Specimen Collection Procedures

Heartland Health Laboratories, Inc.

 

Specimen Collection Protocol

* FOR SPECIMENS NOT COLLECTED BY HEARTLAND HEALTH LABORATORY*

 

Supplies provided:

Heartland Health Laboratories provides the following supplies for lab testing: sterile collection cups with bags, 24-hour urine collection containers (on request), sterile culture swabs with culturette for transport, occult blood cards, and requisition forms. Special supplies are required for testing the flu. Please call the lab for supplies when needed.

 

Specimen Integrity:

Any laboratory result is only as good as the specimen provided. To assure accurate results it is vital that specimens be collected and handled in an appropriate manner.

To help ensure the best possible results for your residents we suggest the following specimen collection protocols:

Identification:

  • Positive identification of Residents by facility staff is required if the resident is unable to identify themselves.
  • Every specimen must be labeled with:
    • Resident’s full legal name (not a nickname)
    • Date of birth
    • Facility name
    • Date/time of collection  
  • Resident identification must be on the container - not the lid.

Resident Preparation:

  • Fasting: A 10 to 12 hour fast is required when glucose and lipid levels are to be determined. While fasting, a resident is restricted to only normal amounts of water.
  • Therapeutic Drug Levels: Please include the resident’s dosage information, including times administered on the request form where applicable. Specimens for medication monitoring are most accurate when obtained just prior to the next scheduled dose.
  • Timed Specimens: To best serve your needs and the needs of your residents, please provide our lab staff as much notification as possible for specially scheduled testing such as antibiotic Peak and Trough testing.

Specimen Rejection:

Specimens not collected and handled according to specific test protocol may be subject to rejection. If in the judgment of our medical technologist, a specimen will yield inaccurate results, we will notify you immediately that another specimen needs to be submitted for testing.

Culture Collection:

