○ Sputum and CSF specimens may be tested but are not ideal
○ BAL or CSF or nasopharyngeal aspirate or sputum: sterile container (1 mL) ○ NP or throat swab: single swab in universal 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.
CSF: ○ Decontaminate skin, collect at least 1 mL of CSF by lumbar puncture Nasal aspirates: ○ Connect mucus trap (Luken’s trap) to suction pump and catheter. Insert end of catheter through external nares to posterior pharynx. Apply suction, slowly withdraw catheter so it is only in nasopharynx for 10s. Flush material out of catheter with small volume of sterile saline (1-1.5 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. Sputum/tracheal aspirate ○ Collect sputum by expectoration or by tracheal aspiration in sterile container ○ For endotracheal aspirates, collect aspirated material using a NEW sterile catheter or in-line catheter and aspirate material from the trachea using a syringe or suction device Throat swab ○ Collect the specimen using a clean, sterile swab by swabbing the posterior oropharynx vigorously and place it in universal transport medium.
Refer to section Sample Processing / Delivery
PHOL
○ Up to 10 days from receipt of specimen at NML
416-586-4800 extension 4469
NO
○ Label specimen container. Place specimens in biohazard bag and seal.
○ Transport specimens to the UHN/SH Microbiology Laboratory at refrigeration temperature (2-8˚C) ASAP after collection
○ SH/UHN Microbiology Laboratory will refer the original specimen to the Public Health Ontario Laboratory for testing. PHOL will refer the specimen to the National Microbiology Laboratory in Winnipeg.