○ Consult with UHN/SH Microbiology Laboratory medical microbiologist on-call if suspecting avian influenza infection
○ Respiratory tract specimens (e.g. NP swab and BAL) and a throat swab should be collected on any hospitalized patient with suspected avian influenza infection ○ Travail history and clinical information must be provided.
○ NP/throat swab: single sterile swab in universal transport medium ○ BAL/pleural fluid: sterile container (2mL) ○ Tissue: sterile container with a small amount of saline (1g) ○ Stool: sterile container (2g) ○ Whole blood/serum: serum separator tube (min volume 5 mL)
Nasopharyngeal swab ○ Insert tip of swab into nostril aiming along the floor of nasal cavity until posterior wall of nasopharynx is reached. Resistance will be felt when reached. Rotate swab for 10-30s. Place swab into transport medium and close tube. Throat swab ○ Collect the specimen using a clean, sterile swab by swabbing the posterior oropharynx vigorously and place it in Amies transport medium
BAL ○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). Instill a large volume of 0.85% sterile saline (nonbacteriostatic) into the airway lumen. Discard the initial fluid recovered (likely contaminated). Collect remaining fluid in a clean, sterile container via suction.
Pleural fluid ○ Decontaminate skin. Insert needle into pleural space, aspirate fluid into syringe OR collect pleural fluid directly from drain if chest tube has been inserted to drain pleural space. Transfer specimen (min volume 2 mL) into sterile, leakproof container
Tissue (Respiratory tract) ○ Collect 5-10 mm3 tissue aseptically using surgical technique. Place in a clean, sterile container with a small amount of sterile saline.
Stool: ○ Collect 10-30 mL of watery, diarrheal stool or 2 grams of loose stool in sterile container. Transport to the laboratory immediately after collection
Whole blood/serum: ○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine, collect at least 5 mL of blood
Refer to section Sample Processing / Delivery
PHOL
○ 1 to 2 days after receipt by PHOL
416-586-4800 extension 4440
YES
○ Label specimen container. Place specimens in biohazard bag and seal.
○ Specimens should be stored at refrigeration temperature (2-8˚C) after collection and transported to the UHN/SH Microbiology Laboratory ASAP after collection.
○ UHN/SH Microbiology Laboratory will test the specimen in house (see Influenza virus – detection), but all samples (positives and negatives) will be sent to PHOL for confirmation.
○ The specimen will be referred to the Public Health Ontario Laboratory for testing. Positive samples will be forwarded to NML for confirmation.