  • Throat: Depress tongue with tongue blade to minimize contamination with saliva. Using the sterile swab provided vigorously swab tonsils, the posterior pharynx and any areas of inflammation, ulceration or exudates. Replace swab in culturette and refrigerate until transport.
  • Nasopharyngeal: Using the sterile swab provided gently pass the swab through the nose into the nasopharynx – rotate and remove. Replace the swab in the culturette and refrigerate until transport.
  • Nasal MRSA Screen: Using the sterile swab provided gently pass the swab through the nose into the nasopharynx – rotate and remove. Replace the swab in the culturette and refrigerate until transport.  This is Positive or Negative test to help identify colonization. No sensitivity is reported.
  • Sputum: Collect from a deep cough into the sterile container provided.  Specimens contaminated with saliva will be rejected. An early morning freshly expectorated sputum is the best sample. Gram stains are routinely performed on sputum specimens. Refrigerate until transport. A swab is acceptable for a sample from a tracheotomy.
  • Stool Specimens: Collect into the sterile container provided. DO NOT contaminate the specimen with urine or toilet water. Refrigerate until transport. Stool samples are routinely cultured for Salmonella and Shigella. This does NOT include C. diff.
  • Stool  for VRE: Collect into sterile container provided. May collect on a rectal swab. DO NOT contaminate the specimen with urine or toilet water. Refrigerate until transport. This is Positive or Negative test to help identify colonization. No sensitivity is reported.
  • Urethral, cervix: Collect specimen with the sterile swab provided and replace in culturette. Refrigerate until transport.
  • Wounds: An open wound must be cleaned first to eliminate normal skin flora. There are three methods to collect a wound culture.  Always include the wound site on sample.
    • Swab: Moisten swab with gel media in transport tube, or with a few drops of sterile saline.  Rotate swab over a 1cm area with enough pressure to express fluid from the wound tissue.  Replace swab in culturette and refrigerate until transport.
    • Tissue Biopsy: Remove non-necrotic tissue from the base of the wound using a scalpel or punch biopsy instrument.  Place tissue in a sterile container provided with a small amount of saline.  DO NOT add formalin.
    • Needle Aspirate: (Abscess, Boil, sterile body fluid): Using sterile technique aspirate a minimum of 1 mL of wound fluid, or sterile body fluid.  Remove needle and cap syringe with a sterile cap.  DO NOT leave needle attached to the syringe, it WILL NOT be transported.  Alternately, put aspirate in a sterile container provided with a small amount of saline.  DO NOT add formalin.
  • Eye: Culture swabs should be obtained before topical anesthetics are applied since they may have antimicrobial activity. Replace swab in culturette and refrigerate until transport.
  • Viral Culture for Herpes: Contact the laboratory to supply instructions and media for collection.
  • Viral Culture (other than Herpes): Collect sputum, urine, stool and body fluids into a sterile container provided and refrigerate until transport.
  • Fungal cultures:
    • Skin Scrapings: Gently scrape skin into a sterile container provided. Keep at room temperature.
    • Wound or other source: Swab area with sterile swab provided and   replace in culturette. Must be collected separately from specimen used for bacterial specimen.
    • Sputum or bodily fluids: Collect in sterile container provided. Refrigerate urine and sputum cultures until transport. Bodily fluids should be left at room temperature.
    • Tissue/Biopsy: 5mL aspirate or 1cc tissue in sterile container with a small amount of saline.  This must be a separate specimen than used for bacterial culture.
  • AFB (Acid Fast Bacillus) Cultures:
    • Sputum: Single, first morning specimen is preferred. Collect in a sterile container provided and refrigerate until transport.
    • Gastrics: First morning specimen after eight hour fast. Collect in a sterile container provided.  These must be cultured as soon as possible after collection.
    • Urine: Collect random, early morning specimen in sterile container provided and refrigerate until transport.
    • Other Body Fluids: Collect in sterile container provided with a small amount of saline. Submit specimen(s) as soon as possible.
  • Stool for Occult Blood: Collect stool in sterile container provided.  Or, inoculate resident sample area of occult blood card with fresh stool (approximately the size of a pea) and place into zip top baggie provided. Store at room temperature until transport. Because of the non-homogeneity of the stool, it is recommended that the test be performed on stool samples from three (3) consecutive days.  Due to a higher possibility of missing a positive result, it is not recommended to use multiple stool specimens from the same day. Specimens received on the occult blood card are stable for 14 days, if received in a sample cup, 3 days.
  • Stool for C.Diff: Collect stool into sterile container provided and refrigerate until transport. The stool MUST take the formation of the cup for testing to be performed. May be collected with stool for culture, or occult blood.  Formed stools will be rejected for C. diff testing.
  • Stool for Ova and Parasites: Collect stool into sterile container provided and refrigerate until transport. May be collected with stool for culture, C.difficile testing or occult blood. A minimum of 2 TBSP stool is required. Sample stability is 24 hours.  Do not submit specimens directly from diapers. Line a diaper with plastic wrap for collection, then transfer specimen to a container.
  • Urine: Collect specimen by “clean catch” or catheter into a sterile container and refrigerate until transport. A “clean catch” is the best specimen to submit for testing.
  • 24-Hour Urine: A full 24-hour urine must be obtained or the testing will be inaccurate. Specimens for Creatinine Clearance/Total Protein require no special additives. Use the orange storage bottle provided and keep urine refrigerated.

 Procedure for 24 hour urine collection:

1) Empty bladder of first morning urine into the toilet. Do not save this specimen. Note the date and time of the first void.

2) Save all urine voided during the next 24 hours up to and including urine from the first morning the following day. If the storage container nears        becoming full before the 24 hour period ends, call the lab as soon as possible for another container.

3) If any urine is lost during the collection, the procedure must be started over or the test results will be inaccurate. If no additive is required the container       may be emptied completely, rinsed, and used again. If additive was added, please call the lab for a new container.

Please note: A caustic preservative may be present in the orange storage container for some tests. Keep the container tightly secured at all times. Pour urine carefully into the storage container. Do not attempt to have your resident urinate directly into the storage container.

 

  • For other Cultures not listed: Please contact the laboratory.

 

Specimen Stability:

  • Urines, Wounds, Sputum, MRSA Swab, Stool, VRE swab, C. diff are all stable for 3 days, if properly handled.
  • Every specimen must be labeled with the resident’s full legal name (not a nickname), Facility name, Date of Birth and DATE/TIME of collection.