J. Michael Miller - A Guide to Specimen Management in Clinical Microbiology

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Library of Congress Cataloging-in-Publication Data

Names: Miller, J. Michael (Jon Michael), 1945- author. | Miller, Shelley A., author.

Title: A guide to specimen management in clinical microbiology / J. Michael

Miller, Microbiology Technical Services, LLC, Dunwoody, Georgia; Shelley

A. Miller, University of California, Los Angeles, Los Angeles, California.

Description: Third edition. | Washington, DC : ASM Press, [2017] | Includes

bibliographical references and index.

Identifiers: LCCN 2016053693 (print) | LCCN 2016054512 (ebook) | ISBN

9781555819613 (pbk.) | ISBN 9781683673118 (ebook)

Subjects: LCSH: Diagnostic microbiology--Handbooks, manuals, etc. |

Diagnostic specimens--Handbooks, manuals, etc.

Classification: LCC QR67 .M54 2017 (print) | LCC QR67 (ebook) | DDC

616.07--dc23

LC record available at https://lccn.loc.gov/2016053693

All Rights Reserved

Printed in the United States of America

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ASM Press, 1752 N St., N.W.,

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Section opening photo credits: Section I (©Zaharia Bogdan Rares/Shutterstock.com),

Section II (©Gotzila Freedom/Shutterstock.com), Section III (©Pongsak A/Shutterstock.com)

Contents

Preface

Acknowledgments

About the Authors

How To Use This Book

SECTION I

Communicating Laboratory Needs

Basic Issues

Selecting a Representative Specimen

Requisitions

Specimen Packaging and Transport

Color-Coded Vacuum Tubes

Catheters Often Used in Medical Procedures

Specimen Priority

Specimen Rejection Criteria

Rejection Statements or Addenda to Laboratory Reports

Specialty Testing

Environmental Samples

Hand Wash Specimens

Laboratory Reports

SECTION II

Specimen Management Policies and Rationale

Collection Times

Collection Procedures

Specimen Transport

Specimen Processing: General

Specimen Processing: Molecular

Lower Respiratory Tract Specimens

Urine Specimens

Wound Specimens

Spinal Fluid Specimens

Throat and Nasopharyngeal Specimens

Vaginal and Endometrial Specimens

Miscellaneous Specimens

SECTION III

Specimen Collection and Processing

Body Fluid Specimens

Abdominal-Peritoneal Fluid (Paracentesis, Ascites)

Blood Specimens

Cerebrospinal Fluid

Pleural-Thoracentesis Fluid

Gastrointestinal Specimens

Duodenal Contents

Gastric Contents

Pinworm Eggs Collected by Adhesive Tape Preparation

Rectal and Anal Swab Specimens

Sigmoidoscopy Specimens for Amebiasis

Stool or Feces for Culture or Parasitology Studies

Stool Specimen Collection Directions

Genital Specimens

General Information

Cervical or Endocervical Specimens

Genital Smears for Herpes

Urethral and Penile Specimens

Respiratory Specimens

General Information

Bronchoscopy-Bronchial Washing

Nasal Specimens

Nasopharyngeal Specimens

Sputum

Tracheal Aspirate

Transtracheal Aspirate

Throat Specimens

Urine Specimens

General Information

Urine from Catheters

Clean-Catch Urine

Cystoscopic Specimens: Bilateral Urethral Catheterization

Suprapubic Aspirate for Urine Cultures

Urine Specimens: Bladder Washout

Urine Specimens: Ileal Conduit

Viruses, Chlamydiae, Rickettsiae, and Fungi

Chlamydia Culture

Specimens for Mycoplasma and Ureaplasma spp.

Fungal Specimens

Rickettsial Specimens

Viral Specimens

Wound Specimens

General Information

Ear (Otitis Media) Specimens

Eye Specimens

Skin and Contiguous Tissue Specimens

SECTION IV

Specimen Management Summary Tables

Bacteriology and Mycology Specimen Collection Guidelines

Specimen Management for Infrequently Encountered Organisms

Specimen Guide for Virus Isolation

Virology Specimen Collection Guidelines

Parasitology: Anatomic Sites Containing Diagnostic Stages

Parasitology Specimen Collection Guidelines

References

Index

Preface

From syndrome-based molecular panels to total lab automation, clinical microbiology has evolved rapidly over the past 18 years since the previous edition of this book. We have witnessed increases in infections due to multidrug-resistant organisms, have overcome a major Ebola outbreak, and are currently tackling the geographic expansion of Zika virus and its potentially devastating effects. Aside from these more contemporary headliner agents, we continue to battle the threat of microorganisms that have been plaguing our world for decades, including HIV, syphilis, and influenza, just to name a few. And while the laboratory processes, diagnostic methods, and diseases may be more advanced and exotic, one unwavering aspect is the need for appropriate, well-collected specimens. In a world where we find ourselves trying to do more each day within the same 24-hour period, it is imperative that time not be wasted on correcting issues that are easily remedied with upfront attention to quality of specimens.

For some reason, clinical microbiologists seem to get more formal training in appropriate specimen selection, collection, preservation, and transport than nurses, physicians, and other medical personnel who are actually obtaining the specimens. Microbiologists can usually agree that a poor specimen, regardless of how it is transported or stored, will provide poor, even inaccurate, results for the physician. Physicians must be able to trust the microbiology laboratory to deliver accurate, clinically relevant results; so it must be emphasized that the quality of the specimen submitted for culture and, ultimately, the person selecting, collecting, labeling, preserving, and transporting it, are essential first steps to achieve this. Therefore, this book is for every member of the health care team—the partnership.