The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [436]
4 If the patient has been incontinent: a sample may be obtained from bedlinen or pads: try to avoid contamination with urine. Urine would cause contamination of the sample (Higgins 2008, E).
5 Using the integrated ‘spoon’, scoop enough faecal material to fill a third of the specimen container (or 10–15 mL of liquid stool). To obtain a suitable amount of specimen for laboratory analysis. E
6 Apply specimen container lid securely. To prevent risk of spillage. E
Postprocedure
7 Dispose of waste, remove apron and gloves, and wash hands with soap and water. To reduce risk of cross-infection (DH 2006, C). Soap and water must be used as alcohol-based handrubs are ineffective for C . diff (DH 2007c, R).
8 Examine the specimen for features such as colour, consistency and odour. Record observations in nursing notes/care plans. To complete as comprehensive nursing assessment (Pellatt 2007a, C).
9 In cases of suspected tapeworms: segments of tapeworm are easily seen in faeces and should be sent to the laboratory for identification. Unless the head is dislodged, the tapeworm will continue to grow. Laboratory confirmation of the presence of the head is essential (Gould and Brooker 2008, E).
10 Label sample and complete microbiology request form (including relevant information such as onset and duration of diarrhoea, fever or recent foreign travel). To maintain accurate records and provide accurate information for laboratory analysis (NMC 2009, C; Weston 2008, E).
11 Dispatch sample to the laboratory as soon as possible or refrigerate at 4–8°C and dispatch within 12 hours. To increase the chance of accurate organism identification and to ensure the best possible conditions for laboratory analysis (Higgins 2007, E).
12 In cases of suspected amoebic dysentery: dispatch the sample to the laboratory immediately. The parasite causing amoebiasis must be identified when mobile and survives for a short period only. Therefore, faeces should remain fresh and warm (Kyle 2007, E).
13 In cases of prolonged diarrhoea, especially in the presence of a fever: dispatch the sample to the laboratory immediately. Due to the risk of C. diff and to ensure prompt diagnosis and initiation of appropriate infection control measures (DH 2007c, C).
Postprocedural considerations
Immediate care
A faecal sample should be transported to the laboratory and processed as soon as possible because a number of important pathogens, such as Shigella, may not survive changes in pH and temperature once outside the body (HPA 2008d). If there is an anticipated delay in despatching the sample to the laboratory, it should be refrigerated at 4–8°C and processed within 12 hours (HPA 2008d).
Ongoing care
The result of specimen analysis will determine the patient’s ongoing care. The involvement of the microbiology and infection control teams is essential to ensure prudent and safe treatment and nursing care. This should include:
effective handwashing techniques to minimize the transmission of organisms
implementation of Standard Precautions (gloves and aprons)
nursing patients with unexpected or unexplained diarrhoea in isolation or cohorted with other infected patients (DH 2007c)
thorough environmental decontamination (DH 2007c)
prudent antibiotic prescribing (DH 2007b).
Education of patient and others
Patients should be provided with information and involved in their care as much as they choose to be (NMC 2008a). Confirmation of an infection diagnosis should be relayed to patients and their families alongside information on management strategies (such as antibiotic therapy, the use of PPE, reasons for isolation and visiting restrictions). The provision of written information, such as leaflets, may also prove useful.
Specimen collection: respiratory tract secretion sampling
Definition
Obtaining a specimen from the respiratory tract is important in diagnosing illness, infections and conditions such as tuberculosis and lung cancer (Guest 2008).