The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [429]
3 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).
4 Place the patient in a dorsal position supported by a pillow and ask her to bring her heels together, bend her legs and draw her heels towards her bottom. To ensure patient assumes correct position for the procedure. E
Procedure
5 For low vaginal swab: insert the swab into the lower part of the vagina and rotate gently but firmly. To obtain appropriate sample. E
6 Allow patient to resume a comfortable position. To aid patient comfort. E
Postprocedure
7 Remove cap from plastic transport tube. To avoid contamination of the swab (HPA 2008a, C).
8 Carefully place swab into plastic transport tube, ensuring it is fully immersed in the transport medium. Ensure cap is firmly secured. To avoid contamination of the swab and to maintain the viability of the sampled material during transportation (HPA 2004, C; Ferguson 2005, E).
9 Remove gloves and apron and wash/decontaminate hands. To reduce risk of cross-infection (DH 2006, C).
10 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).
11 Arrange prompt delivery to the microbiology laboratory (within 4 hours). To increase the chance of accurate organism identification and to ensure the best possible conditions for laboratory analysis (Higgins 2007, C).
Procedure guideline 11.12 Swab sampling: wound
Essential equipment
Gloves
Apron
Sterile bacterial or viral swab (with transport medium)
Appropriate documentation/form
Dressing pack, cleansing solution and dressing (post sampling procedure)
Optional quipment
0.9% sodium chloride
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 Remove current dressing, if applicable. To expose wound in preparation for swabbing. E
4 Rewash and decontaminate hands. Open sterile dressing pack, decant sterile swab and don sterile gloves. To reduce the risk of cross-infection (DH 2007a, C) and prepare equipment for sampling.
Procedure
5 Roll swab in a ‘zig-zag’ motion to cover the entire wound surface whilst simultaneously rotating the swab between the thumb and forefinger. To maximize collection of micro-organisms within the wound bed (Rushing 2006, C).
6 Use enough pressure to express fluid from within the wound tissue but avoid taking a specimen from exudates or touching the wound margin at the skin. To gather as much exudate as possible without contaminating the sterile swab with resident skin flora (Kingsley 2001, E).
7 If the wound is dry, the tip of the swab should be moistened with 0.9% sodium chloride. To make the swab more absorbent and to increase survival of pathogens present prior to culture (Weston 2008, E).
8 If pus is present, it should be aspirated using a sterile syringe and decanted into a sterile specimen pot. To yield the optimum number of micro-organisms present within the wound (Weston 2008, E).
Postprocedure
9 Remove cap from plastic transport tube. To avoid contamination of the swab (HPA 2008a, C).
10 Carefully place swab into plastic transport tube, ensuring it is fully immersed in the transport medium. Ensure cap is firmly secured. To avoid contamination of the swab and to maintain the viability of the sampled material during transportation (Ferguson 2005, E).
11 Redress the wound, if applicable, as per patient care plan. To redress the wound. E
12 Remove gloves and apron, discard all clinical waste and wash/decontaminate