Download Instructions for Collection of Samples for

Bacteriology/CL3
Please click on the hyperlink to be taken to the relevant test entry in the Test Database
Genital swabs
for bacterial
culture
URETHRAL SWAB
MICROSCOPY CULTURE
AND SENSITIVITIES
For general aspects of taking genital swab samples we recommend that users follow either their local
protocols or “The Royal Marsden Manual of Clinical Nursing Procedures”.
GENITAL SWABS (HVS)
MICROSCOPY, CULTURE &
SUSCEPTIBILITY
Low vaginal swabs (LVS)
Link to generic advice sheet on using e-swabs: How to use liquid e-swabs


Use pink top e-swab
Insert the swab into the lower part of the vagina and rotate gently but firmly.
High vaginal swabs (HVS)
 Use speculum to separate the vaginal walls.
 Wipe away any excess cervical mucus with a cotton swab.

Use pink top e-swab to sample as high as possible in the vaginal vault.
Penile (urethral) swabs
 Use orange top urethral e-swab

The patient should not have passed urine for at least one hour.

Retract prepuce. Pass the swab gently through the urethral meatus and rotate gently.
Selotape slide
FAECES PARASITOLOGY
Sampling instructions for the investigation of threadworm (Enterobius vermicularis):
 Apply clear sellotape to the perianal region, pressing the adhesive side firmly against the left and
right perianal folds several times. Fold the tape in half, adhesive side inwards and place in sterile
universal. Label sample, complete microbiology request form and clearly label as selotape for
Enterobius vermicularis.
 Alternatively, a moistened cotton swab can be used to swab the perianal area. Place the swab in a
sterile universal container. Label sample, complete microbiology request form and clearly label as
perianal swab for Enterobius vermicularis.
Upper
respiratory
swabs for
THROAT, EYES, EARS,
NOSE AND MOUTH SWAB
For general aspects of taking upper respiratory swab samples we recommend that users follow either their
local protocols or “The Royal Marsden Manual of Clinical Nursing Procedures”.
bacterial culture
MICROSCOPY CULTURE &
SUSCEPTIBILITY
PERNASAL SWAB
CULTURE &
SUSCEPTIBILITY
NB: Sending actual pus is preferable to swabs if present.
Link to generic advice sheet on using e-swabs: How to use liquid e-swabs
Throat swab for M,C&S
 Ask patient to sit upright facing a strong light, tilt head backwards, open mouth and stick out tongue.
 Depress tongue with a spatula.
 Ask patient to say ‘Ah’.
 Quickly but gently roll the swab over any area of exudate or inflammation or over the tonsils and
posterior pharynx.
 Carefully withdraw the swab, avoiding touching any other area of the mouth or tongue.
Eye swab for M,C&S
 Ask patient to look upwards.
 Using aseptic technique, hold the swab parallel to the cornea and gently rub the conjunctiva in the
lower eyelids from nasal side outwards.
 Swab any pus or exudates as well as any lesion of interest.
 If both eyes are to be swabbed, label swabs ‘right’ and ‘left’ accordingly.
 NB: Separate samples must be collected into appropriate transport media for detection of viruses,
chlamydia or Neisseria gonorrhoeae.
Ear Swab for M,C&S
 Ensure no antibiotics or other therapeutic drops have been used in the aural region three hours
before taking the swab.
 Using aseptic technique, rotate swab gently once at the entrance of the auditory meatus to collect
any pus or exudates.
Nose swab for M,C&S
 Ask patient to tilt head backwards.
 Moisten swab with sterile saline.
 Insert swab inside the anterior nares with the tip directed upwards and gently rotate. Swab any pus or
exudates.
 Repeat the procedure with the same swab in the other nostril.
Mouth swab for M,C&S
 Sample pus if present, otherwise sample any lesions or inflamed areas. A tongue depressor or
spatula may be helpful to aid vision and avoid contamination from other parts of the mouth.
Pernasal swab for M,C&S
 Pernasal swabs can be ordered from Pathology Stores in the usual way.
 Remove cap from media tube by twisting.
 Gently insert the fine, flexible pernasal (turquoise top) swab along the floor of the nasal cavity until it
touches the posterior naso-pharynx & rotate 2-3 times before withdrawing. If obstruction is
encountered, withdraw and re-insert through other nostril.
 Insert the swab into the charcoal media tube.
 Ensure the swab is labelled accurately along with the completed request form.
http://www.heftpathology.com/images/stories/directorate/Microlife%20GP%20Pertussis%20%20Oct%202012.pdf
MRSA
screening
MRSA SCREEN
Link to trust guidance:
http://intranet_1/infectioncontrol/MRSA%20Screening%20quick%20guide%20for%20clinical%20staff%20%2
0Nov%202013.pdf
AND poster: http://intranet_1/infectioncontrol/Dual%20Swab%20Poster.pdf
Pernasal swab
for PCR (nonculture)
detection of
Bordetella
pertussis
REAL-TIME PCR
DETECTION OF
BORDETELLA
PERTUSSIS
Pernasal swab for PCR
 Pernasal swabs can be ordered from Pathology Stores in the usual way.
