Published on February 25, 2008
Module 3:Collection and Transportation of Tuberculosis Specimens: Module 3: Collection and Transportation of Tuberculosis Specimens Learning Objectives: Learning Objectives Describe specifications of suitable containers for sputum collection Explain the collection strategy: spot/morning/spot Describe and demonstrate safe and correct collection of sputum Describe options for specimen collection, handling and transport Assess quality of collected sputum specimen Outline requirements for a properly labeled specimen Content Overview: Content Overview Suitable specimen containers The number and timing of specimen collection How to collect a specimen Specimen handling and referral Assessing specimen quality Specimen Collection Container: Specifications: Specimen Collection Container: Specifications 50 ml capacity Translucent or clear material Single-use combustible material Screw-capped with a water-tight seal Easily-labeled walls Specimen Collection: Specimen Collection Three (3) specimens optimal for identifying infectious cases of tuberculosis Make collection convenient and efficient for both patient and laboratory worker Timing of Specimen Collection: Timing of Specimen Collection Spot–Morning–Spot WHO/IUATLD Recommendation Spot initial visit to the clinic Early morning first sputum in the morning Spot second visit to the clinic Spot-Morning-Spot : Spot-Morning-Spot Advantages Requires only two visits (convenience to the patient) A spot specimen is available in case the patient does not return with the morning specimen Disadvantages Two out of three specimens may be of poor quality High risk of missing a case if only the first specimen is properly examined Collection Considerations : Collection Considerations Yield decreases rapidly after three specimens Morning specimens on average better Collect three morning specimens from hospitalised patients Two good examinations may be most efficient with high workload Follow NTP guidelines for exact specimen collection strategy Follow-up Specimens for Monitoring Treatment: Follow-up Specimens for Monitoring Treatment Collected during and at end of treatment Early morning specimen Consult NTP guidelines for exact collection frequency Country NTP: Country NTP Discuss the country related NTP guidelines for specimen collection Specimen Collection: Safety: Specimen Collection: Safety The patient is a greater danger to staff than the specimen! Instruct patient to cover the mouth when coughing Never collect sputum in the laboratory! Collect OUTSIDE Collect away from other people Do not stand near patient during specimen collection Advantages of Open Air Collection: Advantages of Open Air Collection Rapidly dilutes aerosols UV light rapidly inactivates the bacilli Specimen Collection Guidelines: Specimen Collection Guidelines Explain clearly to patient Why sputum is needed Three samples required Spot–morning –spot What is a good sample and how to obtain it Opening and tight closing of containers Not to soil the exterior of the container Transport of sputum containers The need to return to the clinic Patient Education: Collection: Patient Education: Collection Best specimen comes from the lung Saliva or nasal secretions are unsatisfactory Remove dentures and rinse mouth with water Need for three sputum samples for optimal diagnosis Patient Instructions: Collection: Patient Instructions: Collection Inhale deeply 2–3 times, breathe out hard each time Cough deeply from the chest Place the open container close to the mouth to collect the specimen Optimum Collection Location: Microscopy Centre: Optimum Collection Location: Microscopy Centre Specimen is fresh Collection supervised Immediate recollection, if necessary Microscopy Not Performed at Health Centre: Referral Options: Microscopy Not Performed at Health Centre: Referral Options Patient Referral Specimen Referral Smear Referral Patient Referral: Disadvantages: Patient Referral: Disadvantages Expense of travel to diagnostic centre Family and work commitments Reluctant to seek help Diagnosis may be delayed Specimen Referral: Specimen Referral Peripheral health centre staff supervises patient collection of specimen. Specimen then forwarded to a microscopy centre. Consider: Frequency of transportation and packaging Potential for leakage and breakage Specimen Referral: Disadvantages : Specimen Referral: Disadvantages The microscopy centre has no direct control over the specimen collection process Higher risk with transporting specimens Requires a safe, fast and regular transport system for specimens and results Follow-up and quality assurance of the process may be needed Slide Referral : Slide Referral Smears require less safety precautions for packaging Peripheral centres must be trained in collection and smear preparation Disadvantages Risk of poor specimen and poor smear Slides are more fragile Request for Sputum Examination Form Should Include: : Request for Sputum Examination Form Should Include: Patient’s name, sex, age, and address Date of collection Name of Health Institution Reason for examination Request for Sputum Examination Form: Request for Sputum Examination Form Labeling Specimen Container: Labeling Specimen Container Specimen Receipt at Laboratory: Specimen Receipt at Laboratory Check specimens for quality: Volume (at least 3–5 ml) Describe sputum consistency (mucoid, purulent, bloody, or watery) Register the specimen and allocate a laboratory serial number Specimen Quality: Specimen Quality Purulent Mucoid Specimen Quality: Specimen Quality Saliva or Induced sputum (?) Blood stained Slide28: Obtaining adequate good quality specimens is critical to ensure accurate and reliable AFB microscopy results Role Play: Sputum Collection: Role Play: Sputum Collection Process Work in groups of 3 Decide roles: (1) health worker, (2) TB suspect patient, (3) observer The health worker instructs the TB suspect patient while the observer provides feedback. Switch roles and repeat the process until everyone has taken on each role once. Purpose To practice educating TB suspect patients on the importance of a properly collected sputum specimen To practice providing instructions on how to collect a sputum specimen to a TB suspect patient. Total Time 30 Minutes Role Play Debrief : Role Play Debrief Did the healthcare worker follow procedure: COMPLETE a Request for Sputum Examination form. LABEL sputum containers. EXPLAIN to the TB suspect how to collect sputum and the importance of a properly collected specimen. ASK the TB suspect to produce a sputum sample. ASK the TB suspect to collect another sample in the morning and then bring it to the diagnostic centre. Did the TB suspect understand instructions? What suggestions for improvements did the observer note? Summary: Summary What is the significance of spot–morning–spot collection? Why is sputum never collected in the laboratory? What are the three options for handling sputum specimens at peripheral health centres not performing microscopy? What are the features of a good quality specimen? How should you label a sputum container?