Don’t routinely send specimens for testing or screening (e.g., for methicillin-resistant Staphylococcus aureus [MRSA]) unless clinical evidence of infection is present (e.g., for incisions or eyes). If the highest quality specimen that can be obtained is through a swab of infected skin, tissue or wound, cleanse the area with sterile saline beforehand to reduce surface contaminants. Do not take a specimen of the discharge unless it is specifically ordered. Improperly collected or poor-quality specimens (including swabs) can reduce patient safety by prompting antimicrobial therapy (in cases of colonization) and increase laboratory and pharmacy expenses. To promote sensible antimicrobial use and optimize the treatment of infected patients, while reducing unnecessary microbiology lab workup, attention should be paid to appropriate specimen collection.
Sources:
Avdic E, et al. The role of the microbiology laboratory in antimicrobial stewardship programs. Infect Dis Clin North Am. 2014 Jun;28(2):215-35. PMID: 24857389.
Bonham P. Swab cultures for diagnosing wound infections: a literature review and clinical guideline. J Wound Ostomy Continence Nurs. 2009 Jul-Aug;36(4):389-95. PMID: 19609159.
MacVane SH, et al. The Role of Antimicrobial Stewardship in the Clinical Microbiology Laboratory: Stepping Up to the Plate. Open Forum Infect Dis. 2016 Sep 21;3(4):ofw201. PMID: 27975076.
Miller JM. Poorly Collected Specimens May Have a Negative Impact on Your Antibiotic Stewardship Program. Clinical Microbiology Newsletter. 2016 Mar 15:38(6);43-8.
Morency-Potvin P, et al. Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship. Clin Microbiol Rev. 2016 Dec 14;30(1):381-407. PMID: 27974411.
Registered Nurses’ Association of Ontario. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition [Internet]. 2016 [cited 2017 Nov 1].