Transfer pleural, pericardial and synovial fluids aspirated aseptically to a sterile universal container and send to the laboratory without delay.

1. Gently pull the lower eyelid down and swab the conjunctiva in a rolling motion to remove any pus or exudates. Do not touch the eyelid to avoid contamination.

2. Replace the swab in its carrier tube and send it to the lab immediately. Fastidious organisms like Neisseria gonorrhoeae may not be viable if transport is delayed.

1. Using a scoop, collect a small amount of stool (1/4 volume of container), taking care to include materials containing pus, mucus or blood if present.

2. Place the stool into a sterile container, screw the cap tightly and send it immediately to the laboratory.

3. If the faeces is liquid, the container may be filled to one-third full (excessive amount will result in spillage when opened).

Notes: 

• Do not contaminate stool with urine 

• For stool clearance culture in case of typhoid, stool should only be sent upon completion of therapy.

Insert a sterile swab deep into the anus so that the swab may come into contact with some faecal material. A satisfactory rectal swab is one which show some faecal staining.

Note:

• Should only be taken if a stool specimen is not available and for CRE/VRE/ESBL carrier (Charcoal Transport Medium). It is a less satisfactory specimen than stool

This is only done for screening of MRSA carriers.

1. The swab needs to be moistened with sterile saline before sampling. 

2. Swab both the anterior nares (same swab) and insert the swab into the nasal cavity until resistance is met at the level of turbinate (approximately 1 inch into the nose) and gently rotate against the nasal mucosa. Replace the swab in its carrier-tube and send the specimen to the laboratory immediately.

Throat swabs are usually obtained to isolate Group A Streptococcus (Streptococcus pyogenes), Corynebacterium diphtheriae, Arcanobacterium haemolyticum, or Fusobacterium necrophorum.

1. Insert the swab carefully through the mouth with the tongue depressed.

2. Rub the swab over each tonsillar area and the posterior pharynx. Any area with exudate should be touched. Do not touch the           tongue or lips to avoid contamination.

3. If diphtheria is suspected: Lift the edge of the pseudomembrane and swab under it to search for deeply located diphtheria 

    organisms.

4. Obtain at least 2 swabs. Place the swab in its carrier tube and send it to the laboratory immediately.

1. Collect the sputum early in the morning.

2. Rinse the mouth, then breathe in and out deeply three times.

3. Cough deeply and spit directly into a sterile container. Ensure that the expectorate is sputum and not saliva.

4. Send the specimen immediately to the laboratory.

Notes:

- Salivary sputum is unsuitable for culture and will be rejected by the laboratory because saliva may contain normal flora from the upper respiratory tract.

1. Place the specimen which is obtained via bronchoscopy into a sterile container.

2. Send the specimen to the laboratory immediately.

1. This is obtained via suprapubic aspiration (aseptic technique - disinfect the skin with 2% chlorhexidine in 70% alcohol.) or cystoscopically.

2. Collect the urine in a sterile boric acid container (20 ml) or sterile container (3-5 ml) and close it tightly. 

3. Send the specimen immediately to laboratory.

Notes: 

1. Send specimen in sterile container to lab within 2 hours & specimen in sterile boric acid container within 24 hours. Delay 

        in specimen receiving will be rejected as it may cause overgrowth of bacteria & affect result interpretation.

2.     Urine sample volume of 20 ml should be provided for sterile boric acid container. Boric acid preservative prevents 

        degradation of white cell and prevent overgrowth of bacteria. Inadequate volume risk the preservative ratio being toxic to 

        the organisms and thus rejected.  Do not use sterile boric acid container if patient cannot provide 20 ml of urine (e.g.     

        pediatric patients).

1. Should be performed aseptically after initial debridement and cleansing (with sterile water or saline) of the wound. Remove 

    all superficial exudates and necrotic tissues.

2. Collect biopsy (3-4mm) or curette sample from the base or advancing margin of the lesion (leading edge of the lesion) - 

    where pathogens should be present, and colonizing organisms are less likely to occur.

3. Collect tissue specimens and aseptically transfer them into a sterile container with a few drops of normal saline to keep them     moist.

4. Send immediately to the laboratory.

Note:

Unsuitable samples for culture that will be rejected include:

• Slough/necrotic materials

• Tissue sent in formalin

1. Disinfect the skin over the inflamed area with 2% chlorhexidine in 70% alcohol.

2. With a sterile syringe, aspirate the pus or exudates and transfer the pus into a sterile container.

3. Send the specimen immediately to the laboratory.

1. High vaginal swab is obtained to diagnose candidiasis and other causes of vaginitis. It is not a suitable sample to look for Neisseria gonorrhoeae.

2. Using a sterile speculum lubricated with sterile normal saline (do not use antiseptic cream), swab either from the posterior fornix or the lateral wall of the vagina.

3. Inoculate the swab into Amies charcoal transport media and send the specimen to the laboratory as soon as possible.

1. Use a plain sterile swab to collect a specimen from the vagina. 

2. Add 1 ml of sterile saline.

3. Send to lab immediately.  Any delay will cause the organism to lose motility and make identification difficult.

1. Collect fresh diarrheal stool (5gm/5ml) into a sterile container.

2. Send specimen immediately to laboratory.

Notes : 

1. Do not perform repeat testing (within 7  days) during the same episode of diarrhea

2. Do not test stool from asymptomatic patients

3. Do not test stool if patient is on laxatives within previous 48 hours

4. Testing for C.  difficile in ≤12  months old & 1-2 years old with diarrhea not routinely recommended in view of high prevalence of asymptomatic carriage

Reject : Formed or hard stool

1. Collect fresh stool (approximately 5g) in a sterile container.

2. Send to the laboratory immediately.

Note:

• Hard stool is unsuitable for testing and will be rejected by laboratory.

• Reject: Stool from children more than 5 years old.

1. Collect fresh stool (approximately 5g) in a sterile container.

2. Send to the laboratory immediately.

Note:

• Hard stool is unsuitable for testing and will be rejected by laboratory.

Acceptable specimen: Sputum, ETT aspirate, Gastric lavage (paediatric only), respiratory secretions,  urine, CSF and body fluids. Swab specimens and Stool are NOT acceptable.

1. For sputum: Collect a minimum of 3 early morning sputum / spot specimen (1 specimen per day). 

2. Collect in a sterile container.

3. If blood specimen: Withdraw 1-5 ml of blood and put into Myco F Lytic Blood Bottle under aseptic technique.

Note:

• Once positive AFB direct smear, repeated sample within 2 weeks will be rejected.

A sample from the bag is obtained as follows:

1. Disinfect the port of the bag with 70% alcohol.

2. Collect at least 30ml of fluid through the disinfected area using a needle and syringe.

3. Place the sample into a sterile container or / and inject 8-10 ml in each Blood culture bottle (Aerobic and Anaerobic).

4. Send to the laboratory immediately.

Notes:

Repeat samples taken during therapy of CAPD peritonitis is discouraged unless there is clearly no clinical response to treatment or the effluent remains cloudy after 72 hours of the therapy.

1. Remove superficial debris by thorough irrigation and cleansing with non-bacteriostatic sterile saline

2. Gently roll swab over the surface of the wound approximately 5 times, focusing on area where there is evidence of pus or inflamed tissue

3. Surface swabs of deeply infected lesions (e.g: sinus tracks from osteomyelitis, pressure sores) usually grow surface contaminants like Coliforms and Pseudomonas.

Notes: 

Wound swab specimens are generally discouraged. Whenever possible please sent tissue specimen

1. Aseptically, transfer 5ml of disinfectant into a sterile bottle.

2. Send immediately to the laboratory.

1. Collect at least 5 ml of venous blood using a syringe and needle, following the standard method.

2. Fill each of the four blood collection tubes (Nil-Gray Cap, TB1-Green Cap, TB2-Yellow Cap, Mitogen-Purple Cap) with 1 ml of venous blood. Ensure the blood volume falls within the black mark on the tubes. Any tubes with a volume outside of the black mark should be rejected, and blood should be re-drawn for all four tubes.

3. Immediately after filling the tubes, shake them ten times, firmly enough to coat the entire inner surface of the tube with blood and to dissolve antigens on the tube walls. If the tubes are not fully coated with blood, shake all the tubes ten more times. When shaking the blood collection tubes, expect the following:

a. The tubes are fully coated with blood. 

b. The gel plug at the bottom of the tube remains undisturbed.

c. Frothing occurs.

d. You can sense the movement of the blood within the tubes while shaking.

