Download Specimen Collection Area - International Panel Physicians Association

Laboratory Workshop:
Specimen Collection
Sean R. Toney
Immigrant, Refugee, and Migrant Health Branch
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention
Panel Physician Training Summit
March 2017
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine
Learning Objectives
After this workshop, participants should be able to:
Identify appropriate sputum collection areas.
Incorporate safety measures and fraud prevention into
collection activities.
Implement proper sputum collection procedures and
Follow requirements outlined in Technical Instructions.
Activity….
This is an interactive activity:
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Participants will be divide into smaller groups
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Each group moves to a designated area in the room
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Each group collectively decides to arrange an indoor,
outdoor, or covered outdoor collection area
• Complete with applicant reception area, waiting area, collection
area, and Directly Observed Therapy (DOT) area
Activity….
This is an interactive activity:
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Each group collectively draws or sketches out the
arrangement of the collection area on paper
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Pros and cons of each groups’ drawing will be discussed
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Participants will discuss collection processes and
procedures
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Participants will discuss specimen storage and transport
TB Sputum Collection Areas
Specimen Collection Area:
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Indoor
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Outdoor
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“Covered” Outdoor
Specimen Collection Area:
OPTIMAL
SATISFACTORY
ADEQUATE / SUFFICIENT / MINIMAL
Specimen Collection Area:
Indoor Requirements
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Negative pressure in booths
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Well-maintained ventilation system
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Adequate air exchange between
applicants
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Booths must allow for direct
observation of applicant by
technologist
TIP:
If you are unsure whether negative pressure system is working, put a strip of thin tape or tissue paper at the booth’s
window and see if it blows inward.
Sputum Specimen Collection Areas
Indoor
Source: Panel Sites:
Thailand and Ukraine
Sputum Specimen Collection Areas
Indoor
Source: Panel Sites:
Turkey and Malaysia
Specimen Collection Area:
Outdoor Requirements
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Adequate sunlight
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Good ventilation
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Collection from multiple
applicants
• Maximum 4 applicants per
technologist
• Minimum of 1.5 meters
between applicants
Sputum Specimen Collection Areas
Outdoor
Source: Panel Sites:
Jamaica and Vietnam, and
Kenya
Sputum Specimen Collection Areas
“Covered” Outdoor
Source: Panel Sites:
DR and Thailand,
and South Africa
Collection Area Considerations:
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Location
• Rooftop / Basement
• Parking lot / Hallway
Size
Service(s) provided
Setup of area
• Organization
Registration
Document check
Waiting area
Bags/Personal Items
DOTs area
Entrances / Exits
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Applicant volume
Flow of applicants
Fraud Prevention
Infection Control
Ventilation
UV lights
Sunlight
Exhaust Fan(s)
Sample storage
Sample transport
Waste Disposal
Job aids
• (Posters / TV)
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Supplies
Containers
Records/Files
Paper towels /
Napkins
Hand Sanitizer
Water
• Wash hands
• Rinse mouth
Collectors
Tables
Chairs
Other…..??
Collection Times
Collection Times
• Early morning; three (3) consecutive days
• Mon / Tue / Wed
• Tue / Wed / Thu
• Consider transport of specimens, if needed
• Consider possibility of missed appointments
Safety Measures
Safety Measures
• Use personal protective
equipment (PPE) for:
• Collecting specimens
• Processing specimens
• Inoculating culture tubes
• PPE includes:
•N95 or FFP2 respirators
•Disposable gloves
•Disposable gowns
• Dispose of infectious materials
•Autoclaving
•Incineration
Safety Measures
• Use personal protective
equipment (PPE) for:
• Collecting specimens
• Processing specimens
• Inoculating culture tubes
• PPE includes:
•N95 or FFP2 respirators
•Disposable gloves
•Disposable gowns
• Dispose of infectious materials
•Autoclaving
•Incineration
Safety Measures
• Use personal protective
equipment (PPE) for:
• Staff
• Applicants / patients
•New
•Follow-up
•DOT
• PPE for applicants includes:
•Surgical / face masks
Medical Fraud Prevention Measures
Medical Fraud Prevention
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Confirm identification
• Passport
o Photo
o Verify signature
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Specimen collection
• Supervised
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Specimen label
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Side of container
Difficult to remove
Numbered or bar-coded
No names
Sputum Collection Procedures
By show of hands….
