
71
o specimens for N. gonorrhoeae can be
| placed directly onto a [?] such as JEMBEC system
commercial transport system
72
o nasopharyngeal swabs for isolation of Bordetella pertussis onto
selective medium
73
o eye, especially [?] should be inoculated directly on an appropriate medium
cornea scrapings
74
used to prevent clotting of specimens such as blood, bone marrow, and synovial fluid because microorganisms will otherwise be bound up in the clot
Anticoagulants
75
higher concentration destroys Neisseria and other anaerobic bacteria
0.025% (w/v) Sodium polyethanol sulfonate (SPS)
76
to ensure the ratio of the specimen to SPS it is necessary to have both [?] available
large (adult size) and small (pediatric size) tubes
77
commonly used in viral culture and isolation of Mycobacterium spp. in the blood; inhibit the growth of gram-positive bacteria and yeast
Heparin
78
should not be used because efficacy has not been demonstrated for a majority of organisms
Citrate, EDTA (ethylenediaminetetraacetic acid)
79
Becton, Dickinson and Company yellow tap may contain either
SPS or ACD (trisodium citrate/citric acid/dextrose – not for microbiology use)
80
Specimen storage is dependent on the
type of transport media (if applicable) and the etiologic agent sought
81
unpreserved urine &stool, swabs, outer ear, sputum and other respiratory specimens, a specimen for detecting Chlamydia trachomatis or viruses, and foreign devices such as catheters
refrigerate (4ºC)
82
prevent overgrowth of NF
refrigerate (4ºC)
83
refrigeration adversely affects the recovery of potential pathogens (anaerobes)
room (ambient) temperature (22 ºC)
84
other body fluids, blood, inner ear, preserved urine & stool, genital, nasal, nasopharynx, throat, tissue and specimens collected for recovery of Neisseria gonorrhoeae
room (ambient) temperature (22 ºC)
85
Specimen labeling
| ▪ labeled at a very least with
o patient’s name, identifying number (hospital number)
o age or birthday
o source (special culture media can be selected if required)
o date and time of collection (ensure that the specimen is processed within an acceptable length of time)
o physician (consultation or early reporting of the result if required)
86
freezer temperature (either -20ºC or -70ºC)
serum for serologic studies
-20ºC
87
freezer temperature (either -20ºC or -70ºC)
tissues or specimen for long-term storage (more than 4 days)
-70ºC
88
enough information should be provided on the specimen label so that the specimen can be matched up with the [?] when it is received in the laboratory
requisition
89
the order form that is sent to the laboratory along with the specimen
Specimen requisition form
90
Specimen requisition form should include:
patient’s name, hospital number, age or date of birth, sex, collection date and time, ordering physician, exact nature and source of specimen, diagnosis, immunization history, current antimicrobial therapy
91
specimens require prompt processing after arrival in the laboratory
Specimen priority
92
level of specimen prioritization
level 1: critical/invasive
level 2: unpreserved
level 3: quantitation required
level 4: preserved
93
represent a potentially life-threatening illness and are from an invasive source
level 1: critical/invasive
94
require immediate processing
level 1: critical/invasive
95
amniotic fluid, blood, brain, cerebrospinal fluid, heart valves, pericardial fluid
level 1: critical/invasive
96
unprotected and may quickly degrade or have an overgrowth of contaminating flora
level 2: unpreserved
97
• provide an optimum growth environment for the fastidious organisms that may be found in the specimen
level 2: unpreserved
98
• body fluid not listed in level 1, bone, drainage from wound, feces, sputum, tissues
level 2: unpreserved
99
those that arrived in the laboratory in holding and transport media
level 4: preserved
100
• catheter tip, urine, tissue
level 3: quantitation required
101
those that arrived in the laboratory in holding and transport media
level 4: preserved
102
the special area designated for receipt of specimen
. Specimen receipt
103
personnel should wear protective clothing as appropriate – laboratory coats, rubber gloves, in some instances surgical masks to prevent
LAI
104
processing of specimen includes:
o the [?] into a logbook or computer terminal
o [?] or determination of whether all criteria for acceptance were met
o for certain specimens, microscopic examination of direct mounts or stained smears to establish a [?]