 Remove cap from media tube by twisting.
 Gently insert the fine, flexible pernasal (turquoise top) swab along the floor of the nasal cavity until it
touches the posterior naso-pharynx & rotate 2-3 times before withdrawing. If obstruction is
encountered, withdraw and re-insert through other nostril.
 Insert the swab back into the empty tube DO NOT use the charcoal tube for PCR tests.
 Ensure the swab is labelled accurately along with the completed request form.
http://www.heftpathology.com/images/stories/directorate/Microlife%20GP%20Pertussis%20%20Oct%202012.pdf
Wound / ulcer
and skin swabs
WOUND, ULCER, SKIN
SWAB CULTURE &
Skin swabs
 For cutaneous sampling, moisten swab with sterile saline and roll e-swab along the area of skin to
for bacterial
culture
SUSCEPTIBILITY.
be sampled.
Wound swabs
 Rotate the e-swab swab tip over a 1 cm square area of viable tissue, at or near the centre of the
wound for 5 seconds, applying enough pressure to express tissue fluid from the wound bed.
 If the wound is dry, the tip of the swab should be moistened with sterile saline.
 NB: If pus is present, it should be aspirated using a sterile syringe and decanted into a sterile
specimen pot.
Ulcer swabs
 Cleanse the wound with tap water or saline to remove surface contaminants.
 Slough and necrotic tissue should also be removed.
 Swab viable tissue displaying signs of infection whilst rotating the e-swab.
Blood Cultures
Normal BLOOD
CULTURE
Already linked to from heftpathogy sample page:
http://www.heftpathology.com/images/stories/directorate/blood%20culture%20SOP%202011.pdf
For Mycobacteria
MYCOBACTERIAL
PRIMARY CULTURE
AND MICROSCOPY
See also HEFT guideline “Blood Culture Sampling in Patients Receiving Haemodialysis”:
http://sharepoint/policies/Guidelines/Blood%20Culture%20Sampling%20in%20Patients%20Receiving%20Ha
emodialysis.pdf
Info on page for mycobacteria:
If blood cultures for M.tuberculosis / MAI are required, please telephone the TB laboratory to request TB
blood culture bottle(s). TB blood cultures received in routine MC&S blood culture bottles cannot be tested.
See also HEFT “Guideline for the Diagnosis of Tuberculosis in Adults”:
http://sharepoint/policies/Guidelines/Guideline%20for%20the%20Diagnosis%20of%20Tuberculosis%20in%2
0Adults.pdf
Red top blood
(Serum) for
antibiotic
assays
GENTAMICIN
ANTIBIOTIC ASSAY
GENTAMICIN,
TOBRAMYCIN ONCE
DAILY REGIME
For taking blood samples we recommend that users follow either their local protocols or “The Royal Marsden
Manual of
Clinical Nursing Procedures”.
Please see HEFT guidelines for specific antibiotics requiring therapeutic drug monitoring (TDM):
http://pharmacy/?page_id=922
TEICOPLANIN
ANTIBIOTIC ASSAY
TOBRAMYCIN
ANTIBIOTIC ASSAY
VANCOMYCIN
ANTIBIOTIC ASSAY
Urines for
M,C&S
URINE MICROSCOPY,
CULTURE AND
SUSCEPTIBILITY
Samples for antibiotic level assays:
 For trough levels: following venepuncture, withdraw the volume of blood appropriate to the blood
sample bottle (red top) using the vacuum-assisted collection system.
 Clearly label blood sample bottle and appropriate form with ‘pre-drug administration blood’.
 Administer intravenous antibiotics as prescribed via the patient’s established vascular access device.
 If peak level required: within an allotted time after administration, withdraw the volume of blood
appropriate to the blood sample bottle (red top) using the vacuum-assisted collection system.
 Clearly label blood sample bottle and appropriate form with ‘post-drug administration blood’.
 If CVAD used: the device must be flushed thoroughly before taking the blood sample. Take and
discard enough blood to clear the device of any residual flushes solution or medications (usually 5–
10 mL is sufficient), then attach vacuum-assisted collection system to take drug level sample.
Indicate on blood sample bottle and appropriate form that sample is from a CVAD.
 Ensure microbiology request forms are completed correctly, including date, exact time and dosage of
previously administered dose.
 Arrange prompt delivery to the microbiology laboratory.
Instructions for patient self-collection of urine (MSU) sample:
Add links to patient leaflets
Instructions for urine sample collection in hospital:
Add link to hospital flow chart poster
Urines for nonculture tests
STREPTOCOCCUS
PNEUMONIAE URINE
ANTIGEN
VIRAL URINE SCREEN
LEGIONELLA URINE
ANTIGEN
CONGENITAL
CYTOMEGALOVIRUS
(CMV) PCR
Urine samples for non-culture tests
 Collect urine in a clean container and transfer to a 20ml white top sterile sample container.
Urines for
mycobacterial
(TB) culture
MYCOBACTERIAL
PRIMARY CULTURE
AND MICROSCOPY
Urine samples for mycobacterial culture
 Collect three early morning urine specimens (i.e. from the first urination after waking).
 Each specimen is to be collected on a different day.
 Use a clean container to collect sufficient urine to fill a 20ml white top sterile sample container.