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How many have collected sputum?
By show of hands….
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How many have seen sputum collected?
By show of hands….
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How many have regular communication with the
lab or specimen collectors?
TB Sputum Specimen Collection
Sputum Collection
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Sputum must be collected from applicants who have:
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Signs or symptoms suggestive of TB disease
Physical exam suggestive of TB disease
Chest x-ray suggestive of TB disease
HIV infection
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Three fasting sputum specimens should be collected
from the patient on three consecutive days
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Important to collect specimens early in the morning
IMPORTANT:
Sputum specimens must be collected early in the morning on three consecutive days!
Sputum Collection
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Provide procedure instructions
• Show applicant how to cough
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Ensure lid is closed tightly to labeled container
Determine suitability of collected specimen
• Collect at least 5 milliliters
• Hold up to the light (sun, lamp) to determine if a quality
specimen has been collected
• Reject saliva; recollect
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Refrigerate specimens if not transported within one
hour to decrease culture contamination rate
IMPORTANT:
Specimen must be sputum, not saliva. Technician will check specimen quantity and quality upon collection.
Laboratory must check specimen quantity and quality again upon arrival at lab.
Sputum Collection: Procedure for Applicant
1.
2.
No eating prior to sputum
collection
Clear nasal passages and
rinse mouth with distilled
water
o
3.
4.
5.
(Do not drink the water)
Take several deep breaths
Cover mouth with tissue
while coughing deeply
Deposit sputum specimen in
wide-mouthed container
Sputum Collection Container
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Container
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Sterile / unused
10 ml - 50 ml capacity
Wide mouth (25mm – 65mm)
Screw top
o Continuous thread
Sputum Specimen Quality
Source: Panel Sites: Vietnam
and Ukraine, and Fujika 2005
Storage and Transport
Storage and Transport
After sputum collected
• Place upright in transport container
• Styrofoam cooler / cool box / metal box
• Gel / ice packs
• Refrigerator (if batch collection, or delay in transport to lab)
• Transport to testing laboratory within an hour
• Hand-carry
• Courier (motorcycle, bus, etc.)
• Package Delivery Service
Source: Panel Sites:
Vietnam, and Pinterest
Applicant Unable to Cough Despite Coaching?
• Perform
• Sputum induction
• Gastric aspiration
• Bronchoscopy (last resort)
• Follow infection control
precautions during all types of
specimen collection
IMPORTANT:
Follow infection control precautions during all types of specimen collection
Sputum Induction
• Procedure must be supervised
• An aerosol of Sterile hypertonic saline (3-15%) is inhaled
• Saline thins and loosens secretions, irritates airways, and stimulates
coughing
• Applicants are instructed to cough into sterile container
• Container should be labeled “induced sputum”
• To prevent rejection by laboratory as saliva
• Patients with reactive airway disease need pretreatment
with a bronchodilator
NOTE:
Patients with reactive airway disease need pretreatment with a bronchodilator
Gastric Aspiration
• Technique used to collect gastric content in young children <5 years
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Inpatient or outpatient procedure
Collect 3, over 3 consecutive days
Mucus swallowed during night is aspirated first thing in morning using a nasogastric tube
Requires immobilization
Must neutralize and transport specimen to laboratory immediately
• TB smears and cultures performed
• ~25 – 50% of children with active TB will be culture (+)
Gastric Aspiration
• Curry International Tuberculosis Center
• http://www.currytbcenter.ucsf.edu/
• Free online step-by-step guide to procedure
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Brief demonstration video clip
Steps to Collect GA
Other helpful tips
List of tools and supplies needed
Reading material for parents
Source: Curry TB Center
Thank you!
[email protected]
http://www.cdc.gov/panelphysicians
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine