Specimen Type

Collection

Guidelines          Device 
                           and/or
                        minimum vol

Time and Temp

Local                  Courier or
Transport ^b        local
                           storage

Replica

limits

Comments

  Fluid or aspirates

Prepare eye for needle aspiration of fluid.

Sterile screw-cap tube or direct inoculate of small amount of fluid onto media.

< 15 min. RT

< 24 h, RT

1/day

Include fungal media.  Anesthetics may be inhibitory to some etiologic agents.

Feces:

     Routine culture

1.  Pass directly into a clean, dry container.

2.  Transport the specimen to lab within 1 h of collection or transfer a portion to a Cary-Blair transport system.

3.  Cary-Blair: carefully remove the cap and attached spoon to pick several spoonfuls of the stool, especially from areas that are slimy, bloody, or watery.  Place the stool into the vial to the fill line.  Mix well.

Clean, leakproof, wide-mouth container or a Cary-Blair transport system; > 2 g

Unpreserved: < 1 h, RT

Cary-Blair transport system: < 24 h, RT

< 24 h, 4^oC

< 48 h, RT or 4^oC

1/day

Do not perform routine stool cultures on patients whose length of stay was > 3 days and the admitting diagnosis was not gastroenteritis.  Culture and toxin tests for Clostridium difficile should be considered in these cases. 

Swabs for routine pathogens are not recommended except in infants and in patients with active diarrhea (see Rectal swabs).

      C. difficile

Pass liquid or soft stool directly into a clean, dry container.  Soft stool is defined as stool assuming the shape of its container.

A swab specimen is not recommended for toxin testing.

Sterile, leakproof, wide-mouth container; > 5 ml

< 1 h, RT;

1-24 h, 4^oC

> 24 h, -20^oC

2 days, 4^oC, for culture

3 days, 4^oC, or longer at
-70^oC for toxin test

1  /2 days

Patients should be passing > 5 liquid or soft stools per 24 h. Testing of formed or hard stool is often unproductive and may indicate only commensal carriage.

Escherichia coli

     0157:H7

Pass liquid or bloody stool into a clean, dry container.

Sterile, leakproof wide-mouth 

container or Cary-Blair transport system

Unpreserved:

 < 1 h, RT;

Cary-Blair transport system < 24 h, RT or 4^oC

< 24 h, 4^oC

< 48 h, RT

1/day

Bloody or liquid stools collected within 6 days of onset from patients with abdominal cramps have the highest yield.

     Leukocytes

Pass feces directly into a clean, dry container.  Transport specimen to lab within 1 h of collection or transfer to ova and parasite transport system (SAF).

Sterile, leakproof, wide-mouth container > 2 ml

Unpreserved:

< 1 h, RT

< 24 h, 4^oC

Indefinite, RT

1/day

 Rectal swab

1.  Carefully insert a swab ~ 1 in. beyond the anal sphincter.

2.  Gently rotate the swab to sample the anal crypts. 

3.  Feces should be visible on the swab for detection of diarrheal pathogens.

Aerobic swab transport

< 2 h, RT

< 24 h, RT

1/day

Reserved for detecting Neisseria gonorrhoeae, Shigella spp., Campylobacter spp., HSV, and anal carriage of group B Streptococcus spp. or for patients unable to pass a specimen.

     Fistulas

See Abscess