Geisinger Medical Laboratories
Microbiology Specimen Collection Instructions

MOLECULAR INFECTIOUS DISEASE SPECIMEN COLLECTION

I.    CHLAMYDIATRACHOMATIS/NEISSERIA GONORRHOEAE
        (endocervical,vaginal, male urethral, female/male urine)

NOTE:

Gen-Probe DNA Amplified Molecular test for C. trachomatis/N. gonorrhoeae is not FDA cleared for testing on prepubescent patients (<14 years) or on known cases of sexual abuse. Cultures for C. trachomatis and N. gonorrhoeae are indicated in these cases.

A. Collection Kits

1. Gen-Probe APTIMA Combo 2 Unisex Swab Collection Kit (endocervical/male urethral)
2. Gen-Probe APTIMA Combo 2 Urine Collection Kit
3. Gen-Probe APTIMA Combo 2 Vaginal Swab Specimen Collection Kit
4. Sterile Urine Collection Cup
   

B.  Collection of Endocervical Specimens

1. Remove excess mucus from cervical os and surrounding mucosa using the cleaning swab (white-shaft swab in package with red  print) provided in the unisex swab collection kit. Discard the cleaning swab.
2. Insert the specimen collection swab (blue-shaft swab in package with green print) provided in the  APTIMA Combo 2 Unisex Swab Collection Kit 1-1.5 cm into endocervical canal.
3. Gently rotate swab for 30 seconds in endocervical canal to ensure adequate sampling.
4. Carefully withdraw swab, avoiding any contact with the vaginal mucosa.
5. Place the specimen swab (blue-shaft swab only) into an appropriately labeled APTIMA Combo 2 Unisex Swab transport media tube.
6. Snap off the swab shaft at the score line or cut shaft to fit tube.  Avoid splashing of contents.
7. Cap tube.
8. Store and transport at room temperature (2-30°C is acceptable).

 

C.     Male Urethral Specimen

NOTE:

Patient should not have urinated for at least one hour prior to sample collection.

1. Insert the specimen collection swab (blue-shaft swab in package with green print) provided in the APTIMA Combo 2 Unisex Swab Collection Kit  2-4 cm into urethra.
2. Once inserted, rotate swab gently at least one full rotation using sufficient pressure to ensure swab comes into contact with all urethral surfaces. Allow swab to remain inserted for two to three seconds.
3. Carefully withdraw swab.
4. Place the specimen swab (blue-shaft swab only) into an appropriately labeled APTIMA Combo 2 Unisex Swab Collection Kit transport media tube.
5. Snap off the swab shaft at the score line or cut shaft to fit tube.  Avoid splashing of contents.
6. Cap tube.
7. Store and transport at room temperature (2-30°C is acceptable).

D. Collection of Urine Specimens

1. General Guidelines
   1. Do not urinate for one hour prior to providing specimen.
   2. 20-30 ml of first-catch urine is the specimen of choice.
   3. Minimum of 2 ml of urine is required.
   4. Do not collect the specimen by catheterization
   5. Females, do not cleanse the labial area prior to providing specimen.
2. Collect the specimen in an appropriately labeled sterile urine collection cup, free of preservatives.
3. Transfer 2 ml of the urine specimen to the Gen-Probe APTIMA Combo 2 Urine Collection Tube.  The correct volume of urine has been added when the fluid level is between the black lines on the collection tube.  Do not submit overfilled or underfilled.
4. Recap the urine collection tube. 
5. Store the specimen and transport it to the laboratory at room temperature (2-30°C is acceptable).

NOTE:

When the Gen-Probe APTIMA Combo 2 Urine Collection Kit is not available, collect the urine specimen in an appropriately labeled sterile urine collection cup, free of preservatives.  Store the specimen and transport it to the testing laboratory at room temperature (2-30°C is acceptable).  The specimen must reach the testing laboratory within 24 hours of collection.

E. Collection of Vaginal Specimens

1. Hold the specimen collection swab (pink-shaft swab in package with pink print), placing your thumb and forefinger in the middle of the swab shaft.
2. Carefully insert the swab into the vagina about 2 inches past the introitus and gently rotate the swab for 10 to 30 second. Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab.
3. Withdraw the swab without touching the skin.
4. Place the swab into the APTIMA Combo 2 Vaginal Swab Specimen Collection Kit transport tube so that the tip of the swab is visible below the tube label.
5. Carefully break the swab shaft against the side of the tube. DO NOT spill the contents of the tube.
6. Cap tube.
7. Store and transport at room temperature (2-30° is acceptable).

NOTE:

The Gen-Probe APTIMA Combo 2 Vaginal Swab Collection Kit is the only Collection Kit approved for vaginal specimens.

