Specimen Management and Rejection criteria in Diagnostic Microbiology -
Dr.T.V.Rao MD
A postgraduate question in Medical Microbiology / Accreditation standards in Laboratory Medicine The much of the success of the Microbiology depends on sample collection criteria, the dependability of the test truly depends on How - Why- Who collected matters, a blind processing will be unproductive and compromises the quality of the laboratory, I wish we have few hospitals truly bothers things go on and leads to many conflicts between clinicians and microbiologists, Many times the clinicians insist that Laboratory personnel should collect the specimens, however it is prime responsibility of the Phlebotomist s in blood cultures, and clinical staff who handle the patients in the patient care areas,
WHY WE NEED ACCOUNTABILITY
Rejection criteria are designed to prevent inaccurate data and to ensure the safety of patients and laboratory personnel.
Microbiology samples that do not meet the required sample and test request requirements will be rejected.
Reasons for sample rejection can include the following
Improperly labelled sample
Unlabelled sample
Incomplete information on the sample
Incomplete information on the requisition
Sub-optimal sample
i.e. leaking urine and/or stool containers, insufficient quantity, inappropriate sample for test request
Duplicate microbiology samples received on the same day
i.e. multiple stool, sputa samples
Sample delayed in transit
Routine Microbiology The most common reasons to reject a specimen are due to the addition of a preservative (such as formalin or alcohol) . • Sputum/Bronchial —Specimens which are poor quality (i.e. saliva) as indicated by gram stain (oral flora, rare polys, presence of epithelial cells). —Limit one (1) per day, not to exceed three (3) per week. • Urine Culture —First morning specimen is preferred, but random specimen will be processed. —Limit one (1) per day not to exceed three (3) per week. —Specimen received after 2 hours of collection if not refrigerated or after 24 hours, if refrigerated. • Urinalysis —Contaminated specimens-i.e., paper, feces. —Specimens submitted in improper container. —Specimen received after 2 hours of collection if not refrigerated or after 8 hours if refrigerated.
Say No to Foleys catheter culturing - Results of Foley catheter tip cultures have not been shown to correlate with the presence of urinary tract infections, therefore, requests for culture of these specimens should be rejected. Person responsible for collection will be notified and requested to send a urine specimen instead. • Feces —Specimen submitted in improper container. Stool specimens sent in a liquid other than saline, formalin, • Other Body Fluids as CSF Pleural ,pericardial amniotic fluids joint aspirates — are rare and vital specimens and best to be performed in spite of limitations in the laboratory and not forget No specimen will be rejected without consulting with Technical Specialist or Pathologist. • Blood Cultures —No more than 4 blood culture sets will be drawn in 24 hours. No more than 3 blood culture sets for each subsequent and separate febrile illness.
Transport Temperature - Specimens left at room temperature will become overgrown with normal bacterial flora. Bacteria can multiply at room temperature particularly in urine samples. Therefore it is very important to have the specimens sent to the laboratory straight away or refrigerated in the specimen collection points. (Exceptions include blood culture bottles, CSF and genitourinary samples for gonococcal culture - these should not be refrigerated be transported to the laboratory as soon as possible)
Mycobacterial Studies (Mycobacteriology )• Poor quality specimen (i.e. saliva). • Specimens <10 br="" mls="">Important - specimens received by the laboratory are not discarded until the physician ordering the test or responsible nursing unit is notified.
Ref and to read more at Pathology Handbook Walsall Healthcare NHS
Dr.T.V.Rao MD
Dr.T.V.Rao MD
A postgraduate question in Medical Microbiology / Accreditation standards in Laboratory Medicine The much of the success of the Microbiology depends on sample collection criteria, the dependability of the test truly depends on How - Why- Who collected matters, a blind processing will be unproductive and compromises the quality of the laboratory, I wish we have few hospitals truly bothers things go on and leads to many conflicts between clinicians and microbiologists, Many times the clinicians insist that Laboratory personnel should collect the specimens, however it is prime responsibility of the Phlebotomist s in blood cultures, and clinical staff who handle the patients in the patient care areas,
WHY WE NEED ACCOUNTABILITY
Rejection criteria are designed to prevent inaccurate data and to ensure the safety of patients and laboratory personnel.
Microbiology samples that do not meet the required sample and test request requirements will be rejected.
Reasons for sample rejection can include the following
Improperly labelled sample
Unlabelled sample
Incomplete information on the sample
Incomplete information on the requisition
Sub-optimal sample
i.e. leaking urine and/or stool containers, insufficient quantity, inappropriate sample for test request
Duplicate microbiology samples received on the same day
i.e. multiple stool, sputa samples
Sample delayed in transit
Routine Microbiology The most common reasons to reject a specimen are due to the addition of a preservative (such as formalin or alcohol) . • Sputum/Bronchial —Specimens which are poor quality (i.e. saliva) as indicated by gram stain (oral flora, rare polys, presence of epithelial cells). —Limit one (1) per day, not to exceed three (3) per week. • Urine Culture —First morning specimen is preferred, but random specimen will be processed. —Limit one (1) per day not to exceed three (3) per week. —Specimen received after 2 hours of collection if not refrigerated or after 24 hours, if refrigerated. • Urinalysis —Contaminated specimens-i.e., paper, feces. —Specimens submitted in improper container. —Specimen received after 2 hours of collection if not refrigerated or after 8 hours if refrigerated.
Say No to Foleys catheter culturing - Results of Foley catheter tip cultures have not been shown to correlate with the presence of urinary tract infections, therefore, requests for culture of these specimens should be rejected. Person responsible for collection will be notified and requested to send a urine specimen instead. • Feces —Specimen submitted in improper container. Stool specimens sent in a liquid other than saline, formalin, • Other Body Fluids as CSF Pleural ,pericardial amniotic fluids joint aspirates — are rare and vital specimens and best to be performed in spite of limitations in the laboratory and not forget No specimen will be rejected without consulting with Technical Specialist or Pathologist. • Blood Cultures —No more than 4 blood culture sets will be drawn in 24 hours. No more than 3 blood culture sets for each subsequent and separate febrile illness.
Transport Temperature - Specimens left at room temperature will become overgrown with normal bacterial flora. Bacteria can multiply at room temperature particularly in urine samples. Therefore it is very important to have the specimens sent to the laboratory straight away or refrigerated in the specimen collection points. (Exceptions include blood culture bottles, CSF and genitourinary samples for gonococcal culture - these should not be refrigerated be transported to the laboratory as soon as possible)
Mycobacterial Studies (Mycobacteriology )• Poor quality specimen (i.e. saliva). • Specimens <10 br="" mls="">Important - specimens received by the laboratory are not discarded until the physician ordering the test or responsible nursing unit is notified.
Ref and to read more at Pathology Handbook Walsall Healthcare NHS
Dr.T.V.Rao MD
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