Tenets_of_Specimen_Management_in_Diagnostic_Microb

Clinical microbiologists are responsible for all major issues and all phases of testing, specimen management, and educat- ing clinicians using microbiology services. Therefore, diagnostic microbiology laboratories in medical institutions and hospitals must be placed under the supervision and direction of clinical microbiologists. Clinical microbiolo- gists must made aware of purchase of instruments, reagents, CONCLUSION Table 2. Sites of infection where the specimen is likely to become contaminated during collection 10 Middle ear Lower respiratory tract Nasal sinus Urinary bladder Endometrium Superficial wounds Fistulae External ear canal Oropharynx Nasopharynx Urethra and perineum Vagina Skin and mucus membranes GI tract Sites of infection Contamination during collection Table 3. Instructions and precautions for collection of mid-stream sample of urine 11-13 Spread labia Using plain soap or antiseptic wipe front to back Dry with tissue paper Begin passing urine Stop flow in midstream Pass several mL into container without touching rim Recap container Pass remaining urine into lavatory Send specimen to laboratory immediately (refrigerate if prolonged transport time) Retract prepuce Clean glans penis using plain soap or antispetic Dry with tissue paper Female patients Sterile specimen container Male patients Journal of Universal College of Medical Sciences (2023) Vol.11 No.02 Issue 28 65 TENETS OF SPECIMEN MANAGEMENT IN DIAGNOSTIC MICROBIOLOGY Rajeshwar Reddy Kasarla, Laxmi Pathak Specimens must be labeled accurately and completely so that interpretation of results will be reliable. Labels such as “eye” and “wound specimens” are not helpful to the interpre- tation of results without more specific site and clinical information. (e.g. surgical site infection after laparotomy). Modern laboratories are advancing with bar coding. Thus, Microbiology laboratories need precise concepts, and special skills to collect the specimens for effective methods in diagnosis. 12,13 The microbiology laboratory should be allowed to set techni- cal policy with specific guidelines to create the optimal and standard operative procedures. A microbiology laboratory policy manual should be available at all times for all medical staff to review or consult and it would be particularly helpful to encourage the nursing staff to review the specimen collec- tion and management portion of the manual. This can facilitate collaboration between the laboratory with the microbiology expertise, and the specimen collection person- nel, who may know very little about microbiology or what the laboratory needs in order to establish or confirm a diagno- sis. For a good laboratory practice, train all personnel respon- sible for collecting, handling, storage, transport and disposal of specimens. All the technical staff should follow the standard universal precautions while handling and disposing the microbiology specimens. 1,2 Everything that grows on a culture plate is not a pathogen. Many body sites have normal microflora that can easily contaminate the specimen. Many junior staff and technical staff start reporting commensal and oral flora as pathogens thus providing irrelevant information that could result in inaccurate diagnosis and inappropriate therapy. Therefore, specimens from sites such as lower respiratory tract (sputum), nasal sinuses, superficial wounds, fistulae, and others require care in collection. 14,15 Optimal specimen collection increases the capabilities of diagnostic reporting. Specimen collection and aseptic precau- tions in collection is a major concern to valid microbiology reporting. Disinfection of the site, if applicable, must be carefully considered during specimen collection. For example, it is imperative to disinfect the skin prior to collec- tion of blood. Otherwise, skin flora may result in a false-posi- tive culture. Severe life threatening septic complications including blood cultures in bacterial infections are contami- nated due to lapses in specimen collection. 16 A frequently contaminated blood culture reports losses the confidence of physicians on microbiology departments. Blood culture and urine cultures contaminated with skin flora during collection are common problem encountered in diagnostic microbiolo- gy laboratories. 16,17 Microbiology laboratory results that are reported should be accurate, significant, and clinically relevant, do not report Streptococcus pneumoniae from throat swabs. Drug suscepti- bility testing should be performed on clinically significant isolates, not on all microorganisms recovered in culture. Appropriate microbiology skills reduce super bugs. Refer peer reviewed diagnostic microbiology text books or else you are communicating the commensals and contaminants as pathogens and with misuse of antibiotic. 18,19 Specimen rejection criteria are essential in order to avoid providing inaccurate results. Specimens of poor quality must be rejected. Rejection of specimens must be done with wisdom and experience and be prepared to say “no” responsibly. Microbiologists should act correctly and responsibly when they call physicians to clarify and resolve problems with specimen submissions. 10,16,17 Storage of Specimens Most samples should be stored at 4 zero.superior C, if the processing is not done within two hours after collection. The CSF sample for bacteriological examination should never be refrigerated as delicate pathogens such as Haemophilus influenzae may die; if delay is expected, it may be kept in an incubator at 37 zero.superior C. For virus isolation, CSF may be kept inside the freezer. CSF being the most precious specimen should be examined imme- diately. Specimens for virus detection should be transported on wet ice and frozen at -80 zero.superior C if testing is delayed for more than two hours; although specimens in viral transport media may be transported at room temperature when rapid delivery to the laboratory within two hours is assured. 20,21 Diagnostic microbiology laboratory results that are reported should be accurate, significant, and clinically relevant. Unfor- tunately, clinical microbiologist services are not utilized to their fullest potential for patient care and welfare, Since most of the hospitals and medical institutions are under the admin- istrative control of non-medical personnel, and diagnostic microbiology laboratories are kept under the control of technical staff who does not have a sound knowledge of clinical microbiology, and of course, due to corruption, which has become an order of the day in developing countries. 19,21