The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [434]
5 If catheter in situ: completely empty catheter bag and hourly chamber (if applicable) or attach new catheter bag. Attach label indicating start time of 24-hour urine collection. To clearly indicate to all practitioners the 24-hour collection period. E
6 If applicable, transfer urine from collection container into large specimen container. To ensure specimen is collected in a suitable container for safe transportation to the laboratory. E
Postprocedure
7 Label sample and complete request form. To maintain accurate records and provide accurate information for laboratory analysis (NMC 2009, C; Weston 2008, E).
8 Dispatch sample to laboratory as soon as possible after completion of the 24-hour period. To allow accurate laboratory processing and analysis (Higgins 2007, C).
Postprocedural considerations
Immediate care
Urine is a very good culture medium so any bacteria present at the time of collection will continue to multiply in the specimen container. Rapid transport or special measures to ensure preservation of the sample are essential for laboratory diagnosis (Garibaldi 1992). Therefore, specimens should be processed immediately as delays of more than 2 hours at room temperature between collection and examination will yield unreliable results, suggesting falsely raised bacteriuria (Higgins 2007).
Where delays in processing are unavoidable, specimens should be refrigerated at 4°C or a boric acid preservative, which holds the bacterial population steady for 48–96 hours, should be utilized (HPA 2008g).
Specimen collection: faecal sampling
Definition
Faecal specimens are primarily obtained for microbiological analysis to isolate and identify pathogenic bacterial, viral or parasitic organisms suspected of causing gastrointestinal infections or in patients with diarrhoea of potentially infectious aetiology (Higgins 2008). Faecal specimens may also be obtained for other non-microbiological testing to detect the presence of other substances, such as occult blood or as part of the national screening programme for colorectal cancer.
Related theory
There are a number of enteric pathogens normally present within the gastrointestinal (GI) tract, along with resident flora, that play an important role in digestion, and in forming a protective, structural and metabolic barrier against the growth of potentially pathogenic bacteria (Kelly et al. 2005). Pathogenic agents that disrupt the balance within the GI tract manifest in symptoms such as prolonged diarrhoea, bloody diarrhoea, nausea, vomiting, abdominal pain and/or fever. Bacteria in faeces are representative of the bacteria present in the GI tract, so the culture of a faecal sample is necessary for identification of GI tract colonization (Lautenbach et al. 2005).
Laboratory investigations are requested for bacterial infections such as Salmonella, Campylobacter, Shigella and Clostridium difficile, viral infections such as norovirus and rotavirus, and parasitic pathogens such as protozoa, tapeworms and amoebiasis (Weston 2008).
Diarrhoea can be defined as an unusual frequency of bowel actions (>3 times in 24 hours) with the passage of loose, unformed faeces (HPA 2008d). It may be attributable to a variety of bacterial, viral or parasitic pathogens and may be associated with antibiotic use, food or travel-related agents (King 2002). Prompt collection of a faecal sample for microbiological investigation is essential in determining the presence and identification of such agents.
Clostridium difficile
Clostridium difficile (C. diff) is recognized as a major healthcare-acquired infection causing diarrhoea associated with antibiotic use and environmental contamination (DH 2006). It is an anaerobic, Gram-positive bacterium that produces spores that are resistant to many disinfectants and can survive in harsh environmental conditions for prolonged periods (Soyfoo and Shaw 2008). It is recognized as having a significant impact upon patient morbidity and mortality and the signs