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close this bookBasic Laboratory Procedures in Clinical Bacteriology (WHO; 1991; 128 pages)
View the documentPreface
View the documentIntroduction
open this folder and view contentsQuality assurance in microbiology
close this folderPart I. Bacteriological investigations
open this folder and view contentsBlood
open this folder and view contentsCerebrospinal fluid
close this folderUrine
View the documentIntroduction
View the documentSpecimen collection
View the documentCulture and interpretation
View the documentInterpretation of quantitative urine culture results
View the documentIdentification
View the documentSusceptibility tests
open this folder and view contentsStool
open this folder and view contentsLower respiratory tract infections
open this folder and view contentsUpper respiratory tract infections
open this folder and view contentsSexually transmitted diseases
open this folder and view contentsPurulent exudates, wounds, and abscesses
open this folder and view contentsAnaerobic bacteriology
open this folder and view contentsAntimicrobial susceptibility testing
open this folder and view contentsPart II. Essential media and reagents for isolation and identification of clinical pathogens
View the documentSelected further reading
View the documentSelected WHO publications of related interest
View the documentBack Cover
 

Specimen collection

It cannot be overemphasized that considerable importance is attached to the method of collection of urine specimens, transport to the laboratory, and the initial efforts by the laboratory to screen and culture the urine. It is the responsibility of the laboratory to provide the physician with sterile, wide-mouthed, glass or plastic jars, beakers, or other suitable receptacles. They should have tight-fitting lids or be covered with brown paper prior to sterilization by dry heat or autoclaving.

Urine specimens may have been collected by a surgical procedure, e.g., suprapubic aspiration, cystoscopy, or catheterization. If not, the laboratory must insist on a clean-catch midstream urine specimen, particularly in females and children. Since urine itself is a good culture medium, all specimens should be processed by the laboratory within 2 hours of collection, or be kept refrigerated at 4 °C until delivery to the laboratory and processed no longer than 18 hours after collection.

Whenever possible, urine specimens for culture should be collected in the morning. It is advisable to ask the patient the night before to refrain from urinating until the specimen is collected.

Women

A woman who is ambulatory should:

1. Wash her hands thoroughly with soap and water and dry them with a clean towel.

2. Undress in a suitable room, spread the labia, and cleanse the vulva and labia thoroughly, using sterile cotton gauze pads and warm soapy water wiping from front to rear.

3. Rinse thoroughly with warm water and dry with a sterile gauze pad. During the entire process the patient should keep the labia separated and not touch the cleansed area with the fingers.

4. Pass urine, discarding the first part of the stream. Collect the remaining urine in the sterile container, closing the lid as soon as the urine has been collected.

5. Hand the clean midstream urine, in the closed container, to the nursing personnel for prompt delivery to the laboratory.

For bedridden patients, the same procedure is followed, except that a nurse must assist the patient or, if necessary, do the entire cleansing procedure before requesting the patient to pass urine.

In both situations every effort must be made to collect a clean-catch urine specimen in a sterile container and to ensure that it is delivered promptly to the laboratory together with information on the patient, clinical diagnosis, and the requested procedures.

Men

A man who is ambulatory should:

1. Wash his hands.

2. Pull back the foreskin (if not circumcised) and pass a small amount of urine.

3. Still holding back the foreskin, pass most of the remaining urine into a sterile container. This is a midstream urine specimen.

4. Place the cover on the container and hand to nursing staff for prompt delivery to the laboratory.

For bedridden patients:

1. If necessary, nursing personnel should pull back the foreskin, wash and dry the glans with soapy water and gauze pads.

2. With foreskin pulled back, the patient should pass a small amount of urine into a urinal.

3. The patient should then pass most of the remaining urine into the sterile container. The cover should be placed on the container and the specimen transported to the laboratory.

Infants and children

Collection of a clean-catch urine specimen from infants and children who are ill in bed or uncooperative can be a problem. Give the child water or other liquid to drink. Clean the external genitalia. The child can be seated on the lap of the mother, nurse, or ward attendant, who should then encourage the child to urinate and collect as much urine as possible in a sterile container. The container should then be covered and delivered to the laboratory for prompt processing.

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