While the paradigm of the conventional gold standard may slowly be shifting away from cultures and organism isolation and on to more rapid, molecular-based methods, it is critical that we, as a laboratory community, continue to insist upon specimen collectors to follow collection guidelines so we can contribute what is expected of us. Anything less borders on malpractice and should be addressed before aberrant and potentially harmful results are reported. Regardless of the issue, we must remember, even in the era of decentralized labs, the specimen is not just a swab or a tube of fluid passing through our doors; it represents a sick patient, a concerned family member, and a treating physician, desperately depending on us to provide accurate, significant, and clinically relevant data. It is our mission to ensure that what comes to our lab in the form of a specimen and what leaves our lab in the form of results is of the highest quality. Please share these policies and processes with all of the medical staff involved in specimen management, share your knowledge, and spread this important information. If you don’t do it, who will?
J. Michael Miller
Shelley A. Miller
Acknowledgments
The valuable reviews and constructive criticisms of John McGowan, Robert Jerris, Mark Neumann, Ellen Jo Baron, Craig Smith, Lynne Garcia, Ben Gold, Don Finnerty, Louis Wilson, and William Reichert are greatly appreciated. We are thankful for the direct and invaluable assistance and contributions of two internationally known pediatric microbiologists, Karen Krisher and Joseph Campos. We acknowledge and appreciate the developmental work done on the summary tables by Dr. Harvey T. Holmes. We wish to thank the laboratory staff of Children’s Healthcare of Atlanta, under Dr. Robert Jerris, and UCLA, under Dr. Romney Humphries, for their cooperation and willingness to participate in many of the photographs illustrating this book. We are also indebted to dozens of colleagues who have been so generous with their advice and knowledge over the years and are always working for the best outcomes for their patients—our thanks goes out to you. And finally, to the countless other microbiologists whose work in the laboratory has made significant contributions to the clinical relevance of laboratory results—we salute you.
About the Authors
How To Use This Book
Since this text is intended to be used by all members of a health care team, some parts are more useful than others to particular members of the team. The book has four major sections.
Communicating Laboratory Needs
For physicians, nurses, specimen collectors, and laboratorians
This section details the premises on which quality microbiology specimen management processes depend. It introduces the concepts of specimen quality and of the relationship of specimen quality to clinical relevance, but it does not detail methods for specimen management. It also outlines some of the criteria that must be adhered to by the microbiology laboratory in the interest of good laboratory practice.
Specimen Management Policies and Rationale
For physicians, nurses, and laboratorians
This important section details why the microbiology laboratory must be involved in each part of the testing process, including the preanalytical, analytical, and postanalytical steps (Fig. 1). It gives the rationale for stringent standards for specimen quality and explains some of the reasons why microbiologists may reject a specimen or insist on additional information.
Figure 1 The total laboratory testing process. Laboratorians must involve themselves in all aspects of specimen management, not just the analytical process.
Specimen Collection and Processing
For all specimen collectors and laboratorians
This “how to collect . . .” section is written in the Clinical and Laboratory Standards Institute format for laboratorians and is intended to help them prepare the collection portion of their procedure manuals. This section also provides instructions for any member of the medical staff involved in selecting, collecting, storing, and transporting specimens to the laboratory for analysis. Each procedure can become a part of a laboratory or nursing procedure manual on specimen collection. Included in this section are specific directions for pediatric needs.
Specimen Management Summary Tables
For all personnel involved with specimen management
This section contains summary information in tabular form for specimen management practices for bacteria, viruses, fungi, and parasites. It is to be used as a quick reference guide that can answer most questions regarding the laboratory needs for a particular specimen.
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