Surface Wound Culture Collections Source Test Name Additional names Specimen Requirements Collection Container
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1 Wound Collections Catheter Insert/Exit Site C&S (Routine ) Swab of vascular catheter insertion/exit site. CUCATHSITE/ Catheter Site C&S Catheter Insert/Exit Site Swab of vascular catheter insertion/exit site. CUCATHSITE/ Catheter Site C&S Catheter Insert/Exit Site Catheter Insert/Exit Site MRSA Screen (ARO) CPO Screen (ARO) (outbreak/exposure) Methicillin resistant Staphylococcus aureus Carbapenemase producing organism Swab of vascular catheter insertion/exit site. Swab of vascular catheter insertion/exit site. CUMRSAIV/ ARO MRSA IV Insertion Site Methicillin Resistant strains of Staphylococcus aureus CUCPOOUTBREAK/ARO CPO Xposure Carbapenemase producing organisms Catheter Tip/Line C&S (Routine ) Clip 5cm off the distal tip of catheter using sterile scissors. CUIVLINE/ Catheter Tip C&S Order includes semi quantitative culture Accurate interpretation of catheter tip cultures is best if concurrent blood culture is taken at time of line removal. Page 1 of 11 Wound s Sept 2015
2 Wound Collections Catheter Tip/Line Catheter Insert /Exit Site (Non-Vascular) C&S (Routine ) Clip 5cm off the distal tip of catheter using sterile scissors. Swab of non-vascular catheter,tube or drain insertion or exit site. Non-vascular catheters include peritoneal, pigtail and technoff. Tube/Drain examples include axiom, chest, feeding (PEG), hemovac, G or J tube, malecot, penrose, saratoga, T-tube (bilary). If indwelling foley catheter insertion site, please see "Urethra" CUIVLINE/ Catheter Tip C&S Order includes semi quantitative culture Accurate interpretation of catheter tip cultures is best if concurrent blood culture is taken at time of line removal. CUCATHSITEN/ Catheter Site (NonVascular)C&S If indwelling foley catheter insertion site, please see "Urethra" Catheter Insert/Exit Site (Non-Vascular) Swab of non-vascular catheter,tube or drain insertion or exit site. Non-vascular catheters include peritoneal, pigtail and technoff. If indwelling foley catheter insertion site, please see "Urethra" CUCATHSITEN/ Catheter Site (NonVascular)C&S If indwelling foley catheter insertion site, please see "Urethra" Page 2 of 11 Wound s Sept 2015
3 Wound Collections Catheter Tip/Line (Non- C&S (Routine ) Tips of non-vascular catheters Vascular) or drain tubes are not suitable specimens for culture, and will be rejected. Non-vascular catheters include peritoneal, pigtail and technoff. Tube/Drain examples include axiom, chest, feeding (PEG), hemovac, G or J tube, malecot, penrose, saratoga, T-tube (bilary). If a indwelling foley catheter tip, a urine specimen should be submitted No testing done Catheter Tip/Line (Non- Vascular) Tips of non-vascular catheters or drain tubes are not suitable specimens for culture, and will be rejected. Non-vascular catheters include peritoneal, pigtail and technoff. Tube/Drain examples include axiom, chest, feeding (PEG), hemovac, G or J tube, malecot, penrose, saratoga, T-tube (bilary). If a indwelling foley catheter tip, a urine specimen should be submitted No testing done Hair Fungus (Dermatophytes) Ringworm (Tinea) Collect affected hairs with the base of the shaft intact if possible. or paper dermatophyte collection kit Refrigerate specimen (4ºC) Transport to lab (at room temperature) within MYCHAIR/ Fungus- Hair Page 3 of 11 Wound s Sept 2015
4 Wound Collections Hair Parasite Lice Exam/Identification Nail/ Nail Clippings Fungus (Dermatophytes) Onychomycosis Using gauze, wipe nail with 70% alcohol. Clip a generous portion of affected area. Skin- Intact Skin C&S (Routine ) Impetigo Swab of skin surface that has had no break in skin integrity. Includes sources such as acne, boil, mild cellulitis, eczema, folliculitis, impetigo, lesion, phlebitis, rash, skin, skin fold. Skin- Intact Skin Skin- Intact Skin MRSA Screen (ARO) Methicillin Resistant Staph aureus Swab of skin surface that has had no break in skin integrity. Includes sources such as acne, boil, mild cellulitis, eczema, folliculitis, impetigo, lesion, phlebitis, rash, skin, skin fold. Swab of groin/perianal area. Using one swab, firmly swab both groins starting at the front of the groin area and extending right back almost to the anus. or paper dermatophyte collection kit Store at room temperature Refrigerate specimen (4ºC) Transport to lab (at room temperature) within PARASCLI/ Parasite-Scabies/Lice Exam MYCNAIL/ Fungus- Nail/Nail Clippings CUSKIN/ Wound C&S- Skin (Intact ) CUSKIN/ Wound C&S- Skin (Intact ) CUMRSAGROIN/ ARO MRSA Groin/Perianal Methicillin Resistant strains of Staphylococcus aureus Complete PHSA Laboratories Parasitology Requisition Page 4 of 11 Wound s Sept 2015