Ensure the bottles are labelled with the day of collection i.e. 1, 2 or 3.
See also HEFT “Guideline for the Diagnosis of Tuberculosis in Adults”:
http://sharepoint/policies/Guidelines/Guideline%20for%20the%20Diagnosis%20of%20Tuberculosis%20in%2
0Adults.pdf
Joint aspirates
JOINT ASPIRATE
MICROSCOPY,
CULTURE &
SUSCEPTIBILITY
16S PCR AND
SEQUENCING
MYCOBACTERIAL
PRIMARY CULTURE
AND MICROSCOPY
For general aspects of taking joint aspirates we recommend that users follow either their local protocols or
“The Royal Marsden Manual of Clinical Nursing Procedures”.
Joint aspirates
 All aspirate samples should be collected aseptically and transferred directly to sterile sample
containers with no additives of any kind.
See also HEFT “Guidelines for the Investigation and Treatment of Prosthetic Joint Infections”:
http://sharepoint/policies/Guidelines/Guidelines%20for%20the%20Investigation%20and%20Treatment%20of
%20Prosthetic%20Joint%20Infections.pdf
See also HEFT “Guideline for the Diagnosis of Tuberculosis in Adults”:
http://sharepoint/policies/Guidelines/Guideline%20for%20the%20Diagnosis%20of%20Tuberculosis%20in%2
0Adults.pdf
Pus and Fluids
(including
pleural, ascitic
and vitreous
fluid)
PUS/FLUIDS
MICROSCOPY,
CULTURE &
SUSCEPTIBILITY
PLEURAL
FLUIDS,INTERCOSTAL
FLUID
MICROSCOPY,CULTURE
& SUSCEPTIBILITY
ASCITIC FLUID
MICROSCOPY,
CULTURE &
SUSCEPTIBILITY
VITREOUS FLUID VIRAL
SCREENING
For general aspects of taking pus and fluid samples we recommend that users follow either their local
protocols or “The Royal Marsden Manual of Clinical Nursing Procedures”.
Fluid and Pus Samples
 All fluid and pus samples should be collected aseptically and transferred directly to sterile sample
containers with no additives of any kind.
For TB culture
See also HEFT “Guideline for the Diagnosis of Tuberculosis in Adults”:
http://sharepoint/policies/Guidelines/Guideline%20for%20the%20Diagnosis%20of%20Tuberculosis%20in%2
0Adults.pdf
For pleural fluids
See also HEFT Guideline “Investigation of a Pleural Effusion”:
http://sharepoint/policies/Guidelines/Investigation%20of%20a%20Pleural%20Effusion.pdf
16S PCR AND
SEQUENCING
MYCOBACTERIAL
PRIMARY CULTURE
AND MICROSCOPY
Continuous
ambulatory
peritoneal
dialysis (CAPD)
fluid
CAPD FLUIDS
MICROSCOPY,
CULTURE &
SUSCEPTIBILITY
For general aspects of CAPD fluid samples we recommend that users follow either their local protocols or
“The Royal Marsden Manual of Clinical Nursing Procedures”.
CAPD Samples
 CAPD fluid should be aseptically transferred from the bag directly to sterile sample containers with no
additives of any kind.
Bacterial
isolates
VTEC O157
16S PCR AND
SEQUENCING
CARBAPENEMASEPRODUCING
ENTEROBACTERIACEA
E RT-PCR
COLISTIN RESISTANT
GRAM NEGATIVE
ORGANISMS FROM
CYSTIC FIBROSIS
PATIENTS
Bacterial isolates
 Please refer bacterial isolates for testing as slope cultures
Mycobacterial
culture
MYCOBACTERIAL
IDENTIFICATION
MYCOBACTERIUM
TUBERCULOSIS
SUSCEPTIBILITY
TESTING
MYCOBACTERIAL
EPIDEMIOLOGICAL
TYPING
Mycobacterial isolates
 Please refer mycobacterial isolates for testing as LJ slope cultures or as liquid culture
 Link to sending MGIT poster