Microbiology Quest Pdf Free Download
Alacoque Whitchurch
If a CDC Select Agent (i.e. anthrax, plague, etc.) is suspected of producing an infection, please notify the Clinical Microbiology/Virology Laboratory at Quest Diagnostics Nichols Institute for instructions. Most clinical samples (i.e. blood, wound, etc.) from patients potentially infected with CDC Select Agents can be collected and processed by routine Clinical Microbiology and Virology Laboratories. If environmental contamination with a CDC Select Agent is suspected, please contact your local Public Health Department for more details on how to handle this sample type. Do not submit environmental samples potentially contaminated with CDC Select Agents to Quest Diagnostics Nichols Institute. A complete list of CDC Select Agents can be found at
Specimen collection from normally sterile sites requires a needle puncture or a surgical procedure. Decontamination of the skin must be performed prior to the collection of specimens such as blood, cerebrospinal fluid and other normally sterile body fluids.
To decontaminate the site effectively, first clean the puncture site with a povidone-iodine preparation or alternate disinfectant to remain on the skin for at least one minute. Then clean the site with 70% alcohol and wait for the alcohol to air dry. After the puncture site has been disinfected, avoid any finger probing unless fingers have also been disinfected.
Specimens for blood cultures must be submitted in blood bottles. After removing the protective cardboard covering, decontaminate the diaphragm tops of two bottles by swabbing with iodine followed by alcohol to remove iodine. Allow alcohol to air dry. After collection of the blood specimen, inject approximately 10 mL into each of the two bottles. Swirl bottles gently to mix, but do not vent. Keep at room temperature (15-30C) until sent to the laboratory.
Submit a separate sterile screw-capped tube containing at least 0.75 mL of cerebrospinal fluid for each test ordered. For microbiological analysis, it is best to submit the second or third tube drawn. Do not send the collection tube.
Follow standard procedures and obtain the specimen by aspiration. Transport the specimen in aerobic or anaerobic transport kits or blood culture bottles depending on clinical condition. Specimens may be submitted in sterile containers for aerobic culture only.
For routine sputum specimens, collection in the early morning is recommended. Patient should gargle with water before collection. The most suitable specimen is the expectoration obtained after a deep cough. Collect specimen in a leakproof sterile screw-capped container, such as the sterile urine container available from Quest Diagnostics Nichols Institute.
All patients should void the first part of the specimen into the toilet, then collect the remainder of the specimen in a sterile container. Urine samples for routine culture must be transported in the urine transport tubes provided by Quest Diagnostics Nichols Institute.
To obtain a clean catch sample of urine from a female patient, a thorough cleansing of the periurethral area is essential before specimen collection. Wash the area with a disinfectant, thoroughly rinse with clean water, and make all efforts to avoid any contact until urination is complete.
For in-dwelling catheters, obtain the specimen with a needle and syringe. Select a puncture site 1-2 inches distal to the meatus and clamp below the puncture site. Cleanse the area to be punctured with 70% alcohol. Aspirate exactly 5 mL of urine with a sterile needle and syringe. Deliver this volume directly into a sterile urine transport tube available from Quest Diagnostics Nichols Institute. Specimens obtained from the collection bag are not suitable for analysis. Foley tips will not be accepted.
For cytoscopic or suprapubic aspiration, follow standard procedure and obtain the specimen by aspiration. Transport the specimen in anaerobic transport tubes available from Quest Diagnostics Nichols Institute. Keep urine refrigerated.
Collect stool without contaminating with urine. Select portions of stool containing pus, blood or mucus and immediately mix into modified Cary-Blair transport media. Stool samples will not be accepted unless they are submitted in transport media. Frozen specimens are not acceptable. Note: Stools for C. difficile are not acceptable in Cary Blair transport and must be refrigerated or frozen at -70 C or below.
Collect 1 mL CSF (minimum) in a sterile plastic conical tube, tightly sealed. Tubes supplied in spinal fluid collection kits are not designed for specimen transport. To avoid leakage, transfer fluid aseptically into a sterile plastic conical tube.
Collect a fasting early-morning specimen. Use sterile saline. Adjust to neutral pH (7.0-7.5) with 100 mg sodium carbonate immediately following collection. 4% NaOH is an acceptable substitute for sodium carbonate. Gastric samples cannot be accepted unless they have been adjusted to neutral pH.