II.    GROUP A STREPTOCOCCUS (throat)

NOTE:

Throat specimens are the only specimen approved for testing. Collect the specimen using approved swab transport systems

A. Collection Swabs

1. BD Custom (Dry) Swab
2. Molecular Testing Swab
3. Remel Bacti-Swab I/II
4. BD or Copan Liquid Amies Medium with Dacron Tip
5. BD or Copan Liquid Stuarts Medium with Dacron Tip.

B. Procedure

1. Using an appropriately labeled swab(s), swab the posterior pharynx, including any visible lesions and irritated areas. Swab both sides of the throat.
2. Return the swab(s) to the transport container.
3. Store and transport at room temperature (15-25°C).

III.      GROUP B STREPTOCOCCUS (vaginal/rectal, vaginal and rectal)

A. Collection Swabs

1. Molecular Testing Swab
2. BBL Liquid Stuart Culture Swab
3. Liquid Stuart Copan Transystem
4. Liquid Stuart Copan Venturi System
5. Liquid Stuart HealthLink Transporter

NOTE:

This assay includes both the culture of the vaginal/rectal swab specimen in LIM Broth followed by real-time PCR

B. Procedure

1. Insert one molecular testing swab into the distal third of the vagina and sample secretions from the mucosa.
2. Rotate the molecular testing swab for 30 seconds to ensure adequate sampling.
3. Carefully withdraw the molecular testing swab and place into appropriately labeled transport container.
4. Insert second molecular testing swab approximate 2.5 cm beyond the anal/rectal sphincter.
5. Gently rotate at least one full turn to sample anal crypts.
6. Carefully withdraw the molecular testing swab and place into above labeled transport container.
7. Store and transport at room temperature (15-25°C).

IV.    HUMAN PAPILLOMA VIRUS - HPV (cervical scraping/biopsy)

A. Collection Using SurePath Preservative Fluid (ThinLayer)

NOTE:

This collection device is for the PrepStain Pap ThinLayer Smear and HPV molecular testing.

1. Collect the cervical sample according to the Pap smear guidelines using the broom-like collection device provided.
2. Using the thumb and forefinger of a gloved hand, disconnect the head of the device from the handle and insert the head into the appropriately labeled collection vial. Do not touch head of device. Discard handle
3. Tightly cap the vial and shake.
4. Store and transport at room temperature (15-25°C).

B. Collection Using Digene Cervical Sampler.

1. Cervical Brushing

NOTE:

Collect Pap smear specimen (separate collection device) before obtaining specimen for HPV DNA testing. Collect the HPV DNA specimen prior to the application of acetic acid or iodine if a colposcopy is being performed. This collection device is for HPV molecular testing only.

1. Collect the Pap cervical sample according to the Pap smear guidelines using the brush-like collection device provided.
2. Insert the brush to the bottom of an appropriately labeled collection device.
3. Snap off shaft of brush handle at score line. Cap device.
4. Store and transport the specimen at room temperature (15-25°C).

         2.  Cervical Biopsy

1. Collect a fresh cervical biopsy specimen up to 5 mm in cross-section by standard methods.  
2. Immediately place the biopsy specimen into an appropriately labeled collection device.
3. Store and transport the specimen at <-20°C.

C.   Collection Using Cytyc PreservCyt Collection (ThinPrep)

NOTE:

This collection device is for the ThinPrep Pap Smear and HPV molecular testing.

1. Collect the cervical sample according to the Pap smear guidelines using the broom-like collection device provided.
2. Separate the broom part of the device from the handle by pulling apart, leaving the broom in the appropriately labeled collection device.
3. Tightly cap the vial and shake.
4. Store and transport the specimen at room temperature (15-25°C).

V.    MRSA ADMISSION SCREEN

A. Collection Swabs

1. Molecular Testing Swab (preferred).
2. BBL Culture Swab Liquid Stuart. Copan Transystem Liquid Stuart.
3. Copan Venturi Transystem Liquid Stuart.
4. BBL Culture Swab Liquid Amies
5. Copan Venturi Liquid Amies
6. BBL Culture Swab Plus Amies Gel without charcoal
7. Copan Venturi Transystem Amies Gel without charcoal

B. Procedure

1. Using an appropriately labeled swab, insert paired swab approximately 1/2 inch into nostril. Rotate swab against inside of nostril for 3 seconds.
2. Apply light pressure on the outside of the nose while rotating swab.
3. Repeat for other nostril with same paired swab.
4. Return both swabs to same transport tube and submit to lab at room temperature (2-30°C) is acceptable.

NOTE:

A dry swab may be used but must be premoistened with sterile physiological (non-bacteriostatic) saline.

VI.   HERPES SIMPLEX VIRUS - PCR

A. Collection of CSF

1. Aseptically collect CSF into appropriate sterile tubes.
2. Transport 1 mL of CSF to laboratory on ice at 2-8°C.

Revised: 12/29/2011