This protocol outlines the procedure to follow when an unacceptable specimen is received for microbial studies.
1. Obtain a new specimen or consult with the physician/nurse before rejecting and/or discarding any specimen that appears to be improperly collected, transported or is unacceptable in any way. Refer to “Specimen Handling: Identification, Integrity & Rejection” in the Quality Assurance Manual.
A. New specimen obtained
a. Discard the unacceptable specimen if a new specimen can be obtained.
b. State that a new specimen was requested and explain why the rejected specimen is unacceptable on the requisition.
1. If the specimen is from a hospital site: send one copy of the requisition to the hospital site for crediting and file one copy in the specimen rejection/problem folder in the Microbiology charges drawer.
2. If the specimen is from an outpatient: do not bill and file in the specimen rejection/problem folder in the Microbiology charges drawer.
B. New specimen not obtained
a. Process the specimen as requested if a new specimen cannot be obtained and the physician/nurse wants the specimen processed. Document on the requisition the date, time and initials of the person called and who requested the work-up of the unacceptable specimen.
b. Final the report when the work-up is completed with the appropriate disclaimer of why the specimen was unacceptable.
2. Make every effort to diplomatically correct the situation if a questionable specimen is received in order to benefit the patient and maintain harmony with fellow employees.
Criteria for Rejection:
Action and/or Note:
1. Discrepancy between physician’s written orders and the requisition.
Consult with sender for resolution.
2. Necessary paperwork not submitted with specimen (i.e.- requisition)
Request necessary paper work needed from sender.
3. Insufficient quantity of specimen received for the procedures requested.
Consult with the physician to determine which procedures should be performed or to obtain additional specimen. See SPF.
a. Discrepancy between patient identification on the requisition and specimen container.
b. No identification on container.
c. Specimen source or type of culture ordered not on requisition
d. Specimen identified by anatomic site only (i.e.-chest, leg, etc.)
a. Consult with sender for resolution. If discrepancy remains unresolved, the specimen is processed but no report issued. See SPF.
b. Request sender to identify and label
c. Consult with sender for necessary
d. Consult with sender for more specific
5. Specimen not labeled with date and time of collection or time of collection.
Disclaimer with the following on the requisition and Vitek report:
“DISCLAIMER: TIME OF SPECIMEN
COLLECTION NOT PROVIDED.”
“DISCLAIMER: DATE AND TIME OF SPECIMEN COLLECTION NOT PROVIDED”
6. Urine and sputum specimens held for more than 2 hours at room temperature from time of collection to media inoculation.
Request new specimen and explain why. See SPF.
7. Leaky or contaminated specimen container.
a. Put on gloves.
b. Decontaminate the outside of the container with a 1:10 dilution of bleach.
c. Reprint the requisition if the original has been contaminated. Discard the contaminated requisition in the appropriate waste container.
d. Process the specimen as usual.
8. Specimen submitted on dry swab (no transport media).
a. Do not process the specimen (Exception-Specimens for Strep screens are acceptable on a dry swab.)
b. Notify sender and request a new specimen. See SPF.
c. If a new specimen cannot be obtained, process the specimen. Disclaimer with "Specimen transported on dry swab - unacceptable for culture" on the requisition and Vitek report.
9. Anaerobe culture requested on an inappropriate source (sputum, stool, vagina, bronchial washing, urine midstream or catheterized, throat, etc.)
a. Discuss the request with the physician. Explain that the specimen has been contaminated with normal flora anaerobes so an anaerobic culture is not appropriate.
b. Process anaerobically if the physician still wants the culture after the above discussion.
10. Bacteriology specimen submitted in Histology/Cytology preservative (i.e. Muccolex, formalin, etc…).
Request new specimen and explain why. See SPF.
11. Sputum cultures with a composite Q score <+1.
If the Composite Q score is <+1, examine the smear no further and proceed as follows:
a. Cancel or credit the Culture charge and order or charge a Gram Stain. Charge a Stat charge if the Gram Stain was ordered Stat.
b. Report as "Specimen not representative of lower respiratory secretions. Please recollect" on the Gram Stain requisition and release these results to the nursing unit.
c. Call the results to the appropriate personnel; explain why the specimen is unacceptable and request a new specimen. Document the call.
d. Retrieve the culture plates from the incubator and discard them.
12. Cultures for N. gonorrhoeae (vagina, urethra, throat, etc.) that have been in transport more than 48 hours or refrigerated.
a. Obtain new specimen. See SPF.
b. Report “Specimen is unacceptable for culture of N. gonorrhoeae due to improper handling.” on the requisition. Return the requisition to the sender.
c. If a new specimen cannot be obtained process the specimen. Disclaimer with "Specimen is unacceptable for culture of N. gonorrhoeae due to improper handling. A false negative result may occur." on the requisition and Vitek report.
13. Stool culture specimen not in Cary Blair Transport Media. Fresh unpreserved specimens must be plated or placed in transport media within two hours after collection.
Obtain a new specimen in Cary Blair Transport Media if more than two hours has elapsed. See SPF.
14. Ova and Parasite Specimens:
a. Visible barium or oil present in specimen.
b. Fresh unpreserved specimens must be examined or placed in fixatives within one hour after collection.
1. Cumitech 9 Collection and Processing of Bacteriological Specimens, Isenberg, Henry D., American Society for Microbiology, Washington, D.C., August 1979, pp 1-4
2. Bacteriology Laboratory Procedure Manual, 11th Ed. 1976, Mayo Clinic, Rochester, Minnesota, p 52
3. Manual of Clinical Microbiology, 6th Edition, American Society of Microbiology, Washington, D.C., 1995, pp 19-30
4. Diagnostic Microbiology, Finegold Sydney, CV Mosby Company, St. Louis, 1978,
5. Microscopic and Bacteriological Comparison of Paired Sputa and Transtracheal Aspirates, Gerkler, R.W., et al, Journal Clinical Microbiology, 1977, pp 396-399
6. Bailey and Scott’s Diagnostic Microbiology, Mosby, 8th Edition, p 19
i. 6-2-81 J. Schaefer/E. Steiner
ii. 6-7-84 E. Steiner (Revised: 11.)
iii. 10-7-85 D. Smothers (Revised: 1-3., 7b., 13a., 13b.)
iv. 3-15-87 B. Dunham (Revised: 13. transport media for stool cultures)
v. September 1991 A. Hall (Revised: C5a. Disclaimer, 13.)
vi. J. Wedig (Revised: 1, 12 revised)
vii. August 1995 C. Harms (Revised: 13 revised)
viii. September 1996 C. Harms (Revised: 4., 14., 11., disclaimer #8 and 12 .added)
April 2010 C. Pregler (Revised: II.1.B.a-b.)
April 2011 C. Brindle (Revised: SPF links added)
January 2012 S. Hafenbredl (no changes)