The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [404]
Consent
The collection of specimens involves invasive procedures and it is therefore essential that practitioners gain consent before beginning any treatment or care (NMC 2008b). Consent is continuous throughout any patient episode and the practitioner must ensure that the patient is kept informed at every stage (Marsden 2007). For specimen collection this includes:
informing the patient of the rationale for specimen collection
what the procedure will involve
ascertaining their level of understanding (especially if they need to be directly involved in the sampling technique)
how long the results may take to be processed
how the results will be made available
information with regard to the implications this may have on their care.
Accurate record keeping and documentation
Good record keeping is an integral part of nursing practice, and it is essential to the provision of safe and effective care (NMC 2009). Accurate, specific and timely documentation of specimen collection should be recorded in the patient notes, care plan or designated record charts/forms such as a microbiological flow chart that details when a specimen was collected, results of analysis, sensitivities or resistance to antimicrobials and changes/modifications to treatment. It is also important to ensure that electronic records are up to date. This assists in the communication and dissemination of information between members of the interprofessional healthcare team.
Preprocedural considerations
Equipment
There are a variety of collection equipment/tools designed for the collection of specimens such as sterile pots, swabs and other receptacles. Advice should be sought from the microbiology department about the best type of container for the required investigation (Higgins 2007). It is essential that the specimen and its transport container are appropriate for the type of organism being investigated; for example, bacterial swabs contain a transport medium that is incompatible with viral specimen analysis. Failure to utilize the correct collection method leads to inaccurate results so it is vital that an adequate quantity of material is obtained to allow complete microbiological examination.
Equipment used for transportation
Within healthcare institutions, specimens should be transported in deep-sided trays that are not used for any other purpose, and are disinfected weekly and whenever contaminated (HSE 2003), or robust, leak-proof containers that conform to ‘Biological Substances, Category B – UN3373’ regulations (HSE 2005). Specimens that need to be moved outside the hospital must be transported using a triple-packaging system (HSE 2005). This consists of a watertight leak-proof, absorbent primary container, a durable, watertight, leak-proof secondary container and an outer container that complies with ‘Biological Substances, Category B – UN 3373’ standards (Pankhurst and Coulter 2009). A box for transportation is essential and should carry a warning label for hazardous material. It must be made of smooth impervious material, such as plastic or metal, which will retain liquid and can be easily disinfected and cleaned in the event of a spillage (HSE 2003).
Handling specimens
Specimens should be obtained using safe techniques and practices and practitioners should be aware of the potential physical and infections hazards associated with the collection of diagnostic specimens within the healthcare environment. Standard (Universal) Infection Control Precautions should be adopted by healthcare workers who have direct contact or exposure to the blood, bodily fluids, secretions and excretions of patients (Gould and Brooker 2008). In addition to personal protection, the person collecting the specimen