• Choose a category
• All
• Classic-Fiction

13 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).

14 Arrange prompt delivery to the microbiology laboratory (keep at room temperature). To increase the chance of accurate organism identification and to ensure the best possible conditions for laboratory analysis (Higgins, 2007, C).

Postprocedural considerations

Immediate care

Specimens may be compromised by incorrect storage and transportation. If not processed immediately, swabs need to be refrigerated or kept at an ambient temperature, depending on where the swab was obtained from, to prevent deterioration of pathogenic micro-organisms (see specific procedure guidelines for exact storage requirements). Advice should be sought from the microbiology laboratory if practitioners are unsure of the storage requirements of the sample.

Documentation

Relevant and detailed information such as clinical presentation, signs and symptoms of infection, and the site and nature of the swab should be indicated on the sample and microbiology request form. This allows the microbiology laboratory to select the most appropriate processing technique and assist in differentiating organisms which would normally be expected at a particular site from those causing infection (Weston 2008).

In accordance with the principles of good record keeping, the date and time of when a swab is sent to the laboratory should be documented clearly and promptly in the patient’s notes and care plan (NMC 2009). This should be done alongside documentation of the clinical nursing assessment, particularly in relation to significant findings that have prompted the collection of the sample such as observation of inflammation or discharge at the site. This assists in communication and the dissemination of information between members of the interprofessional healthcare team.

Specimen collection: urine sampling

Definition

Urine samples are intended to identify any organisms causing infection within the urinary tract (Hampson 2006). Urinary tract infections (UTIs) result from the presence and multiplication of bacteria in one or more structures of the urinary tract with associated tissue invasion (HPA 2008g).

Related theory

Protection against infection is normally given by the constant flow of urine and regular bladder emptying, which prevent the colonization of micro-organisms (HPA 2008g). The urethra is colonized with naturally occurring flora but urine proximal to the distal urethra is normally sterile. As urine passes through the urethra some of these micro-organisms are flushed through and normal urine will naturally contain a small number of bacteria. Therefore, the presence of bacteriuria is insignificant in the absence of clinical symptoms of an infection (Weston 2008).

Urinary tract infections account for 19.7% of all overall hospital-acquired infections (DH 2007b). UTIs in adults are common, particularly in women due to the short female urethra and its close proximity to the perineum (HPA 2008g).

Evidence-based approaches

Rationale

Urine sample requests for Microscopy, Culture and Sensitivity (MC&S) constitute the largest single category of specimens examined in microbiological laboratories. The main value of urine culture is to identify bacteria and their sensitivity to antibiotics (Higgins 2007).

Urine sampling should be considered in combination with clinical assessment and urinalysis to avoid unnecessary sample processing which has time and cost implications for the microbiology laboratory (Simerville et al. 2005). A clinical assessment would involve examination of the odour, turbidity and colour, whether there are obvious signs of haematuria and pain particularly around the suprapubic area (Dulczak and Kirk 2005). Urinalysis may reveal a high pH, the presence of blood or positivity to leucocyte esterase (an enzyme released by white