- entry of essential data
- visual examination
- presumptive diagnosis
105
Information on the label does not match the information on the requisition form
Rejection of unacceptable specimen
106
Specimen is leaking
Rejection of unacceptable specimen
107
Quantity of specimen is insufficient for testing
quantity not sufficient (QNS)
108
Specimen is leaking
Rejection of unacceptable specimen
109
Rejection of unacceptable specimen
Specimen transport time exceeded [?] without proper preservation
2 hours
110
Specimen received in a [?], which, in essence, kills any microorganisms present
fixative (formalin)
111
Exception: large specimens in which the time exposure to preservative is [?] – tissue should be bisected with sterile knife or scissors and an innermost portion sampled for culture
short (less than 1 hour)
112
Specimen received for [?] from a site known to have anaerobes as part of the normal flora (vagina, mouth)
anaerobic culture
113
Specimen is dried up
Rejection of unacceptable specimen
114
24-hour sputum collection
Rejection of unacceptable specimen
115
It is difficult to prevent contamination, and an individual collection containing a high concentration of microorganisms will be diluted out by subsequent less concentrated samples
Rejection of unacceptable specimen: 24-hour sputum collection
116
Smears of secretions from the uterine cervix, vaginal canal or anus for Gram’s stain detection of
Neisseria gonorrhoeae
117
Contaminated with barium, chemical dyes, or oily chemicals
Rejection of unacceptable specimen
118
(processing the specimen would produce information of questionable medical value)
From Foley catheter
119
Duplicate specimen (except blood culture) received in
24 hours
120
Transport time exceeds [?] post-collection and the specimen is not preserved
2 hours
121
Rejected for anaerobic culture: gastric washings, midstream urine, prostatic secretion collected transurethrally, feces (except for recovery of Clostridium species associated with the [?] – C. difficile, C. perfringens, C. septicum), ileostomy or colostomy swab, throat, nose or other oropharyngeal specimens (except for deep tissue samples obtained during [?]), superficial skin and environmental specimens.
gastrointestinal disease; surgical procedures
122
Regardless of the reason for rejection, it may be more politically correct to state that the specimen cannot be accepted due to the inability to [?], rather than to use the word “rejected”.
correctly interpret the results
123
It may be necessary to do the best possible job on a less than optimum specimen if it would be impossible to collect the specimen again because
o the patient is taking antibiotics
o the tissues were collected at surgery
o the patient would have to undergo a second invasive procedure (bone marrow or spinal tap)
124
A notation regarding improper collection should be added to the [?] in this instance because only the primary caregiver can determine the validity of the result
final report
125
chosen before skin disinfection
Site
126
with existing IV line: blood is drawn before the existing IV line (blood [?] IV line is diluted)
above
127
less desirable to draw blood through [?] (prosthetic devices are difficult to decontaminate completely)
vascular shunt or catheter
128
preferred antiseptic agent
70% alcohol and antiseptic
129
kill surface and subsurface bacteria
iodine
130
fewer than [?] of blood were commonly found in patients with clinically significant bacteremia
30 cfu/mL
131
of blood per culture – strongly recommended
10 mL (absolute minimum) to 20 mL
132
volume is directly proportional to
yield
133
is enough for children
1 to 5 mL
134
of bacteria results to serious disease in children
10cfu/mL
135
is enough for children
1 to 5 mL
136
Number of blood culture:
dependent on the characteristic of the disease; if blood volume is adequate, usually [?] blood cultures are sufficient to achieve optimum blood culture sensitivity
2 or 3
137
it is generally accepted that [?] blood cultures be spaced an hour apart
2 to 3
138
if immediate therapy is needed: [?] at one time, 20 mL from each of two separate venipuncture sites, using 2 separate needles and syringes before patient is given antimicrobial therapy
40 mL
139
a delay beyond [?] can delay the detection of positive cultures
2 hours
140
inhibit numerous organisms and not recommended for use
Heparin, citrate, EDTA
141
best anticoagulant for blood; anticomplementary, antiphagocytic
0.025% to 0.03% (w/v) SPS
142
interferes with the activity of some antimicrobial agents
aminoglycoside
143
inhibit the growth of few microorganisms - ---
| addition of [?] counteract inhibitory actions of SPS (but recovery may be decreased)
1.2% gelatin
144
of blood to unmodified medium has been found to be adequate in conventional blood culture
1:5 ratio
145
blood culture bottle contents:
- trypticase soy broth
- brain-heart infusion broth