5 Wound Collections Skin- Intact Skin Virus Detection/ PCR (NAAT) Skin- Intact Skin Skin Scrapings Skin Scrapings Virus Detection/ PCR (NAAT) Fungus (Dermatophytes) Parasite Exam/Identification Herpes Virus (HSV) Varicella Virus (VSV) Poxvirus Vaccinia Smallpox Athlete's Foot Malassezia Ringworm (Tinea) Jock Itch Scabies Includes vesicular lesions on skin in genital region. Unroof the lesion with a tuberculin syringe or broken edge of a sterile swab shaft. Swab the broken blister and place swab into. Alternately, the contents of the lesion may be aspirated with the syringe and transferred directly to the vile of transport medium. Consult with microbiologist Cleanse the skin with 70% alcohol to reduce bacterial contamination. Gently scrape the skin surface at the active margin on the lesion. Do not draw blood. If scalp, gently scraping with a sterile toothbrush or small brush works well. Scabies investigation: Add one or two drops mineral oil to suspected lesion, using sterile scalpel blade or microscope slide, scrape skin vigorously to remove top of papule and expose end of tract. Alternately mount scrapings between two slides with mineral oil. UTM Universal Transport Medium for Virus UTM Universal Transport Medium for Virus or paper dermatophyte collection kit Refrigerate specimen (4ºC) Transport to lab (at room temperature) within Store at room temperature VIRSKIN/ Virus Detection Skin/Lesion Order includes detection of Herpes (HSV) and Varicella (VSV) viruses If smallpox or vaccinia suspected, contact a microbiologist immediately VIRSKIN/ Virus Detection Skin/Lesion/Wound If smallpox or vaccinia suspected, contact a microbiologist immediately MYCSKIN/ Fungus- Skin Scrapings PARASCLI/ Parasite-Scabies/Lice Exam Complete PHSA Laboratories Virology Requisition Complete PHSA Laboratories Virology Requisition Complete PHSA Laboratories Parasitology Requisition Page 5 of 11 Wound s Sept 2015
6 Wound Collections Tube/ Drain Insertion/Exit C&S (Routine Site ) Tube/Drain Insertion/Exit Site Ulcer C&S (Routine ) Use swab to collect exudate/pus. Avoid touching skin/catheter/drain with swab. Tube/Drain site examples include axiom, chest, feeding (PEG), hemovac, G or J tube, malecot, penrose, saratoga, T- tube (bilary). Use swab to collect exudate/pus. Avoid touching skin/catheter /drain with swab. Tube/Drain site examples include axiom, chest, feeding (PEG), hemovac, G or J tube, malecot, penrose, saratoga, T- tube (bilary). Site preparation is critical to proper culture interpretation touching contaminating skin with swab. CUTUBESITE/ Wound C&S- Tube/Drain Site CUTUBESITE/ Wound C&S- Tube/Drain Site Please indicate type of ulcer e.g. decubitus, diabetic. Consult microbiologist if genital ulcer and Hemophilus ducreyi (Chanchroid) requested Page 6 of 11 Wound s Sept 2015
7 Wound Collections Ulcer Site preparation is critical to proper culture interpretation touching contaminating skin with swab. Please indicate type of ulcer e.g. decubitus, diabetic Wound- Ulcer C&S (Routine ) Site preparation is critical to proper culture interpretation touching contaminating skin with swab. If Anthrax or Francisella (Tularemia) is suspected, consult microbiologist before collecting specimen, as special laboratory precautions are required. Wound- Ulcer Site preparation is critical to proper culture interpretation touching contaminating skin with swab. Please indicate type of ulcer e.g. decubitus, diabetic Consult microbiologist if genital ulcer and Hemophilus ducreyi (Chanchroid) requested Please indicate type of ulcer e.g. decubitus, diabetic Page 7 of 11 Wound s Sept 2015