4. The blood tubes must then be incubated at 37°C within 16 hours.

Remarks:

• Too vigarous shaking will cause gel tube detached

• Request will be rejected:

a) The blood volume not within the black mark line

b) Blood received late (after 12pm)

c) Gel detached

1. Send BI test tubes that has gone through the autoclaving cycle together with untreated BI (Control) to the laboratory.

2. Ensure both the BI TEST and BI CONTROL are from the same batch.

Note:  

The same applies to BI test tubes of any brand.

Clean cutaneous and scalp lesions with 70% alcohol prior to sampling as this will improve the chances of detecting fungus on microscopic examination, as well as reducing the likelihood of bacterial contamination of cultures. Prior cleaning is essential if ointments, creams or powders have been applied to the lesion. Skin, nails and hair specimen should be collected into folded squares of paper or directly onto agar plate.

1. Skin

   • Material should be collected from cutaneous lesions by scraping outwards from the margin of the lesion with the edge of a glass microscope slide or a blunt scalpel.

2. Hair

   • Specimen from the scalp should include hair roots, the contents of plugged follicles and skin scales.

   • Hairs should be plucked from the scalp with forceps or the scalp is brushed with a plastic hairbrush and collected onto an agar plate.

3. Nails

   • Nail specimens should be taken from any discoloured, dystrophic or brittle parts of the nail.

   • Specimen should be cut as far as possible from the edge of the nail and should include the full thickness of the nail.

Scrapping of materials from the ear are to be preferred, although swabs can also be used.

1. Material from patients with suspected fungal infections of the cornea (keratomycosis) should be collected by scrapping the ulcer. The entire base of the ulcer, as well as the edges, should be scrapped. (Swab is not suitable for sampling corneal lesions).

2. The material is collected directly onto agar plates for culture and to a glass slide for microscopic examinations.

Drying of slides

Air dry the slides on a rack on bench or in a slide tray with the cover open.

Slides must be dried completely before they are packed and transport to the lab to avoid rejection by laboratory.

*Do not send wet smear

1. Clean the skin surface in the region of the intravascular catheter with the 70% alcohol-soaked cotton swab and withdraw the catheter using sterile forceps. After withdrawal apply pressure to the puncture site.

2. Cut the distal 5cm of the catheter off with sterile scissors and place in a dry, sterile container; transport to the laboratory as soon as possible.

1. Mycobacterium leprae Viability & Drug Sensitivity Test  (Mouse Foot Pad Inoculation)

• Take a minimum size of 4mm x 12mm skin biopsy samples or a minimum of 5 mm punch biopsy.

• Place the samples into sterile screw capped containers without preservatives for mouse foot pad inoculation for culture & sensitivity. 

2. Mycobacterium leprae Viability & Drug Sensitivity Test (PCR)

• Take a minimum size of 4mm x 12mm skin biopsy samples or a minimum of 5mm punch biopsy.

• Place the samples into a sterile screw capped container without preservatives or with 70% ethanol for molecular testing. 

Plain Tube :

1. Draw 3-5 ml of blood into a plain tube with / without gel (without anticoagulants).

2. Clot at ambient temperature.

3. Dispatch to the laboratory within 4 hours of collection for serum separation by centrifugation.

4. For HCV Viral load, request forms must be signed by specialist / consultant.

EDTA Tube :

1. Draw a sufficient amount of blood with the indicated anticoagulant.

2.  This tube contains EDTA as an anticoagulant

3.   After tube has been filled with blood, immediately invert tube several times in order to prevent coagulation.

Lithium Heparin :

1.  Draw a sufficient amount of blood with the indicated anticoagulant.

2.  This tube contains lithium heparin - used for drawing heparinized plasma or whole blood for special tests such as Dihydrorhodamine Test (DHR).

3.   After tube has been filled with blood, immediately invert tube several times in order to prevent coagulation.

Sodium Heparin :

1.   Draw a sufficient amount of blood with the indicated anticoagulant.

2.   This tube contains sodium heparin—used for drawing heparinized plasma or whole blood for special tests such as HLA Cross Matching.

