Francisella tularensis

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 in sterile container with 1 mL of saline.

Lymph nodes
○ Decontaminate skin, collect lymph node via biopsy or needle aspirate with sterile technique. Place in sterile container

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

Whole blood/serum
○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine, collect at least 5 mL of blood if multiple tests will be ordered

Wound aspirate
○ Decontaminate skin, collect aspirate of wound using a syringe and needle. Dispense aspirated fluid into sterile container

Wound swab
○ Cleanse wound to decontaminate surface. Collect specimen from a superficial wound using a sterile swab and the Levine method, by rotating the swab over a 1cm3 area applying sufficient pressure to express fluid from the tissue.