The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [425]
Preprocedural considerations
Equipment
Commercially produced swabs are aseptically packaged in plastic transport tubes which contain either a bacterial or viral transport medium designed to maintain micro-organism viability between sampling and processing (Lawrence and Ameen 1998). If unsure, the practitioner should liaise with the microbiology laboratory to clarify which is the most suitable swab for a particular investigation or type of specimen.
Specific patient preparations
It may be necessary to position the patient in order to obtain the required sample.
Procedure guideline 11.4 Swab sampling: ear
Essential equipment
Gloves
Apron
Sterile swab (with transport medium)
Appropriate documentation/form
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure the patient understands the procedure and gives valid consent (NMC 2008b, C).
2 Wash hands with bactericidal soap and water, or decontaminate physically clean hands with alcohol-based handrub. Don apron and gloves. To reduce the risk of cross-infection and specimen contamination (DH 2007a, C).
3 Ensure no antibiotics or other therapeutic drops have been used in the aural region 3 hours before taking the swab. To prevent collection of such therapeutic agents which may mask pathogenic organisms and invalidate the specimen (Hampson 2006, E).
Procedure
4 Remove the swab from outer packaging and place at the entrance of the auditory meatus as shown in Action Figure 4. Rotate gently once. To avoid trauma to the ear and to collect secretions/suitable specimen material (Mims 2004, E).
Postprocedure
5 Remove cap from plastic transport tube. To avoid contamination of the swab and to maintain the viability of the sampled material during transportation (Ferguson 2005, E; HPA 2008a, C).
6 Remove gloves and apron and wash/decontaminate hands. To reduce risk of cross-infection (DH 2006, C).
7 Complete microbiology request form (including relevant information such as exact site, nature of specimen and investigation required). To maintain accurate records and provide accurate information for laboratory analysis (NMC 2009, C; Weston 2008, E).
8 Arrange prompt delivery to the microbiology laboratory or refrigerate at 4–8°C. To increase the chance of accurate organism identification and to ensure the best possible conditions for laboratory analysis (Higgins 2007, C; HPA 2008c, C).
Action Figure 4 Area to be swabbed when sampling the outer ear.
Procedure guideline 11.5 Swab sampling: eye
Essential equipment
Gloves
Apron
Sterile bacterial or viral swab (with transport medium)
Appropriate documentation/form
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure the patient understands the procedure and gives valid consent (NMC 2008b, C).
2 Wash hands with bactericidal soap and water, or decontaminate physically clean hands with alcohol-based handrub. Don apron and gloves. To reduce the risk of cross-infection and specimen contamination (DH 2007a, C).
3 Seek advice from the microbiology laboratory as to the correct culture medium and swab required. Different culture media and swabs are required for bacteria, viruses and chlamydia (Higgins 2007, C).
Procedure
4 Ask patient to look upwards. To prevent corneal damage (Stollery et al. 2005, E).
5 Hold the swab parallel to the cornea and gently rub the conjunctiva in the lower eyelids from nasal side outwards. To ensure that a swab of the correct site is taken and to avoid contamination by touching the eyelid (Stollery et al. 2005, E).
6 If for chlamydia specimen: apply slightly more pressure when swabbing To obtain as many organisms as possible from the follicles and to sweep organisms away from the lower punctum (Stollery et al. 2005, E).
7 If both eyes are to be swabbed, label swabs ‘right’ and