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.