- supplemented peptone
- thioglycolate broth
146
specialized broth bases:
Columbia or Brucella broth
147
enhance recovery of staphylococci,
| particularly when patients receive bacteriostatic drugs
resin-containing medium
148
examples of Osmotic stabilizers
• sucrose, mannitol, sorbose
149
enhance recovery of staphylococci,
| particularly when patients receive bacteriostatic drugs
resin-containing medium
150
examples of resin-containing medium
BACTEC system (Becton-Dickinson), BacT/ALERT
151
significantly increases yield of microorganisms over standard blood culture media
Activated charcoal particles
152
examples of Activated charcoal particles
BacT/ALERT
153
one of the least clinically relevant specimens --- contaminated with saliva
Expectorated Sputum
154
. Lower Respiratory Tract Specimens
1. Sputum
2. Bronchial washings or aspirate
3. Bronchoalveolar lavage (BAL) samples
4. Protected bronchial brush samples
5. Transtracheal aspirates
6. Other invasive procedures (thoracentesis, needle aspiration of material from the involved area of the lung, open lung biopsy)
155
Upper Respiratory Tract Specimens
1. Throat swab
| 2. Nasopharyngeal swab
156
Urine Specimens
1. Clean-catch midstream urine
2. Suprapubic bladder aspirate
3. Straight (Single )catheterized urine
4. Indwelling catheter
157
Lower genital tract
1. Urethral discharge
| 2. Cervical/Vaginal
158
deep-coughed specimen
Expectorated Sputum
159
patient preparation
• should not have been ingested food for 1 to 2 hrs before expectorating
• patent with dentures should remove dentures first
• mouth rinsed with saline or water just before expectoration
• expectorate with the aid of a deep cough directly into a sterile container
Expectorated Sputum
160
deep-coughed specimen
Expectorated Sputum
161
single Expectorated Sputum specimen is adequate for detection of
bacterial lower respiratory tract infection
162
three separate early morning Expectorated Sputum specimens (collected on successive days) are appropriate for
fungal and mycobacterial infection
163
--- stimulate acceptable sputum
postural drainage and thoracic percussion
164
collected by allowing the patient to breathe aerosolized droplets of a solution containing 15% sodium chloride and [?] for 10 minutes, or until a strong cough reflex is initiated
10% glycerine
165
watery, resembling saliva, although they often contain material directly from alveolar spaces
Induced Sputum
166
used to obtain sputum specimen. It is placed in-line between the vacuum circuit and the suction catheter.
ndotracheal or tracheostomy suction specimen
Lukens trap (“sputum trap”):
167
Bronchial washings or aspirate is collected through
broncoscopy
168
obtained by instilling a small amount of [?] into the bronchial tree and withdrawing the fluid when purulent secretions are not visualized
sterile physiologic saline
169
may still be contaminated with URT flora such as
viridians streptococci and Neisseria spp.
170
Bronchoalveolar lavage (BAL) samples is collected through
broncoscopy
171
high volume of saline [?} is infused into a lung segment through the bronchoscope to obtain cells and proteins of the pulmonary interstitium and alveolar spaces
(100 to 300 mL)
172
safe and practical method for diagnosing [?] in immunesuppressed patients
opportunistic pulmonary infections
173
```
Bronchoalveolar lavage (BAL) samples
is suitable for detecting [?]
```
Pneumocystis cyst and fungal elements
174
obtained via a [?] as part of broncoscopy examination
protected catheter bronchial brush
175
obtained by inserting a small plastic catheter into the trachea via a needle previously inserted through the skin and [?]
cricothyroid membrane
176
used to isolate anaerobes
Transtracheal aspirates
177
Transtracheal aspirates
indicated when:
o the patient is debilitated and cannot spontaneously expectorate a sputum sample
o routine sputum samples have failed to recover a causative organism in the face of clinical bacterial pneumonia
o an anaerobic pulmonary infection is suspected
178
thoracentesis is obtained from patient with
pleural empyema
179
excellent specimen that accurately reflects the bacteriology of an associated [?]
pneumonia
180
may be performed percutaneously
needle aspiration of material from the involved area of the lung
181
if no material is withdrawn into the syringe after the first try, approximately [?] can be injected and then withdrawn into the syringe
3 mL of sterile saline
182
with several side effects; frequently use in [?]
children
183
most invasive procedure of collecting respiratory secretion; performed by surgeon
open lung biopsy
184
used to procure a
wedge of lung tissue
185
open lung biopsy is used for the diagnosis of severe
viral infections
186
are suitable for collecting most URT microorganisms
cotton-, dacron-, or calcium alginate-tipped swabs
187
Use only sterile swabs with
plastic or metal shafts.
