The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [405]
In relation to specimen collection, Standard (Universal) Infection Control Precautions should include the following (Tilmouth and Tilmouth 2009).
Hand hygiene.
The use of personal protection equipment (PPE).
Safe sharps management.
Safe handling, storage and transportation of specimens.
Waste management.
Clean environment management.
Personal and collective management of exposure to body fluids and blood.
Selection of PPE should be based upon an assessment of risk to exposure to body fluids (Hairon 2008). As minimum precautions, gloves and aprons should be worn when handling all body fluids. Protective face wear (e.g. goggles, masks and visors) should be worn during any procedure where there is risk of blood, bodily fluid, secretions or excretions splashing into the eyes or face (Gould 2002).
Specimens should be placed in a double, self-sealing bag with one compartment containing the specimen and the other containing the request form. The specimen container used should be appropriate for the purpose and the lid should be securely closed immediately to avoid spillage and contamination. The specimen should not be overfilled and not be externally contaminated by the contents. Any accidental spillages must be cleaned up immediately by staff wearing appropriate protective equipment (HSE 2003).
If a specimen is suspected or known to present an infectious hazard, particularly Hazard Group 3 pathogens (such as hepatitis B or C virus, HIV, Mycobacterium tuberculosis), this must be clearly indicated with a ‘danger of infection’ label on the specimen and the request form to enable those handling the specimen to take appropriate precautions (HSE 2003).
Specimens from patients who have recently been treated with toxic therapy such as gene therapy, cytotoxic drugs, radioactivity or active metabolites need to be handled with caution. Local guidelines on the labelling, bagging and transportation of such samples to the laboratory should be followed. For example, in the case of gene therapy, the specimen must be labelled with a ‘biohazard’ label, double bagged and transported to the laboratory in a secure box with a fastenable lid.
Selecting specimens
Selecting a specimen that is representative of the disease process is critical to the ability of the laboratory to provide information that is accurate, significant and clinically relevant (Miller 1998). Specimens should only be taken when there are clinical signs of infection (or in the case of specific swabs, such as skin or nasal swabs, as part of an infection screening regimen). Signs of infection such as fever should trigger a careful clinical assessment to ensure that unnecessary tests are avoided and the most useful laboratory samples are obtained to identify therapeutic options (Gould and Brooker 2008). Specimens may also be collected for other diagnostic procedures such as cervical smears, semen collection and lumbar puncture. Tissue sampling may also be indicated during endoscopy or biopsies.
Wherever possible, specimens should be collected before patients are commenced on any treatment such as antibiotics or antiseptics. Treatment with antibiotics before the causative organism has been identified may inhibit its growth, so that it is not easily detected during analysis, yielding a misleading false negative (Weston 2008). If, however, the patient is already receiving such treatment, this must be clearly indicated on the requisition form.
Assessment and recording tools
Request forms
The form should include as much information as possible as this allows the laboratory to select the most appropriate media inoculation for examination and result interpretation (Weston 2008).
Request forms should include the following information.
Patient’s name, date of birth, ward and/or department.