Enterovirus

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.

Bronchial washing/brush specimens
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). For washings, inject aliquots of approximately 20 to 30 mL of 0.85% sterile saline (nonbacteriostatic) for adults or 5 mL for children. Suction washings into a sterile container.
○ For brushings, instill brush to collect cellular material from bronchial epithelial wall. Place protected brush sample (cut off approximately 30-40mm from the end of the brush) in sterile container with 1 mL of saline.

Lung aspirates
○ Samples should be collected aseptically through decontaminated skin using a syringe and needle and placed in a sterile container and submitted to the laboratory ASAP.

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 into sterile, leakproof container

Tissue (Respiratory tract or non-respiratory)
○ Collect 5-10 mm3 tissue aseptically using surgical technique. Place in a clean, sterile container with a small amount of sterile saline. Do not wrap tissue in gauze.

Sputum/tracheal aspirate
○ Collect sputum by expectoration, induction 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 placing it in universal transport medium.

Stool:
○ Pass stool into a clean, dry pan or container mounted on the toilet. Collect two sets of at least 5 mL of watery diarrheal stool (10 to 30 mL preferred) or approximately 1 gram of fecal material or a walnut-sized portion of stool. Transport to the laboratory immediately after collection.

CSF
○ Decontaminate skin, collect at least 1mL of CSF into a sterile container. Collect appropriate amount of CSF for each additional test requested.

Blood
○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine, collect at least 5 mL of blood Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine, collect at least 5 mL of blood

Aspirates/fluids
○ Collect aspirates using a sterile needle and dispense into a clean sterile container (min volume 1 mL)

Skin lesion swabs
○ De-roof or remove crusted material from lesions and swab the base of lesion or use a needle to aspirate fluid. Place swab in universal transport medium or place aspirate in sterile container.