3.   After tube has been filled with blood, immediately invert tube several times in order to prevent coagulation.

Note:  

Haemolysed, icteric or lipaemia specimens invalidate certain tests. If such specimens are received, the samples will be rejected to assure that results are of clinical value.

1. Prior to urine specimen collection, the patient should have not urinated for at least 1 hour.

2. Do not clean the genital area (female patient) or the tip of the penis (male patient).

3. Collect 10 ml of the initial portion of urine stream (first catch) into a sterile container. 

4. Send the specimen to laboratory immediately or in ice pack (2°C-8°C) for longer storage.

5. Request form should be signature by Dermatologist Specialist.

1. Designated clinician to inform Pathologist / MO / SO on-call on specimen collection from Person under investigation (PUI) for EVD.

2. Fill up request forms (PER-PAT301 for tests in EVD RT-PCR) and label containers appropriately. Prepare dispatch list for specimen send to MKAK.

3. Wear appropriate personal protective equipment (PPE) with double gloves.

4. Carry only label container(s) to patient’s room / area for specimen collection. Ensure correct patient identification.

5. Collect 4-5 ml blood in serum separator tube (provided by Serology laboratory).

6. Place the serum separator tube into a water and leak proof secondary container (hardy plastic container) with sufficient absorbent material.

7. Wipe the external surface of the secondary container with 1% sodium hypochlorite and allow to air dry.

8. Place the secondary container into a sturdy; leak-proof outer container (box, flask, Styrofoam box, chiller box) containing ice. Size should not exceed 9 x 9 x 9 inches.

9. Wipe the external surface of the outer container with 1% sodium hypochlorite and allow to air dry.

10. Inform laboratory prior to dispatch. Please check MKAK website for Officer in-charge. The laboratory address is Unit Molekular, Makmal Kesihatan Awam Kebangsaan (MKAK), Lot 1853, Kg. Melayu, 47000 Sungai Buloh, Selangor.

1. Collect 2.5 ml of baby’s blood into EDTA tube (fresh blood taken <48 hours) at birth and at 2     weeks of life.  

2. Send together with mother’s blood (2.5 ml of blood in EDTA tube; fresh blood taken <48 hours (except abandon babies).

3. Send the specimen to laboratory immediately.

1. Collect 2.5 ml of blood each into 2 EDTA tubes freshly blood taking.

2. Should inform Microbiologist before sending a sample.

1. Collect 2.5 ml of blood each into 2 EDTA tubes.

2. Send the specimen to laboratory immediately.

3. Forms must be signed by a specialist / consultant.

1. Collect 2.5 ml of blood into  EDTA tube.

2. Send the specimen to laboratory immediately.

3. Need gastro-hepatologist signature and must be attached with Hep C Viral Load result .

1. Collect a minimum of 0.3 ml of the aspirated sample.

2. Place specimen into an empty sterile sterile container.

3. Send directly to laboratory within 2 hours after collection.

1. An appointment is required for all the tests.

2. Please call 03-26162782 / 2581 / 2587 (IMR).

3. Collect 6 ml blood for anaemic patient and 15 ml blood for patient with TWBC < 1.5 x 103cells / ml.

4. Patient must not have blood transfusion 3 weeks preceding blood collection. Sample should be taken a day before transportation.

1. Carefully insert the swab into patient’s nostril. The swab tip should be inserted up to an inch from the edge of the nostril.

2. Dap along the lining of the nostril to ensure that both mucus and cells are collected. Turn the swab several times and remove the swab.

3. Repeat at the other nostril using the same swab tip.

1. Sputum is preferably collected when the patient first wakes up in the morning after a deep cough or after a session of physiotherapy.

2. Ask the patient to cough deeply and spit directly into a sterile universal bottle. Ensure that the expectorate is sputum and not saliva.

3. Send the specimens in ice to the laboratory as soon as possible in triple packaging. Keep specimens at 4°C. If delay is unavoidable, store it in a refrigerator.

Note:

Send nasopharyngeal aspirate, trans tracheal aspirate or lung aspirate whenever possible or indicated.  These specimens are more representative of the lower respiratory tract and are devoid of contaminants from the mouth.

