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 LifeBridge Health - Department of Pathology
Microbiology
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| I. |
Extent of Services |
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The Microbiology Laboratory is divided into the following subspecialties: |
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Bacteriology |
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Mycology |
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Parasitology |
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Mycobacteriology |
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Urinalysis |
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Rapid Antigen Detection |
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| II. |
Microbiology Hours of Operation: 7 days per week, 24 hours per day |
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Bacteriology: Diagnostic services available 7 days per week. Shift 1 (8:30AM to 5:00 PM. Rapid diagnostic antigen detection may be ordered STAT 24 hours per day. |
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Mycology: Diagnostic services 5 days per week. Monday through Friday. |
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Parasitology: Limited diagnostic services available 7 days a week |
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Mycobacteriology: Diagnostic services 7 days per week. Direct smears available 24 hours per day, 7 days a week. Concentrated smears available Monday through Friday. |
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Rapid Antigen Detection: RSV, Rotavirus, Pediatric CSF bacterial antigen tests, influenza A/B available 7 days per week, 24 hours per day. |
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Urinalysis: Chemistry and Microscopic analysis available 7 days per week, 24 hours per day. |
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| III. |
Holiday Schedule (Memorial day, July 4, Labor Day, Thanksgiving, Christmas, and New Years Day): |
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Diagnostic services limited to Bacteriology, Urinalysis and rapid antigen detection tests. |
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| IV. |
Microbiology Emergency Contact Numbers |
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1. |
Medical Director, Microbiology Laboratory |
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Dr. Deepa Dutta 601-5088 (office) 806-6568 (pager) |
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Manager |
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Tammy Galitzer 601-4019 (office) |
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Specimen Collection and Transport Tables
| I. |
Principle |
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It is critical that the laboratory provide complete guidelines for the proper collection and transport of specimens to ensure quality patient care. All diagnostic information from the microbiology laboratory is contingent on the quality of the specimen received. |
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Consequences of a poorly collected and/or poorly transported specimen include failure to isolate the causative microorganism and recovery of contaminants or normal flora, which can lead to improper treatment of the patient. Direct specimen smears are also utilized to determine the quality of the specimen, to provide rapid information for diagnosis and therapy, and to allow the physician to determine if additional specimens should be collected. |
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| II. |
Specimen |
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A. |
General Considerations |
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This procedure addresses instructions that must be communicated to physicians, nurses, phlebotomy teams, etc., best accomplished by incorporation into a departmental guide on obtaining and transporting specimens. |
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1. |
Safety considerations |
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a)
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Follow universal precaution guidelines. Treating all specimens as hazardous eliminates the need for warning labels. |
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b)
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Technologists should use appropriate barrier protection when collecting and handling specimens. If there is risk of splashing, protective eyewear, face masks, or biohazard hood may be necessary. |
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c)
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Do not contaminate the external surface of the collection container and/or accompanying paperwork. |
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d)
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Direct handling of specimens in transit from the patient to the lab must be minimized. Plastic seal-able bags with a separate pouch for the lab requisition orders should be used. |
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Specimens obtained by a physician using needle aspiration should be transferred to a sterile tube or anaerobic transport vial prior to transport of the specimen to the laboratory. If there is little material in the syringe, the physician should draw a small amount of sterile nonbacteriostatic 0. 85%NaCl or sterile broth through the syringe and transfer the specimen to a sterile tube. The physician should use a protective device while removing the needle to avoid injury and should replace the needle with a sterile cap prior to transporting the syringe to the laboratory. |
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2. |
General guidelines for proper specimen collection. |
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a)
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Collect specimen before administration of antimicrobial agents. |
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b)
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Collect specimen with as little contamination from indigenous microbial flora as possible. |
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c)
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Utilize appropriate collection devices. Use sterile equipment and aseptic technique to collect specimens to prevent introduction of microorganisms during invasive procedures. |
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d)
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Clearly label the specimen container with the patient's name and unit identification number. Submit specimen with microbiology requisition to the laboratory ASAP. |
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e)
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Collect an adequate amount of specimen. Inadequate amounts of specimen may yield false negative results. |
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f)
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Notify the laboratory when unusual pathogens are suspected or if a "rule-out" request is appropriate (e.g., Group B strep - rectal swab, etc.). |
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g)
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Consider geographic location and season when notifying the laboratory of rule-out requests. For example, Coccidiodes immitis is endemic in the southwestern US Rotavirus is more commonly found in infants and children in the winter. |
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h)
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Identify the specimen source and/or specific site correctly so that proper culture media will be selected during processing in the laboratory. |
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i)
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If a specimen is to be collected through intact skin, cleanse the skin first. For example, use 70% alcohol followed by iodine solution (1 to 2% tincture of iodine or 10% solution of povidone-iodine.) Prevent burn by tincture of iodine by removing excess after specimen has been collected (Be sure the patient is not allergic to iodine!) |
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j)
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Collect specimens in sturdy, sterile, screw-cap, leak-proof containers with lids that do not create an aerosol when opened. |
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3. |
General guidelines for proper specimen transport. |
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a)
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Transport all specimens to the microbiology lab promptly. |
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To ensure survival and isolation of fastidious organisms and to prevent overgrowth by more hardy bacteria
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To shorten the duration of specimen contact with some local anesthetics used m collection procedures that may have antibacterial properties.
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To provide a more accurate diagnosis of the infectious disease process.
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b)
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Alternatives to prompt delivery |
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Refrigerate most specimens at 2-80 C. The following are exceptions.
(a) If blood is cultured in broth, incubate it at 35 to 370 C. If it is in an Isolator tube, hold it at room temperature.
(b) Specimens that may harbor temperature sensitive organisms such as Neisseria species should be left at room temperature.
(c) For anaerobic specimens use anaerobic transport system.
(d) Stool specimens - transport immediately to the laboratory. If not possible, introduce specimen into Cary Blair transport vial.
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For Parasitology examination, introduce specimen into PVA / 10% Formalin vials.
(e) Hold CSF specimens at room temperature unless they are to be cultured for viruses. Transport CSF specimens immediatly to the laboratory.
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4. |
Use of specimen transport systems |
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a)
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Anaerobic transport systems are used to ensure the viability of anaerobic organisms in transit to the laboratory. A few examples are described in Table 1 (Transport systems for anaerobic specimens). |
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b)
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Aerobic transport methods are listed in Table 2. Although sterile swabs can be used for collection and transport of specimens, the test request should be considered prior to specimen collection. Certain types of swabs should be used for the collection and transport of certain cultures, as described in Table 2 (Transport systems for aerobic specimens). |
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c)
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Specific transport containers for specimens are listed in Table 3 (Specimen transport guide). |
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NOTE: Refer to pneumatic tube transport system manual for specific instructions on sending specimens thru this system. |
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