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Obtaining Specimens for Microbiological Evaluation IPM-2.

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Presentation on theme: "Obtaining Specimens for Microbiological Evaluation IPM-2."— Presentation transcript:

1 Obtaining Specimens for Microbiological Evaluation IPM-2

2 Bacteremia I zMost bacteremias are intermittent zOne blood culture is rarely sufficient yStaphylococcus epidermidis xFrequent contaminant xCommonest cause of PVE zTwo blood cultures usually sufficient yThree or four if suspect likely contaminant yAntibiotic therapy

3 Blood Cultures - Volume The magnitude of bacteremia may be low (<1cfu/ml) Higher volumes have higher yield

4 Blood Cultures - Lab Aspects zAdditives (SPS, resins) increase yield zAerobic and anaerobic bottle = one blood culture zFive days incubation sufficient yException: Brucella, Histoplasma, Mycobacterium, Bartonella, Legionella zAutomated Systems detect CO 2 ySubculture detected bottles

5 Aerobic/Anaerobic Blood Culture Bottles

6 AFB Blood Culture Bottle

7 Obtaining Blood Culture zLocate the vein zPrep kit yAlcohol 5 sec. Dry 30-60 sec yTincture of Iodine-center to periphery. Dry 45-60 sec zRemove caps, clean with alcohol zPut on gloves zWithout palpating, draw 20 ml and put 10 in anaerobic and 10 in aerobic bottle zDispose of syringe in sharps container zLabel bottles and send to lab

8 Blood Culture Prep Kit

9 Sputum Culture Reliability zExpectorated unreliable because of contamination yReliability  if physician observes zLaboratory reliability screen y> 25 PMN’s, < 10 oral squamous cells per hpf

10 Sputum Container

11 Sputum zGram stain yUseful for immediate therapy yMay be more reliable than culture xMany PMN’s with single bacterial morphology zAFB - first morning specimen zPneumocystis carinii - induced specimen

12 Nasal Cultures zVirus yUse wire swab yPlace in nose 1-3 cm, rotate, 10-15 sec yObtain viral transport medium from lab zBacterial yCulturette with rigid or wire swab ySuspect pertussis - special media

13 Wire Swab

14 Throat Cultures zFor Group A strept, diphtheria, gonorrhea zTongue blade - visualize pharynx and tonsils zRub swab over tonsils and pharynx yINCLUDE ANY EXUDATE zInsert into holder, crush vial

15 Swabs for Bacterial (red) and Viral (green) Cultures

16 Cerebrospinal Fluid zUse sterile technique zFirst or second tube to Microbiology zStudies yGram stain - one drop cloudy fluid or sediment yAerobic culture - 1.0 ml yViral culture - 1.0 ml yAFB or fungal culture - up to 10 ml

17 Wounds: General Principles zClosed space infections provide reliable specimens zOpen wounds heavily contaminated yMay quantitate zMay obtain culture by aspirating advancing border zCulture skin, soft tissue or wound abscesses for anaerobic and aerobic organisms yTransport in capped syringe or special tube

18 Wound Culture zClosed space abscesses yDecontaminate skin yInsert needle and aspirate or aspirate pus after incision zOpen wound yRemove superficial exudate yAspirate through margin or swab (least reliable) zTransport yCapped syringe or anaerobic transport tube yRapidly to lab

19 Urine - General zCollection method must avoid contamination yClean catch, midstream voided yCatheterized urine ySuprapubic aspiration zCultures performed quantitatively yLess than 10,000 per ml suggest contamination

20 Clean Catch, Midstream Urine zCleanse periurethral area with soap and water zPass initial urine into toilet, then collect specimen in cup zInstructions to patient are critical

21 Instructions for Patient 1.Remove underpants completely so they will not get soiled. 2.Sit comfortably on the seat, but do not leave your knees in front of you. Instead swing one knee to the side as far as you can. 3.Spread yourself with one hand, and continue to hold yourself spread while you clean and collect the specimen. 4.Wash—Be sure you wash well and rinse well before you collect your urine sample. Wash only the area from which you pass urine. You do not have to wash hard, but wash slowly. Be sure to wipe from the front of your body towards the back. Wash between the folds of skin as carefully as you can. 5.Do not put sponges in the toilet. Put them back in the plate. 6.Rinse—After you have washed with each soap pad, rinse with each moistened pad with the same front to back motion. Do not use any pad more than once. 7.Hold cup by the outside and pass your urine into the cup. If you touch the inside of the cup or drop it on the floor, ask the nurse to give you a new one.

22 Catheterized Urine zCleanse periurethral area with soap and water zDO NOT RECONTAMINATE zInsert catheter into bladder yDiscard initial urine yCollect specimen in sterile cup zChronic indwelling Foley catheter yClamp tubing below junction (or port) yDisinfect with alcohol yInsert needle (on syringe) through port or catheter wall and aspirate

23 Suprapubic Aspiration zBE CERTAIN BLADDER IS FULL - PALPATE OR PERCUSS zPrep skin with alcohol or iodine zAnesthetize with lidocaine zIntroduce needle 2.0 cm above symphysis zAspirate 20 ml for culture

24 Suprapubic Aspiration

25 Wire Swab

26 IV Start Kit

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