A Guide to Specimen Management in Clinical Microbiology. J. Michael Miller
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Specimen Collection and Processing
Body Fluid Specimens
Abdominal-Peritoneal Fluid (Paracentesis, Ascites)
Blood Specimens
Cerebrospinal Fluid
Pleural-Thoracentesis Fluid
Gastrointestinal Specimens
Duodenal Contents
Gastric Contents
Pinworm Eggs Collected by Adhesive Tape Preparation
Rectal and Anal Swab Specimens
Sigmoidoscopy Specimens for Amebiasis
Stool or Feces for Culture or Parasitology Studies
Stool Specimen Collection Directions
Genital Specimens
General Information
Cervical or Endocervical Specimens
Genital Smears for Herpes
Urethral and Penile Specimens
Respiratory Specimens
General Information
Bronchoscopy-Bronchial Washing
Nasal Specimens
Nasopharyngeal Specimens
Sputum
Tracheal Aspirate
Transtracheal Aspirate
Throat Specimens
Urine Specimens
General Information
Urine from Catheters
Clean-Catch Urine
Cystoscopic Specimens: Bilateral Urethral Catheterization
Suprapubic Aspirate for Urine Cultures
Urine Specimens: Bladder Washout
Urine Specimens: Ileal Conduit
Viruses, Chlamydiae, Rickettsiae, and Fungi
Chlamydia Culture
Specimens for Mycoplasma and Ureaplasma spp.
Fungal Specimens
Rickettsial Specimens
Viral Specimens
Wound Specimens
General Information
Ear (Otitis Media) Specimens
Eye Specimens
Skin and Contiguous Tissue Specimens
Specimen Management Summary Tables
Bacteriology and Mycology Specimen Collection Guidelines
Specimen Management for Infrequently Encountered Organisms
Specimen Guide for Virus Isolation
Virology Specimen Collection Guidelines
Parasitology: Anatomic Sites Containing Diagnostic Stages
Parasitology Specimen Collection Guidelines
Preface
From syndrome-based molecular panels to total lab automation, clinical microbiology has evolved rapidly over the past 18 years since the previous edition of this book. We have witnessed increases in infections due to multidrug-resistant organisms, have overcome a major Ebola outbreak, and are currently tackling the geographic expansion of Zika virus and its potentially devastating effects. Aside from these more contemporary headliner agents, we continue to battle the threat of microorganisms that have been plaguing our world for decades, including HIV, syphilis, and influenza, just to name a few. And while the laboratory processes, diagnostic methods, and diseases may be more advanced and exotic, one unwavering aspect is the need for appropriate, well-collected specimens. In a world where we find ourselves trying to do more each day within the same 24-hour period, it is imperative that time not be wasted on correcting issues that are easily remedied with upfront attention to quality of specimens.
For some reason, clinical microbiologists seem to get more formal training in appropriate specimen selection, collection, preservation, and transport than nurses, physicians, and other medical personnel who are actually obtaining the specimens. Microbiologists can usually agree that a poor specimen, regardless of how it is transported or stored, will provide poor, even inaccurate, results for the physician. Physicians must be able to trust the microbiology laboratory to deliver accurate, clinically relevant results; so it must be emphasized that the quality of the specimen submitted for culture and, ultimately, the person selecting, collecting, labeling, preserving, and transporting it, are essential first steps to achieve this. Therefore, this book is for every member of the health care team—the partnership.
The overall aim of this edition was not to reinvent the wheel when it comes to providing guidance on specimen collection and management, because not much has changed since prior editions. Rather, it is meant to make the content more readable and accessible for its users, both specimen collectors and laboratory personnel, as well as to provide updates in specimen collection for newer methodologies (e.g., nucleic acid amplification tests) that are now in almost every laboratory. In the age of molecular testing in microbiology, the principles of specimen selection, collection, and transport are certainly no less important than they have been over the years. Close attention must be paid to the manufacturer recommendations for specimen collection and management, and unless the laboratory is prepared to validate