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AFB cultures on swabs
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Don
medicine forum beginner


Joined: 29 Apr 2005
Posts: 18

PostPosted: Tue Feb 21, 2006 10:40 pm    Post subject: AFB cultures on swabs Reply with quote

Hello all:

I have a micro qusetion, Judy are you the expert?

We ocassionally get tissue "swabs" from the OR. We are a satellite lab so we
send AFB, fungus cultures to the big hospital. We plate routine cultures
in-house and do the gram stains.

My question is this. When we get a "swab" (culturette) from OR with routine,
fungus and AFB cultures on it, should we or should we not culture the
routine, do the grams stain then send the swab out for AFB and fungus?

We have an arguement here that yes, we do that. I say NO. You risk
contamination of the swab (touching it to a non-sterile glass slide from
gram stain). Contamination may make it more difficult to extract AFB
organisms from the swab. I worked a few month years and years ago doing AFB
cultures and this is what I remember.

Any comments, yea or nay? Oh yes, please don't suggest we keep sterile glass
slides. We have a hard time keeping paper towels in the joint.

Thanks,
D
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John Gentile
medicine forum beginner


Joined: 30 Apr 2005
Posts: 40

PostPosted: Wed Feb 22, 2006 4:02 am    Post subject: Re: AFB cultures on swabs Reply with quote

On 2006-02-21 17:40:10 -0500, "Don" <dpagates@verizon.net> said:

Quote:
Hello all:

I have a micro qusetion, Judy are you the expert?

We ocassionally get tissue "swabs" from the OR. We are a satellite lab
so we send AFB, fungus cultures to the big hospital. We plate routine
cultures in-house and do the gram stains.

My question is this. When we get a "swab" (culturette) from OR with
routine, fungus and AFB cultures on it, should we or should we not
culture the routine, do the grams stain then send the swab out for AFB
and fungus?

We have an arguement here that yes, we do that. I say NO. You risk
contamination of the swab (touching it to a non-sterile glass slide
from gram stain). Contamination may make it more difficult to extract
AFB organisms from the swab. I worked a few month years and years ago
doing AFB cultures and this is what I remember.

Any comments, yea or nay? Oh yes, please don't suggest we keep sterile
glass slides. We have a hard time keeping paper towels in the joint.

Thanks,
D

I've worked for many years in our TB lab (before we were downsized and
outsourced). I would say that if they want different cultures they MUST
provide different swabs - 1 each for the TB, the Fungus and the Routine
Bact cultures. It is not only a matter of inhibitors in some of the
media, but also sample quantity. You make a good point about non
sterile slides, but if a GS is necessary then you should attempt to
sterilize the slides. And another question - if this is "tissue" from
the OR then why not send real tissue that can be cut and ground up and
distributed to the different labs - a whole lot better for the quantity
of the specimen and also able to get the organisms IN the tissue not
just ON the tissue.
--
John Gentile, MS M(ASCP)
Laboratory Information Manager
Providence, VAMC
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JEDilworth
medicine forum addict


Joined: 06 May 2005
Posts: 87

PostPosted: Wed Feb 22, 2006 4:05 am    Post subject: Re: AFB cultures on swabs Reply with quote

I am not an expert - I've just worked in micro a helluva long time
[sigh/smile].

Our laboratory does NOT accept swabs for acid fast culture - period. We
reject them. Docs aren't happy, but if they're in the OR, it's easy to
suck up fluids in syringes or send a bit of tissue, which are superior
to swabs in all cases. They are much better specimens. We are slowly
working on our OR's to send liquid or tissue for ALL cultures but it is
an uphill battle. You can grind the tissue, plate the bacterial
cultures, and send the grindings on for AFB.

All fluids must be spun at centifugation appropriate for AFB cultures -
15 minutes at 2500 rpm (not sure of the rpm's - check your AFB
procedures). At a previous lab I worked at, our Ph.D. had us take off
200 ml (if one of those big bottles of pleural fluid or thoracentesis
fluid came down) into four 50 ml conical tubes. We would spin all four,
pour off the supernatant, and combine sediments for culturing (all
performed under a BSC). At my current job, we don't do that, and I think
we should. Obviously you don't get that kind of volume with some fluids.
If specimens are obviously contaminated with bacteria, then we run the
specimen through decontamination procedures.

If your facility insists on accepting swabs, I would insist on the OR
sending you a separate swab for AFB. If they don't, another thing you
can do is this, which actually is a superior way for plating all swab
cultures: vortex the swab in about 0.5 ml saline (a bit more if you're
doing AFB and fungus off of them). Remove the swab. Then, using a
sterile squeegee pipette, use this saline for inoculating your plates
and making your smears. The vortexing loosens the bacteria from the swab
fibers and you will get good recovery this way. That way you can send on
the saline that's left to the main lab for AFB/fungus and you don't have
to worry about contaminating the swab. We were doing this for awhile
(don't really know why we stopped) and had a rack of sterile salines
made up for this purpose ahead of time.

Hope this helps.

Judy Dilworth, M.T. (ASCP)
Microbiology

"Don" <dpagates@verizon.net> wrote in message
news:eFMKf.8376$HU.5393@trnddc04...
Quote:
Hello all:

We occasionally get tissue "swabs" from the OR.
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Don
medicine forum beginner


Joined: 29 Apr 2005
Posts: 18

PostPosted: Fri Apr 07, 2006 2:49 am    Post subject: Re: AFB cultures on swabs Reply with quote

Sorry it took so long for me to get back. Thanks for all your input.


Quote:
Our laboratory does NOT accept swabs for acid fast culture - period. We
reject them. Docs aren't happy, but if they're in the OR, it's easy to
suck up fluids in syringes or send a bit of tissue, which are superior

I wish! OR at our hospital is way "superior" in their God-complex than
anyone else. But I agree, no swabs.


Quote:

If your facility insists on accepting swabs, I would insist on the OR
sending you a separate swab for AFB. If they don't, another thing you
can do is this, which actually is a superior way for plating all swab
cultures: vortex the swab in about 0.5 ml saline (a bit more if you're
doing AFB and fungus off of them).

I like the idea. But it's so much easier for me to just send it along to our
big hospital. I don't plate, GS or anything. I figure the big house's bark
is louder than my bite. But they don't complain.

The point of my original post was more "local". We have techs at our lab -a
satellite, insisting on plating and gram staining. Like we get brownie
points or something. I just prefer to let the experts in Micro at the big
hospital handle it. But I do like the idea of vortexing in sterile saline.



Quote:
Hope this helps.

Judy Dilworth, M.T. (ASCP)
Microbiology

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