188
Options for Nasopharyngeal swab include
flocked, foam, spun polyester (e.g., dacron), and spun rayon tipped swabs.
189
DO NOT [?], as they may contain substances that inactivate some viruses and/or interfere with
some molecular assays.
use cotton, calcium alginate swabs or swabs with wooden sticks
190
collected by aseptically inserting a needle into the subarachnoid space, usually at the level of the lumbar spine
Cerebrospinal Fluid
191
▪ puncture site for CSF collection
- 3rd or 4th lumbar interspace (or lower) in
adults
- 4th or 5th interspace in children
vary if an infection is present at the preferred site
192
avoid locally infected site:
prevent
| introduction of infection into the CNS
193
procedure: performed aseptically
a. Thorough cleanse of the patient’s skin and apply of a [?]
b. The spinal needle is advanced into the [?], and often a pop is heard on penetration of the dura mater.
c. Immediately after the dura mater has been entered and before any CSF had been removed, the physician takes the initial or [?] of the CSF using a manometer that attached to the spinal needle.
d. If CSF pressure is normal, [?](approximately 15% of the estimated total CSF volume) can be removed safely.
e. After the CSF has been removed and before the spinal needle has been withdrawn, the physician takes the [?]
f. Both CSF pressure and values and the amount of CSF removed are recorded in the [?]
- local anesthesia.
- lumbar interspace
- “opening” pressure
- 20 mL CSF
- “closing” CSF pressure
- patient’s chart.
194
* normal CSF pressure for an adult in a lateral recumbent position range from
* slightly higher in a
50 to 180 mm Hg; sitting position
195
* If CSF pressure is abnormal only [?] should be removed
| * Infant and children: remove proportionately
1 to 2 mL; smaller volumes of CSF
196
CSF collected is dispensed into 3 or more sequentially labelled [?]
sterile collection tubes
197
1st tube
chemical and immunologic testing
198
2nd tube
microbial testing
199
3rd tube
reserved for the microscopic examination of cellular components (rbc and wbc counts and cytologic studies)
200
any minimal blood contamination resulting from [?] during the initial tap normally does not affect results
vessel injury
201
▪ If only small amount of CSF is obtained
o use [?]
o ordering physician [?] the test desired
o microbiology laboratory receives the specimen first to ensure [?] of a sterile specimen, followed by cell counts, chemical and immunologic testing
- single collection tube
- prioritizes
- culturing
202
delay can cause inaccurate results
falsely [?] caused by lysis of wbc
low cell counts
203
delay can cause inaccurate results
falsely [?] caused by glycolysis
high lactate levels
204
delay can cause inaccurate results
[?] of viable microbial organisms
jeopardized recovery
205
chemical and immunologic testing (tube 1)
frozen (-15º to -30 °C)
206
microbiologic studies (tube 2)
room temperature (19° to 26 °C)
207
cell counts and cytologic studies (tube 3)
refrigerated (2° to 8°C)
208
must be frozen and saved for possible future chemical or immunologic studies
excess CSF
209
least invasive procedure
Clean-catch midstream urine
210
Clean-catch midstream urine
first morning specimen is preferred because it provides a
more concentrated sample
211
must be performed carefully for optimum results, especially in females
Clean-catch midstream urine
212
procedure
• patient should clean [?] area well with a mild soap to avoid contamination and rinse well to remove soap (bacteriostatic)
• retract the [?], begin to void, and then collect a midstream urine sample
periurethral
| labia folds or glans penis
213
washes contaminants from the urethra
first portion of urine
214
is more representative of that in the bladder
midstream portion
215
advantages of Clean-catch midstream urine
it is neither invasive nor uncomfortable
it is simple and inexpensive
it can be performed in almost any clinical setting
there is no risk of introducing bacteria into the bladder by catheterization
there is no risk of complications
216
Colony counts from urine specimens collected by this method correlate reasonably well with those of specimens collected via
suprapubic aspiration or straight catheterization.
