Download REVIEW OF SALIVA SAMPLING: It’s Mmm, Mmm, good.

INTRO TO SALIVA SAMPLING
Prepared By: Rachel Klimmek, RN
Doctoral Student & Research Nurse
Last Updated: November 14, 2009
Purpose of this Training Module
• To provide basic information on how and why
saliva samples will be collected as part of this
study
• To explain why this spit is so valuable to the
success of the study and this research
LEARNING OBJECTIVES
• Upon completion of this training module,
trainees will be able to:
– Explain WHAT SALIVA can tell us in this study
– Describe WHEN saliva will be collected, and from
WHO
– Describe INSTRUCTIONS that should be given to
study participants before collecting saliva
at home
– Demonstrate the PROPER TECHNIQUES
for saliva collection
What can we learn from SALIVA?
• ANSWER: A WHOLE LOT!
• Saliva contains many things,
including chemicals called “BIOMARKERS”
• There are over twenty (!) different biomarkers
that can be detected in human saliva
• Among these biomarkers is “CORTISOL”
• Cortisol is what the saliva samples in this
study will measure
What does CORTISOL tell us?
• CORTISOL is commonly used to
measure the amount of STRESS
a person is experiencing, and
how well their body reacts to
that STRESS
• It can show when someone
might be at risk for infection
because they are
IMMUNO-SUPPRESSED
• Levels of CORTISOL have also
been associated with
DEPRESSION, ANXIETY, & PTSD
What do we need to know about
measuring CORTISOL?
• When someone is experiencing STRESS, their body
produces extra CORTISOL
• This can also happen when they are WORKING HARD
(like exercising or doing physical labor)
• This CORTISOL can be measured in their saliva
(although some things, like the food they have been eating,
can affect this)
• Natural levels of CORTISOL in someone’s body change over
the course of the day, so it’s important to measure the level
several times during the day to get an accurate
measurement
The Physiology of Cortisol
(For the medically curious)
SEES EVENT
STRESSFUL
EVENT
BRAIN SENSES
EVENT & TELLS
BODY TO MAKE
CORTISOL!!!
GLANDS
PRODUCE MORE
CORTISOL
When Will We Sample Saliva?
IN THE BEGINNING
• Right after participants have
enrolled in the study, the
CHW will instruct elders and
their support persons on
how to collect their own
saliva samples for the study
at home
AT THE END
• One month following
completion of cancer
treatment, the CHW will
instruct the elder and their
support person to collect a
second set of saliva samples
Who will we collect Saliva from?
African American Elders
receiving treatment for Cancer
Support Persons of Elders
Saying that cancer can be a stressful experience for patients and those who
support them is an understatement. This study is designed to help reduce some of
that stress for participants who receive Patient Navigation Support. Measuring the
levels of CORTISOL in SALIVA SAMPLES from these participants will give us
information about how much stress participants are experiencing, and how well
the support is working.
The oldfashioned way
Step-by-Step Tutorial in Spit Sampling
SO – HOW DO WE DO IT?
The MODERN Way
WHAT SUPPLIES ARE NEEDED?
• 6 SALIVETTES (plastic tubes with cotton)
• 2 large Ziploc bags (one with salivettes to
be collected, the other for completed salivettes)
• 6 SALIVETTE LABELS
• SALIVA SAMPLE LOG sheet for participants
• Pen to record time & date on labels and log
• Clock or Watch to know time of saliva collection
• PRE-PAID MAILER to send completed salivettes
back to lab
What’s Involved?
• Participants will carefully remove a piece of
sterile cotton from the inside of a plastic
container called a “salivette” and place it in
their mouths
• Participants will keep the cotton in their
mouths until it is well saturated with saliva
• Then participants will spit the cotton back into
the plastic tube and cap it tightly
Salivette (in pieces)
STERILE
COTTON
INSIDE
WHOLE
SALIVETTE
HOW LONG SHOULD PARTICIPANTS KEEP
THE COTTON SWABS IN THEIR MOUTHS?
– About 3 minutes or until swab is COMPLETELY WET
Don’t Forget the Time & Date!!
• Recording the date and time each sample is
collected is extremely important
• This information should be recorded on the
label of each salivette once it has been
completed
• Participants should also answer questions on
their “Saliva Sampling Log” for each sample
collected
HOW MANY SAMPLES WILL EACH
PARTICIPANT COLLECT?
– 3 samples each day X 2 days in a row = 6 samples
– FIRST DAY OF SAMPLING:
• 1st Sample: When Participant WAKES UP before they
even get out of bed
• 2nd Sample: 30 minutes later
• 3rd Sample: When Participants goes to bed
– SAME PATTERN REPEATED ON SECOND DAY OF
SAMPLING for 3 more samples
WHAT IF THEIR MOUTH IS TOO DRY
TO GET A GOOD SAMPLE?
– If the participant’s mouth is TOO DRY when they
first wake up to get a good sample, they SHOULD
• Take a sip of water
• Wait 10 minutes and TRY AGAIN with the extra salivette
provided in the sampling kit
• Make a note of this on their sampling log
WHERE SHOULD COMPLETED
SAMPLES BE STORED?
– Participants should place saturated cotton swabs
back into the plastic salivette containers and
place the caps back on the containers
– Salivette containers with saturated swabs should
then be placed into the Ziploc bag marked
“Completed Samples”
– This Ziploc bag should be kept in the participants’
refrigerator (NOT FREEZER) until all samples
have been collected and are ready to be mailed
back to the lab
WHAT SHOULD WE TELL THEM
NOT TO DO ON THE DAYS THEY
COLLECT THEIR SAMPLES?
– Avoid eating, drinking, or brushing teeth within 15 minutes
before collecting a saliva sample
– Avoid drinking or eating dairy products within 1 hour
before collecting a saliva sample
– Avoid eating chips within 1 hour before collecting a saliva
sample
– Avoid Exercising within 1 hour before collecting a sample
– Make note of ANY OPTIONAL MEDICATIONS taken on
these days
– Avoid drinking alcohol on sampling days
(These activities could affect the quality of the samples!)
WHAT SHOULD BE DONE WHEN ALL
THE SAMPLES ARE COLLECTED?
– Completed samples should be sealed within the Ziploc
bag provided for “Completed Samples”
– Participants should double-check that all samples
have labels with the time & dates the samples were
collected
– Participants should place their Sampling Logs in the
Pre-Paid Mailer provided, along with the Ziploc bag
containing ALL 6 completed samples
– The Pre-paid Mailer can be placed in any mailbox to
be returned to the lab, free of charge.
WHY ARE WE DOING THIS?
• ANSWER:
– To collect valuable data
for the study that will tell
us about the amount of
stress participants are
experiencing, and how
receiving navigation
support might be
associated with changes
in this stress (hopefully
for the better!)
YOU’VE MADE IT THROUGH!
SO…
(Don’t forget to take the post-test after you’re finished
reviewing the material in this module)