General guidelines for proper specimen collection.

1. Collect specimen before administering antimicrobial agents when possible.
2. Collect specimen with as little contamination from indigenous microflora as possible to ensure that the sample will be representative of the infected site.
3. Use sterile equipment and aseptic technique to collect specimens to prevent introduction of microorganisms during invasive procedures.
4. Collect an adequate amount of specimen. Inadequate amounts of specimen may yield false-negative results.
5. Inform the clinical micro lab when "rule-out" requests are important. Consider geographic location and season when notifying the laboratory of rule-out requests.
6. Identify the specimen source and/or specific site correctly so that proper culture media will be selected during processing in the laboratory.
7. If a specimen is to be collected through intact skin, cleanse the skin first using the Chloraprep® disinfection kit. Refer to disinfection procedure found under collection of blood specimens.
8. Collect specimens in sturdy, sterile, screw-cap, leakproof containers with lids that are tightened to prevent leakage.

General guidelines for proper specimen transport:

1. Transport all specimens to the laboratory promptly to ensure the survival and isolation of fastidious organisms and to prevent overgrowth by more hardy bacteria.
   • Transport urine and respiratory specimens (if not in transport system) to the laboratory within 1 hour of collection unless they are refrigerated.
   • Specimens should be less than 2 hours old when received.

2. Alternatives to prompt delivery.

Refrigerate most specimens at 2 to 8°C. CSF, blood cultures, stool cultures, anaerobic cultures, and specimens submitted on selective media for Neisseria gonorrhoeae should not be refrigerated. Refer to specific following guidelines:

• Hold blood bottles at room temperature.
• Specimens that may harbor temperature-sensitive organisms such as Neisseria species should be left at room temperature. Inoculated Thayer-Martin plates or other selective transport media for N. gonorrhoeae should not be more than 30 minutes old
• For anaerobic specimens, use anaerobic transport system and maintain at room temperature. See Table 2. Wound and body fluid specimens submitted in other containers must be received within one hour of collection
• Stool specimens
  • For bacterial culture, mix stool with the transport medium in the orange or green topped para-pak C & S vial. Fecal specimens must be received in transport medium for optimal detection of pathogens.
  • For parasitology examination, mix stool with preservative in both vials in the collection kit (pink & blue topped vials).
  • For detection of C. difficile submit stool in clean, sterile plastic container.
• Hold CSF specimens at room temperature (unless they are to be cultured for viruses). Bacterial culture & gram stain must be set up first before refrigerating the remainder of the specimen.
• All specimens for viral culture must be refrigerated.
3. Use of specimen transport systems.
   • Urine transport tube is recommended to preserve urine specimen prior to culture.
   • Anaerobic transport systems are used to ensure the viability of anaerobic organisms in transit to the laboratory.
   • Double swab collection kits must be used for a gram stain and culture to be performed. A gram stain provides valuable, rapid clinical information. Single swabs received in microbiology can only be set up for culture.
   • Consult the lab handbook, by specific procedure, for container requirements.
   • Sterile fluids in Blood bottles: The Laboratory will accept sterile body fluids placed in blood culture bottles. However, it is recommended that the fluid be submitted in a sterile tube as well so a gram stain may be performed and provide timely notification of organisms present.