Sputum/tracheal aspirate
○ Collect sputum by expectoration or by tracheal aspiration in sterile container. Collect 3 sputum specimens (spontaneous or induced) on the same day at least 1 hour apart or optimally, 3 early morning sputum specimens for 3 consecutive days. Do not pool specimens or have the patient rinse mouth with tap water before producing sputum.
○ 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
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. Avoid contaminating bronchoscope with tap water as it can produce false positives.
Esophageal brushing
○ Instill brush to collect cellular material from esophageal wall. Place protected brush sample in sterile container with 1 mL of saline.
Tissue (lung)
○ Collect 5-10 mm3 tissue aseptically using surgical technique or aspiration with a fine needle. Place in a clean, sterile container with a small amount of sterile saline. Do not submit tissue samples on gauze.