○ Contact UHN/SH microbiologist on call if MERS-CoV infection is suspected
○ Multiple respiratory specimens should be collected (e.g. both NP and throat swab are required plus lower respiratory specimen if possible). Do not induce sputum production.
○ NP/throat swab: single swab in universal transport medium ○ BAL/bronchial washings/sputum/ pleural fluid : sterile container (min 1 mL) ○ Whole blood/Serum: serum separator tube (clotted blood) (min volume 5 mL) ○ Stool: sterile container (min 1 gram) ○ Tissue: sterile container with small amount of normal saline (min 1 gram)
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 ○ 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.
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. Repeat collection with second nostril.
Throat swab: ○ Collect the specimen using a clean, sterile swab by swabbing the posterior oropharynx vigorously and placing it in universal transport medium.
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
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 ○ Collect 5-10 mm3 tissue aseptically using surgical technique/fine needle. Place in a clean, sterile container with a small amount of sterile saline. Do not wrap tissue in gauze.
Blood/serum: ○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine, collect at least 5 mL of blood
Stool ○ Collect a single stool specimen in a sterile container.
Refer to section Sample Processing / Delivery
PHOL
○ Up to 2 days
416-586-4800 extension 4557
YES; prior to the collection of specimens
○ Label specimen container. Place specimens in biohazard bag and seal.
○ Specimens should be stored and transported to the UHN/SH Microbiology Laboratory at refrigeration temperature (2-8˚C) immediately after collection.
○ Specimens should be transported to the laboratory on foot and NOT through the pneumatic tube system
○ The specimen will be referred to the Public Health Ontario Laboratory for testing. Positive specimens by PCR at PHOL will be sent to NML for confirmation.