Sputum Collection

1. State the rules or precautions to be observed for collection of such specimen

SPUTUM AND THROAT SWAB

The best specimen is the early morning specimen that the patient produces. These are
specimens which are difficult to collect because these are contaminated by oropharygeal flora. If
sputum cultures are ordered times three, it is best to collect three early morning on three
consecutive days. Expectorated sputum from the lower lungs airways, is the most contaminated
specimen. Do not have the patient expectorate saliva or post-nasal drip into the container.
The individual rinses his or her mouth with water and then expectorates a specimen preferably
5-10 mL, resulting from a deep cough.

For persons with nonproductive coughs, a specimen may be induced by allowing the individual
to breathe aerosolized droplets of a solution of 15% sodium and 10% glycerin for about 10
minutes or until a cough reflex is initiated. (Henry's)
Bailey's and Scott's
1. Food should not have been ingested for 1 to 2 hrs before expectoration.

2. Mouth should be rinsed with saline or water just before expectoration

3. Patients should be instructed to provide a deep coughed specimen

4. The material should be expelled into a sterile container.

INDUCED

Before specimen collection, patients should brush the buccal mucosa, tongue, and gums with a
wet tooth brush An early morning specimen is recommended. For 3 consecutive
specimen, Collect each specimen first thing in the morning for 3 consecutive days.
Collection should be made in well ventilated spaces.

1. Upon rising in the morning, prior to collection, patient should rinse mouth well with water
(not mouthwash). Do not eat, drink or smoke before collecting.

2. Take plastic cup/tube and make sure the cup/tube is clean. Do not touch the rim of the
container
 3. Inhale as deeply as possible. Breathe in and out three times or lean forward. Expectorate
into sputum collection container, while coughing as deeply and vigorously as possible then
spit it out.

4. Collect atleast 5 ml or 1-2 tbsp of sputum.

5. Tightly cap container so no spillage occurs.

6. Wash and dry outside of container and label the SPECIMEN CONTAINER with name and
date and time of collection.

Throat cultures are contraindicated for patient with inflamed epiglottis. Throat Cultures
are screened for beta strep only. They are reported as no beta strep, Strep pyogenes (group A
beta strep) or beta strep, not group A. If Candida is suspected, please order fungal culture.

2. Describe in detail the collection of specimen.

A. THROAT SWAB

1. Collect specimen under good lighting. Depress the tongue with a tongue blade and pass
the swab firmly over the back of the patient's throat, tonsils or tonsillar fossae and any
area of inflammation and or exudation.

2. Return the swab to the transport tube and break the media ampule at the base of the tube
to moisten the swab.

3. Label the swab transport tube with patient name.

4. DO NOT mail specimen. Give to the laboratory as requested or in pickup sites.

B. SPUTUM

COLLECT A DSSM SPUTUM SPECIMEN: DOH

1. The patient should rinse his mouth with water to remove food remnants to avoid
contamination of specimen
2. Whenever possible, sputum should be collected in open air.
- If this cannot be done, it should be collected in an empty room with open windows solely
designated as sputum collection area.
3. The patient is usually more comfortable if he is separated from other patients at the time of
collection
4. The DOTS facility staff should demonstrate to the patient how to produce good sputum
specimen by instructing him/her as follows:
 A. Breathe deeply two times, hold breath for a few seconds after each inhalation and
then exhale slowly.
B. Repeat the entire sequence twice
C. After inhaling deeply for the third time, at the height of deep inspiration, instruct the
patient to cough forcefully and spit sputum in the container
5. The DOTS facility staff should stay behind the patient during the procedure and observe
precautions against infection.
- It is recommended to collect sputum specimens in the designated sputum collection area
where aerosols containing tubercle bacilli are diluted and sterilized by direct sunlight.
6. The DOTS Facility Staff should check the quality and quantity of sputum specimen. material.
The ideal appearance of good quality sputum specimen is purulent, yellowish, and
cheesy-like.
When a patient has only coughed up saliva or has not expectorated approximately 3 to 5 mL
(1/2 to 1 teaspoon) of sputum, the DOTS facility staff should ask the patient to repeat coughing
until he produces good quality sputum specimen.
7. Patients should be advised to carefully expectorate into the container to avoid contamination
of the exterior surface of the container.
- When the outer surface of the container is contaminated with sputum, the patient should wipe
the container and properly dispose whatever is used to clean the container in the trash Used
sputum cups and other paraphernalia should be treated with disinfectant and disposed off
properly.
5% Lysol
1% Sodium hypochlorite
Phenol

3. How many samples are usually collected for laboratory studies? What is the usual
volume?

SPUTUM: A volume of 5 to 10 ml is adequate and there is no advantage in collecting a larger

volume. The sample should contain recently discharged material from the bronchial tree
with minimal saliva content. If sputum cultures are ordered times three, it is best to collect
three early morning on three consecutive days.

THROAT SWAB: Sweep the swab back and forth across the posterior pharynx, tonsillar areas,
and any inflamed or ulcerated areas to obtain sample.
4. Discuss how to handle the specimen after collection? from the collection to the lab.
what to do with the specimen when it cannot be brought back to the lab. be able to
state which specimen must not be refrigerated.

Throat Swab: Refrigerate specimen for transport. Deliver to lab within 48 hours.
Sputum:

Sputum culture will be rejected if >25 epithelial cells per low power field are seen on the Gram
Stain.
• Should be transported within sealable, leak proof, plastic bags; specimen bags should be
marked with biohazard label.
• Patient specimens or culture isolates must be triple packaged before being shipped.
• Specimens must be delivered to the laboratory promptly
• Specimens should be transported within one hour. Specimens that cannot be processed within
one hour of the time of collection should be refrigerated during transport to and storage in the
laboratory prior to processing. This will decrease overgrowth with contaminating organisms
likely to be present.