HTHSCI 2HH3 Lecture Notes - Lecture 5: Dysuria, Antigen, Body Fluid
26 May 2018
School
Department
Course
Professor
Laboratory Specimen Collections and Microbiology
Patient Safety
• Estimated that the overall error rate in healthcare in the US is 31-69%
• The error rate in the performance of the test is very low.
• Most eos ou i the eal pe-aaltial phase : before the specimen gets to the
lab
o Wrong test, order entry, patient-specimen misidentification, quality of sample
collection poor, wrong container, inappropriate storage and transport
Patient Identification
• One of the most important processes in specimen collection
• Why?
• 50% of deaths from transfusion related to errors in identification
• Adverse outcomes related to errors in identification
• Laboratory accreditation (CAP and OLA)
• Benchmark recommends <0.4% misidentification of samples
• 2 nurses must sign off on the specimen to make sure it is correct
• Ee health ae pofessioal MD, RN ust ofi the patiet’s idetifiatio efoe
any intervention
• TWO patient identifiers required:
o Full name
o Hospital accession number
o OHIP number
o Date of Birth
• Important to ask the patient for their full name and another unique identifier
• If unconscious patient, verify identification by their hospital bracelet
Laboratory Requisition
• Unique identification of the patient
• Gender, age, DOB
• Specimen type, anatomic site, clinical information
• Test Ordered
• Date and Time of collection
• Who requested the test → most responsible physician
o Must be uniquely identified
o Copy to physician
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Clinical Consequences
• The blood culture belongs to another patient and that patient requires treatment for
the infection
o The patient does not receive treatment and has complications that impact on
morbidity and mortality
• The blood culture ordered on the wrong patient may result in treatment that is not
required
o Potential side effects
o Increased length of stay
o Delay of surgery
o Cost
General Principles of Specimen Collections
Maximize ability to isolate pathogen
• Collect specimen before the patient is put on antibiotics
• Choose the correct specimen container
o Transport media (liquid, gel, charcoal) is designed to preserve the pathogen
despite a delay getting the specimen to the laboratory.
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o There are different transport media for bacteria vs viruses vs parasites
o Some transport media (example in blood culture bottles) have resins to bind to
antibiotics
• Volume of specimen – usually maximum volume is preferred
• Timing – collect when the organism will be most abundant
• First morning urine best for urinary tract infection
Minimize contamination with normal flora:
• Many specimens are in contact with non-sterile surfaces:
• Blood culture collection requires disinfection of skin
o Skin commensal flora: coagulase negative staphylococcus, viridans
streptococci, Propionibacterium
• Urine cultures and genital tract
o Female genital tract: lactobacillus, streptococci, anaerobes
o A midstream urine minimizes contamination with genital tract flora
Safety during collection
Follow infection control precautions when collecting specimens
• Routine practises for all specimens – wear gloves and lab coats/gown when collecting
specimens
• For blood samples, wear gloves when taking blood
• Do not re-use tourniquets if possible as can transmit MDR organisms
• Additional precautions depending on patient symptoms or organism
• Contact precautions for patients with MRSA or VRE
• Droplet precautions for patients with respiratory symptoms
• Be aware of outbreaks and novel strains
o eg/ SARS, avian influenza where airborne precautions are recommended for
collection
Safety during collection
For needles and sharps
• Never re-sheath (unless an approved aid used)
• Never bend, break or cut
• Dispose of in a puncture-resistant disposal container made of rigid plastic, metal or stiff
cardboard
o Container must have a lid
o Do NOT overstuff
o Mark container with biohazard sign
• In Ontario: safety engineered needles or needle-less systems are required by law
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