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Appropriate Collection and

Handling of Respiratory

Specimens


Specimen Collection

• Who collects specimens?

• Who will be collecting or has collected in the past?

• Who does not collect specimens?


Objectives

• PPE

• Specimen Collection (Timing)

• Specimen types

• Labeling

• Storage

• Package and shipping

• Examples


Specimen CollectionOverview: Points to Consider

• The time of specimen collection relative to symptom

onset and clinical presentation are very important

when considering what specimens to collect

• Maintain proper infection control when collecting

specimens

• Use approved collection methods and equipment

when collecting specimens

• Handle, store and ship specimens appropriately


• Gloves

• Mask (fitted N-95)

• Protective clothing

• Eye protection

• Sharps protection

Specimen CollectionPersonal Protective Equipment (PPE)Personal Protective Equipment (PPE)


• Respiratory specimens– Collect as soon as possible after symptoms

begin (ideally within 7 days)

– Ideally before antiviral medications are

administered

– Collect multiple specimens on multiple days

Specimen CollectionTimingTiming


• Serum for serology

– Paired serum samples are most useful

– Acute sample (within 7 days after symptom

onset)

– Convalescent sample (2 weeks or more after

acute sample)



Virus

shedding

Antibody response

PCR

Antigen detection / Culture

Incubation Antibody detection

Days After Onset of Illness



Rhinitis (common cold)

Pharyngitis/Tonsilitis

Laryngitis

Tracheitis

Laryngotraceobronchistis (croup)

Bronchitis

Bronchiolitis

Pneumonia

Specimen CollectionUpper and Lower Respiratory TractUpper & Lower Respiratory Tract


• URT specimens

– nasal swab (N)

– nasopharyngeal swab (NP)

– nasophyaryngeal wash or aspirate

(NW/NA)

– NW/NA > NP > N

– oropharyngeal (throat) swab or wash

Specimen CollectionTypes of Respiratory Tract SpecimensTypes of Respiratory Tract Specimens

http://www.anigenetics .com/products /images /2010-02-03(7).jpg


Specimen CollectionSwab Specimen CollectionSwab Specimen Collection


• LRT specimens

– sputum

– tracheal aspirates

– bronchoalveolar lavage (BAL)

– pleural fluid (sterile)

Specimen CollectionTypes of Respiratory Tract Specimens, Slide #2Types of Respiratory Tract Specimens, slide #2


Specimen CollectionClinical PresentationClinical Presentation


• Should be drayon, rayon, or polyester fiber swabs

• Select swabs with serrated shafts

• Do not use calciumalginate or cotton swabsnor ones with woodensticks; they may inhibit PCR

Specimen CollectionSwab SpecimensSwab Specimens

NP swab

OP swab


Specimen CollectionSwab Specimens

NP swab

OP swab


Hernes SS, et al. Eur J Clin Microbiol Infect Dis. 2011;30:159-65.

Munywoki PK, et al. J Clin Microbiol. 2011;49:3365-7.

Abu-Diab A, et al. J Clin Microbiol. 2008;46:2414-7.

Specimen CollectionFlocked SwabsFlocked Swabs


World Health Organization

Specimen CollectionViral Transport MediaViral Transport Media


Specimen CollectionNP vs OP Swabs


Specimen CollectionNP vs OP SwabsSwab

s, slide #1


• Specimen labeling

• Specimen documentation

• Specimen storage

• Specimen packaging/Shipping

Specimen Labeling, Storage, and

Transport


• Label all specimen containers with:

• Patient name

• Patient ID number Specimen type(s)

Date collected.

Specimen Labeling


• Each package with specimen(s ) should include line lis t :

Pa tient name

Patient ID number

Specimen type(s )

Date collected

Clinica l contact name, phone #, ema il

Clinica l submitte r, a ffla tion, phone #, ema il

Re levant clinica l informa tion (symptoms , da te of onse t, e tc.)

For deaths : pre liminary autopsy report

WHO specimen transport guidelines: http://www.who.int/csr/emc97_3.pdf

Specimen Documentation

http://www.who.int/csr/emc97_3.pdf


• The shippe r – not the transport

company – is responsible for the

shipme nt until the package reaches

its destina tion.• Primary packaging

• Prima ry conta ine r must be water tight.

• Wrap multiple conta ine rs individua lly to prevent

breakage.

• Everything in the primary conta ine r, including

transport media , is cons ide red the infectious

substance.

Specimen Packaging


Specimen Packaging




• Specimens must be kept cool

• if transported ≤72 h, keep at 4oC

• if transported >72 h, keep at -70oC (ship on dry ice)

• Avoid repeated freeze/thaw cycles; do not use frost-free

freezers

• Sera may be stored at 4oC for up to one week; long term

storage at -20oC in non-frost-free freezer acceptable

• Prepare multiple aliquots of specimens

Specimen Storage




• Improperly identified specimens (specimen

container info and form do not match)

• No identification on specimen container or form

• Specimens with insufficient quantity for testing

• Improper specimen type sent

• Spillage or possibility of cross contamination

• Specimens shipped at improper temperature

• Excessive specimen transport time

Specimen CollectionUnacceptable SpecimensUnacceptable Specimens


Specimen Storage


Examples


MERS-CoV

• Who collects MERS samples?

• Correct sample types for MERS-CoV


Specimen CollectionMERS-CoV: Changes in Interim GuidelinesMERS-CoV: Changes in Interim Guidelines


• Lower respiratory tract specimens (sputum, trach

aspirate, BAL)

• Nasopharyngeal/Oropharyngeal (NP/OP) swabs

combined

• Serum and/or whole blood (PCR and serology)

• Use approved collection methods and equipment

when collecting specimens (BSL2 or BSL2+)

• Handle, store and ship specimens as per protocol

• Proper infection control when collecting specimens

NOTE: More sample and more specimen types collected on multiple days

may enhance MERS-CoV diagnosis.

Specimen CollectionMERS-CoV: Preferred SpecimensMERS-CoV: Changes in Interim Guidelines


Influenza (HPAI/LPAI)

• Who collects HPAI/LPAI samples?

• Correct sample types for HPAI/LPAI


URTI

• a nasopharyngeal swab, or

• a nasal aspira te or

• two swabs combine d (ex. NPS/OPS)

LRTI

• endotracheal aspira te

• bronchoa lve ola r la vage fluid (BAL)

NOTE: If possible, multiple specimens from different sites over 2 days

Specimen CollectionHPAI: Preferred SpecimensMERS-CoV: Changes in Interim Guidelines


• Use proper PPE

• Collected at the appropriate time

• Collect the appropriate specimen

• Use the proper collection equipment

• Label the specimen

• Proper storage

• Package and ship

Conclusions


Questions

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