1. Collect the specimen through a tracheostomy or endotracheal tube (ETT).

2. Carefully pass the catheter through the site and into the trachea.

3. Aspirate material from the trachea using a syringe or an intermittent suction device.

4. Place the specimen in sterile container.

1. Specimen can be obtained by inhalation of hypertonic saline using ultrasonic nebulizers for 20 minutes.

2. Collect the specimen in sterile container.

3. Send the specimen to laboratory immediately.

Transfer pleural aspirated aseptically to a sterile universal container and send to the laboratory without delay.

1. An appointment from IMR is required for all tests related to PID.

2. Please call 03-26162782 during office hour, and provides:

3. Details of the patient and test required

4. Contact details i.e. telephone number(s) and email address

5. On the date of appointment, collect all the specimens. Refer Appendix 25.

6. Label and pack all the specimens in biohazard plastic together with PID screening request form.

7. Then, keep all specimens and form into an envelope and write full address on it (Allergy & Immunology Research Centre, Institute for Medical Research (IMR), Jalan Pahang, KL). Please make a note on the envelope, this specimen must be sent WITHOUT ice.

8. Send to Biochemistry laboratory, and pass it to on-call staff for recording 

9. MUST ARRIVED BEFORE 6.00 am.

10. Samples should reach the PID laboratory, AIRC, IMR by 12 noon.

11. Blood must be processed within 24 hours of withdrawal.

1. Insert rectal swab 4-6 cm into rectum.

2. Roll swab against rectal mucosa, avoid excessive stool sampling.

3. Break swab off into a vial of viral transport medium. The swab must remain in the VTM. 

4. Tightly recap the vial of VTM. 

5. Send the specimen to laboratory immediately.

1. Wipe vesicle with saline.

2. Disrupt vesicle and collect fluid with swab. Using the same swab, collect cells from base of lesion. 

3. Place the swab immediately into a viral transport media (VTM) and break applicator sticks off near the tip to permit tightening of the cap 

4. Send the specimen to laboratory immediately.

1. Wipe area with sterile saline.

2. Aspirate fluid from vesicle using a sterile needle.

3. Immediately rinse the syringe in 1-2 ml of VTM.

1. Put the patient in the sitting position. Ask the patient to tilt the head slightly and open the mouth.

2. Depress the tongue with tongue depressor. Use a sweeping motion to swab the posterior pharyngeal wall and tonsillar pillars. Have the subject say “aah” to elevate the uvula. (Use sterile Dacron or rayon swab with plastic shaft. DO NOT use calcium alginate or cotton swab or ones with wooden sticks).

3. Avoid swabbing the soft palate and do not touch the tongue with the swab tip. (N.B. This procedure can induce the gag reflex).

4. Place the swab immediately into a VTM and break applicator sticks off near the tip to permit tightening of the cap. Transport with ice.

All special and appointment-oriented tests should be discussed between the doctor and the laboratory personnel to clarify, investigate and make an appropriate date for sending the specimens to the laboratories that are doing the tests such as IMR, HKL, MKAK Sg. Buloh and   Hospital Sg. Buloh.

Collect faeces into a sterile / clean wide-mouth screw-capped plastic container and send to the laboratory without delay.

1. Collect two (2) adult thumb size (10 mg) stool specimens, 24 hours apart, into sterile container within a 2-week period.

2. Send the specimen to laboratory immediately.

Note: 

Rectal swab not encouraged. Specimen should be collected within 14 days after onset of illness. 

1. If possible, sample should consist of both the middle and the edge section of the tissue.

2. Small sample of minimum roughly 0.3 cm size is appropriate.

3. Place tissue in an empty sterile container and do not add formalin into the specimen.

4. Sent directly to laboratory within 2 hours after being taken.

Specific guidelines:

1. Specimen should be sealed and send directly to Serology Laboratory.

2. Chain of custody should be maintained at all times and record book should accompany the samples.

Note:

Sample collection of various tests should follow the guidelines as of normal microbiological requirements and the specific headings are referred.

Aqueous Humor:

1.       An ophthalmologist performs a sterile anterior chamber paracentesis using a fine needle to aspirate approximately 200 μL of aqueous humor.

2.       The collected fluid is transferred to a sterile, screw-top tube for transport.

Vitreous Humor:

1.       A vitreous sample is collected during a diagnostic vitrectomy, a surgical procedure to remove a portion of the vitreous gel.

2.       This sample is also transferred to a sterile, screw-top tube.