Collection Medium:

Rejection Criteria:

Sputum specimen or dry swab.

Delivery Instructions:

Transport the specimen to the Microbiology laboratory (6004 BT) 
immediately on ice or refrigerate. From 2245 to 0700, deliver specimen 
to Specimen Control (6240 RCP) on ice.

If the tube system is used, ensure specimens are in leak-proof 
containers that are securely closed and double bagged. Do not send 
traps through the tube system.

Specimen
Instructions:

Collect nasopharyngeal swab in viral transport medium (33595). 
Alternatively, collect tracheal aspirate, bronchoalveolar lavage, 
bronchial wash, or nasopharyngeal wash/aspirate in sterile, leak-proof 
container.

See specific viral agents for more details.
A. Biopsy or tissue - Keep moist with sterile saline or viral transport 
media [do not use viral transport media (VTM) if bacterial, AFB, or 
fungal cultures are also requested; VTM is available in kits from 
Hospital Stores (923740, 33595, 33625)].

B. Blood or buffy coat culture - collect 10 mL of blood in a
lavender (EDTA) tube.

C. Bone Marrow - collect in a lavender (EDTA) tube.

D. CSF - collect 1-5 mL in a sterile container.

E. Nasopharyngeal swab: Collect specimen using the flexible minitip
   flocked swab (Hospital Stores #33595).
   1. Measure the distance from the patient's nostril to the
      nasopharynx (half the distance from nostril to base of the ear)
      and hold the swab at that location. Do not advance the swab
      beyond that point.
   2. Gently insert the swab along the base of one nostril (straight
      back, not upwards) and continue along the floor of the nasal
      passage until reaching the nasopharynx.
   3. Rotate swab 2-3 times and hold in place for 5 seconds. Place swab
      in tube containing viral transport medium. Break off the excess
      length of swab at the score mark to permit capping of the tube.

F. Nasopharyngeal wash/aspirate:
   1. Assemble equipment:
      Sterile specimen trap
      Personal Protective Equipment (gloves, surgical mask, eye
        protection)
      Appropriate size suction catheter (8 fr for infants/children,
        10/12 fr for adults)
      Normal saline vial
      Wall suction
      Bag or cup of ice for specimen transport to laboratory
   2. Place patient with the head tilted slightly back.
   3. With sterile gloved hand, insert suction catheter into the
      patient's nose to the depth of the nasopharyngeal area (beyond
      the turbinates).  Do not remove catheter until end of procedure.
      (see diagram)
   4. With the non-sterile gloved hand, instill approximately 1-2 mL
      normal saline outside the catheter.
   5. Apply suction to aspirate nasopharyngeal secretions.
   6. Above steps may need to be repeated to obtain 1 mL sample in
      specimen trap.
   7. Remove catheter from patient. With specimen trap still in-line,
      rinse catheter with remaining saline to clear secretions.
   8. Specimens transported by tube system must be transferred from
      trap to a leak-proof sterile container (be sure the lid is
      tightly secured).

G. Respiratory secretions - Collect specimens in sterile, leak-proof 
container. Sputum is unacceptable for viral cultures.

H. Sterile Body fluids: Use sterile, leak-proof containers.

I. Swab - Only use swabs available in transport kits. For respiratory 
virus testing use nasopharyngeal swab in flexible minitip flocked swab 
kit (33595, green sticker). For skin lesions use regular flocked swab 
in HSV/VZV kit (33625, beige sticker). For Chlamydia PCR testing use 
Chlamydia transport kit (923740) - large swab for female cervical 
specimens and small swab with metal shaft to collect male urethral 
specimens.

J. Vesicle - Expose the base of the lesion by lifting the cap of the 
vesicle or ulcer. Using swab from Regular flocked swab collection kit 
(33625), swab the entire base of the lesion firmly to collect cellular 
material (without causing bleeding). Place swab in viral transport 
media and transport immediately on ice.

K. Urine - collect 1-10 mL of clean voided midstream morning urine
in a sterile, leak-proof container.

Testing Schedule:

0700-1630, 7 days a week, including holidays.

Comments:

Viruses that may be isolated at UIHC include respiratory viruses 
(influenza A including H1N1; influenza B; RSV; parainfluenza 1, 2, 3; 
adenovirus), Herpes Simplex virus (HSV)/varicella-zoster virus (VZV), 
and cytomegalovirus (CMV). Specimens submitted for culture of other 
viruses (including enteroviruses and nonrespiratory specimens submitted 
for adenovirus culture) will be sent to the University Hygienic 
Laboratory (UHL). PCR assays for the detection of HSV (CSF), 
enterovirus (CSF), and CMV (blood or CSF) are available in the 
Molecular Pathology laboratory (see individual test listings). Requests 
for CMV PCR on amniotic fluid will be sent to a reference laboratory 
(see "CMV Quant PCR, Amniotic Fluid"). Requests for detection of 
enteric adenovirus antigens 40-41 in stool specimens will be sent to a 
reference laboratory for an ELISA test (see "Adenovirus Antigen, 
Fecal".

See also:
Adenovirus 40-41 Antigens by EIA, Fecal
CMV Quant PCR, Amniotic Fluid

See Additional Information:
Specimens Requiring Immediate Delivery