8 Wound Collections Wound- Abscess (Pus) C&S (Routine ) Tonsillar abscess Swab (Quinsy) Wound- Abscess (Pus) Swab Wound- Skin Broken C&S (Routine ) Proper preparation of site prior to specimen collection is critical for accurate culture interpretation. Cleanse site, wiping away any surface exudate with sterile Pass swab deep into lesion, firmly sampling the advancing margin. Swabs are suboptimal specimens. Aspirated pus is specimen of choice. Proper preparation of site prior to specimen collection is critical for accurate culture interpretation. Cleanse site, wiping away any surface exudate with sterile Pass swab deep into lesion, firmly sampling the advancing margin. Swabs are suboptimal specimens. Aspirated pus is specimen of choice. Swab of skin surface that has lost some skin integrity including sources such as abrasion, blister, carbuncle, laceration, hematoma, insect bite, superficial burns and ulcers. Site preparation is critical to culture interpretation. touching swab to contaminating skin. CUABSCESS/ Wound C&S- Abscess/Pus (Swab) Anaerobic culture will be done on aspirated specimens CUABSCESS/ Wound C&S- Abscess/Pus (Swab) Anaerobic culture will be done on aspirated specimens CUWOUND/ Wound C&S- Skin (Broken ) If specimen collected from an ulcer Both orders includes Gram stain and culture Please indicate source of wound and any relevant clinical history Page 8 of 11 Wound s Sept 2015
9 Wound Collections Wound- Skin Broken Wound- Skin Broken Wound- Skin Broken Wound- Skin Intact Wound- Skin Intact MRSA Screen (ARO) CPO Screen (ARO) (outbreak/exposure)) Methicillin Resistant Staph aureus Carbapenemase producing organism Swab of skin surface that lost some skin integrity including sources such as abrasion, blister, carbuncle, laceration, hematoma, insect bite, superficial burns and ulcers. Site preparation is critical to proper culture interpretation touching contaminating skin with swab. Swab of one open draining wound. Swab of one open draining wound. C&S (Routine ) Impetigo Swab of skin surface that has had no break in skin integrity. Includes sources such as acne, boil,mild cellulitis, eczema, folliculitis, impetigo, lesion, phlebitis, rash, skin, skin fold. Swab of skin surface that has had no break in skin integrity. Includes sources such as acne, boil, mild cellulitis, eczema, folliculitis, impetigo, lesion, phlebitis, rash, skin, skin fold. CUWOUND/ Wound C&S- Skin (Broken ) If specimen collected from an ulcer Both orders includes Gram stain and culture Please indicate source of wound and any relevant clinical history CUMRSAWOUND/ ARO MRSA Open Wound Methicillin Resistant strains of Staphylococcus aureus CUCPOOUTBREAK/ARO CPO Xposure Carbapenemase producing organisms CUSKIN/ Wound C&S- Skin (Intact ) CUSKIN/ Wound C&S- Skin (Intact ) Page 9 of 11 Wound s Sept 2015
10 Wound Collections Wound- Skin Intact MRSA Screen (ARO) Submit individual swab of each open draining wound site Wound- Skin Broken MRSA Screen (ARO) Methicillin Resistant Staph aureus Methicillin Resistant Staph aureus Abscess (Pus) Swab C&S (Routine ) Quinsy (Tonsillar abscess) Abscess (Pus) Swab Swab of one open draining wound. Proper preparation of site prior to specimen collection is critical for accurate culture interpretation. Cleanse site, wiping away any surface exudate with sterile Pass swab deep into lesion, firmly sampling the advancing margin. Swabs are suboptimal specimens. Aspirated pus is specimen of choice. Proper preparation of site prior to specimen collection is critical for accurate culture interpretation. Cleanse site, wiping away any surface exudate with sterile Pass swab deep into lesion, firmly sampling the advancing margin. Swabs are suboptimal specimens. Aspirated pus is specimen of choice. CUMRSAGROIN/ ARO MRSA Groin/Perianal Methicillin Resistant strains of Staphylococcus aureus CUMRSAWOUND/ ARO MRSA Open Wound Methicillin Resistant strains of Staphylococcus aureus CUABSCESS/ Wound C&S- Abscess/Pus (Swab) Anaerobic culture will be done on aspirated specimens CUABSCESS/ Wound C&S- Abscess/Pus (Swab) Anaerobic culture will be done on aspirated specimens Page 10 of 11 Wound s Sept 2015
11 Wound Collections Fluid- Drainage Tube C&S (Routine ) Includes drain material from axiom tube, chest tube, gastric, pigtail, hemovac, JP drain, malecot, penrose, saratoga, T-tube. Aseptically collect fluid from disinfected drainage tube. Do not collect specimen that has pooled into the collection reservoir. Fluid- Drainage Tube Includes drain material from axiom tube, chest tube, gastric, pigtail, hemovac, JP drain, malecot, penrose, saratoga, T-tube. Aseptically collect fluid from disinfected drainage tube. Do not collect specimen that has pooled into the collection reservoir. Do NOT submit specimen in a syringe Do NOT submit specimen in a syringe CUFLUIDD/ Fluid/Aspirate C&S- PO Drain CUFLUIDD/ Fluid/Aspirate C&S- PO Drain Page 11 of 11 Wound s Sept 2015
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