217
Greater than 100,000 colonies/ml represents urinary tract infection. For counts between 10,000 and 100,000, the culutre is .
indeterminate
218
disadvantages of Clean-catch midstream urine
- urine sample passes through the distal urethra and can become contaminated with commensal bacteria. - There may be difficulties with proper collection of samples from elderly patients, as well as from those
patients who have physical or other types of impairments, which adds to the importance of collecting specimens properly to avoid contamination.
219
Suprapubic bladder aspirate
urine is withdrawn directly into a syringe through a [?], thereby ensuring a contamination-free specimen
percutaneously inserted needle
220
Suprapubic bladder aspirate
is punctured using a needle and syringe and sampled following proper skin preparation
full bladder
221
best method to avoid contamination of
| specimens with bacteria in the distal urethra
Suprapubic bladder aspirate
222
disadvantages of Suprapubic bladder aspirate
used infrequently because it is not indicated clinically (except in rare circumstances)
it is invasive and uncomfortable
it requires too much time and too many resources to be practical
223
allows collection of bladder urine with less urethral contamination; slightly invasive
Straight (Single )catheterized urine
224
next-best technique for obtaining urine specimens with minimal contamination, but, again, it is not indicated clinically for most patients because it is too labor intensive and costly for routine use and it is invasive
Straight (Single )catheterized urine
225
disadvantages of Straight (Single )catheterized urine
the process of inserting a catheter through the urethra can introduce bacteria into the bladder (and thereby cause UTI), and rare complications have been reported
226
should be clamped off above the port to allow collection of freshly voided urine
catheter tubing
227
should then be cleaned vigorously with 70% ethanol and urine aspirated via a needle and syringe
catheter port or wall of the tubing
228
(cotton or rayon treated with charcoal to absorb material toxic to gonococci and wrapped tightly over one end of a thin wire shaft)
use urogenital swab
229
swabs are generally more toxic for HSV, gonococci, chlamydiae, and mycoplasmas than are treated cotton\ swabs
calcium alginate
230
(least toxic): recommended for viral specimens; also
| acceptable for chlamydiae and genital mycoplasmas
Dacron swabs
231
swab is inserted approximately[?] into the urethra and rotated gently before withdrawing
2 cm
232
in case of [?] is not needed collect the discharge
profuse discharge (male) swab
233
mucus is removed by gently rubbing the area with cotton ball
Cervical/Vaginal
234
swab is inserted into the cervical canal and rotated and moved from side to side for [?] then gently before withdrawing
30 seconds
235
collected in clean (not necessarily sterile), wide mouthed containers that can be covered with a [?]
tight-fitting lid
236
containers must be free of preservatives, detergents, or metal ions
Fecal Specimen
237
preserves viability of intestinal bacterial pathogens (Campylobacter and Vibrio)
0.5% to 0.16% Cary-Blair
238
equal parts of glycerol and [?] supports viability of Shigella better than Cary-Blair
0.033 M phosphate buffer (pH 7.0)
239
useful in newborns or in severely debilitated adults
Rectal swab
240
more effective in recovering Shigella, Clostridium difficile
Rectal swab
241
clean area with alcohol; collected from advancing margin of the lesion and should be collected by needle aspiration rather than by swab
Wound discharge
242
aspirated material should be placed in a sterile tube or transport vial and not [?] onto a swab
“squirted”
243
It is the [?] responsibility to provide clinicians with a collection manual or instruction cards listing optimal specimen collection techniques and transport information
microbiologist’s
244
Specimen collection instruction to clinicians and nurses
a. safety considerations
b. selection of appropriate anatomic site
c. collection instructions including type of swab or transport medium
d. transport instructions including time and temperature
e. labeling instructions including minimum patient demographic information (minimum of two patient identifiers)
f. special instructions such as patient preparation
g. sterile versus nonsterile collection devices
h. minimum acceptable quality
245
Instructions must be written at the same time instructed in a concise set of
verbal instructions