Collect sputum using a sputum collection kit. Remove and cap the conical tube. Seal tightly to leakage and send the conical tube to the laboratory. A first morning specimen consisting prevent of 5-10 mL of sputum is preferred. Do not send saliva. Specimens sent in 70% alcohol are not acceptable.
Submit I gram of tissue, if possible, in a sterile container without fixative or preservative. Keep moist with a small quantity of sterile saline or nutritive broth. Collect aseptically and avoid indigenous microbiota. Select caseous portion if available. Refrigerate. Do not freeze.
Submit biopsy specimen in sterile container without fixative or preservative. Swabs in transport medium are acceptable only if biopsy sample material or aspirate is not obtainable. For a cutaneous ulcer, collect the biopsy sample from the periphery of the lesion, or aspirate material from under the margin of the lesion. If the infection was acquired in Africa, Australia, Mexico, South America, Indonesia, New Guinea, or Malaysia, note this on the test request form; as Mycobacterium ulcerans may require prolonged incubation.
Collect specimens from the following sites using a culture swab transport medium system: mouth, nose, nasopharynx, ear, eye, wound, vagina, cervix, or urethra. Use a sterile plastic container for respiratory secretions, body fluids, tissue, bone marrow, CSF, urine, hair, skin, nail, contact lens fluid and/or contact lenses. Refer to the database for the current collection method for blood. Store and transport specimens at 4C. Dermatological specimens may be shipped at 15-30C.
General considerations: All specimens must be transported in the multi-microbe transport media (VCM supplied at your request). Samples submitted without suitable transport media will not be accepted. Refrigerated stability for all mycoplasma/ureaplasma cultures is 48 hours. Specimens transported and stored at -70C are stable indefinitely. Freezing is preferred if transport time is expected to exceed 24 hours. It is preferable to vigorously agitate the swab in the transport media for 30 seconds, and express the material from the swab into the transport media. Discard the swab. Inhibitory agents may be present in the material of the swab tip or shaft. If viral cultures are requested, submit a separate sample according to the standards outlined in the virology section.
Collect tracheal aspirate, sputum, throat or nasopharyngeal swabs and submit in the multi-microbe transport medium (VCM) supplied upon request. Refrigerate (48-hr stability) or freeze at -70C (indefinite stability; transport on dry ice: do not thaw). Freezing is preferred if transport time is expected to exceed 24 hours.
Collect tracheal aspirates from newborns to detect pneumonia caused by ureaplasma urealyticum Submit in multi-microbe transport medium (VCM) supplied upon request. Refrigerate (48-hr stability) or freeze at -70C (indefinite stability; transport on dry ice; do not thaw). Freezing is preferred if transport time is expected to exceed 24 hours. Adult genital specimens include: vaginal, cervical or urethral swabs, amniotic fluid, CSF, urine or semen submitted in multi-microbe transport refrigerated or frozen as detailed above.
Centrifuge blood within 2 hours of collection and freeze without removing the plasma. Do not thaw. Alternatively, submit EDTA (lavender-top tube) or ACD (yellow-top tube) frozen plasma that has been removed from cells and frozen within 2 hours of collection. Avoid repeated freezing and thawing. Note that specimens collected in ACD anticoagulant will have results that are 15% lower than those collected in EDTA, owing to the dilution effect of the liquid anticoagulant.
A series of three specimens submitted on separate days within a 10 day period is usually recommended. Collect stool without contamination by urine. Immediately, within one hour maximum, mix amount of stool indicated by fill line into both a modified PVA and 10% formalin containers. These transport tube sets are available upon request. Transport and store at room temperature. Do not freeze.
Blood smears should be prepared within 24 hours after collection. Both thin (prepared as for hematology examination with a feathered edge) and thick (3 small drops pooled together- the size of a dime) smears should be submitted in a slide carrier. Submit several of each and include a backup EDTA tube of whole blood for each exam requested. These slides must be air dried without applying heat or fixing by any method.
Collect fresh stool in sterile, leakproof container without media, serum, preservative, or metal ion. For patients requiring the use of diapers, first line the diaper with clean plastic to prevent absorption. Then transfer 2 g or 2 mL of the stool specimen from the plastic-lined diaper to the sterile container. Do not submit the diaper itself. Do not use VCM or equivalent. Do not use any media, preservative, or additive. Freeze at -70 C or refrigerate. Freezing is preferred if transport time is to expected to exceed 24 hours. Stable for 3 days refrigerated, longer if frozen.
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