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Changes simplify respiratory culture ordering and receiving

04 Mar 2018

One code helps Specimen Management; changes highlighted



By: Renee Gerros, MT, Senior Microbiology Specialist and Clark McDonald, MD, Laboratory Medical Director

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If your work involves respiratory culture orders, please note the following changes that began on Feb. 19. A need was shown to simplify the ordering and receiving process to allow Specimen Management to handle all samples the same -- leading to one orderable code, the ability to receive all samples immediately and simplification of the Gram strain screening process. Questions? Contact information at bottom.

Changes from current policies in BOLD 

  • Respiratory cultures will be orderable only by the Epic code LAB7032, Culture, Respiratory/Gram Stain (Lab test code RESPC).
  • This test is for culture requests on expectorated sputum, tracheal aspirate, mini-BAL, BAL, bronchial wash and bronchial biopsy.
  • All samples sent to the laboratory will be received into the computer systems so the ordering source will know the status of the request.  
  • Because expectorated sputa and aspirated tracheal secretions are superficially contaminated with upper-airway flora, microscopic screening of specimens reduces the production of potentially misleading information and increases the diagnostic utility of culture results. These samples will continue to be screened for culture acceptance per the following guidelines (best practice policy and a CAP requirement):
    • Rare or no organisms seen are not cultured. Not indicative of bacterial infection.
    • Greater than 10 squamous epithelial cells/lpf indicates oropharyngeal contamination and re-collection is recommended if clinically indicated. Phone calls for re-collection will no longer be made.
    • Any sample with a predominate morphotype (bacteria) seen on Gram stain is cultured when Polys are present, regardless of epithelial cells.

Questions? Refer to the link below, or contact Dr. McDonald at 503-814-3357 or Renee Gerros at 503-814-1640.  

http://jcm.asm.org/content/49/9_Supplement/S30.full

Lower Respiratory Tract Infections. Coordinating ed. S.E. Sharp. American Society for Microbiology, Washington D.C Cumitech 7B. 2004.