Handling Specimens

Lab Services : Handling Specimens

Handling Specimens

Doctor requests a clinical microbiology examination by filling out a complete examination request form.
Patients whose specimens will be taken should not receive antibiotics or be free of antibiotics for at least 3 days.
The specimen will be taken according to the location of infection and store it in a temporary specimen storage area. If there is a delay, delivery within > 2 hours, the specimen will be sent in an appropriate transport medium.
Lab personnel attaches a label that includes the identity and time of specimen collection.
If the specimen is a cito specimen and a critical specimen, the doctor should notify the LMK counter officer beforehand.
Critical specimens include: sterile body fluids (blood, pleural fluid, pericardial fluid, joint fluid, cerebrospinal fluid), eyes (if Pseudomonas aeruginosa and Bacillus sp. grow in culture) and all specimens from the ICU.
A cito examination is including microscopic diphtheria examination, and cito examination as a request of doctor.

Pengelolaan Spesimen

Dokter pengirim melakukan permintaan pemeriksaan mikrobiologi klinik dengan mengisi formulir permintaan pemeriksaan secara lengkap.
Pasien yang akan diambil spesimennya sebaiknya belum mendapat antibiotik atau bebas antibiotik minimal 3 hari.
Petugas pengambil spesimen melakukan pengambilan spesimen sesuai lokasi infeksi dan menyimpan spesimen dalam tempat penyimpanan spesimen sementara, bila terjadi penundaan, pengiriman dalam waktu > 2jam, spesimen dikirimkan dalam medium transpor yang sesuai.
Petugas pengambil spesimen menempelkan label yang mencantumkan identitas dan waktu pengambilan spesimen.
Apabila spesimen merupakan spesimen cito dan spesimen kritis, dokter pengirim terlebih dahulu memberitahukan petugas di LMK.
Spesimen kritis antara lain: cairan tubuh steril (darah, cairan pleura, cairan perikardial, cairan sendi, cairan serebrospinal), mata (apabila pada biakan tumbuh Pseudomonas aeruginosa dan Bacillus sp) dan semua spesimen dari ICU.
Pemeriksaan cito antara lain pemeriksaan difteri mikroskopik, dan specimen cito atas permintaan dokter pemeriksa

Handling Specimen for Molecular Microbiology Examination

Specimen	Medium Transport
Blood EDTA/serum/plasma	at least 1 mL.
Sputum/BAL fluid/pleural fluid /urine/brain fluid/other sterile body fluids	sterile pots at least 1 mL.
Aqueous	in syringe at least 50 µL
Feses	sterile pots at least 250 mg.
Tissue	sterile pots and moistened with physiological fluid (e.g. NaCl 0.9% or Phosphate buffered saline solution) at least 250 mg.
Swab of suspect of viral infection (nasopharynx/ oropharynx/armpit/anal/rectal/vesicle base/ endocervix)	VTM (virus transport media) tubes or in physiological fluid (e.g. NaCl 0.9% or Phosphate buffer saline) at least 250 µL.
Swab of suspect of bacterial infection (nasopharynx/ oropharynx/armpit/anal/rectal/ vesicle base/endocervix)	in physiological fluid (e.g. NaCl 0.9% or Phosphate buffer saline) at least 250 µL
Culture isolate	positive blood culture bottle.

Spesimen	Medium Transpor
Darah EDTA/serum/plasma	Minimal 1 ml
Sputum/cairan BAL/cairan pleura/ urine/cairan otak/cairan tubuh steril lainnya	Pot steril minimal 1 ml
Cairan mata	Minimal 50 µl
Feses	Pot steril minimal 250 mg.
Jaringan	Pot steril dan sudah dibasahi dengan cairan fisiologis (misalnya NaCl 0,9 % atau larutan Phosphate buffer saline) minimal 250 mg.
Swab suspek infeksi virus (nasofaring/ orofaring/ketiak/anal/rektal/dasar vesikel/endoserviks)	VTM (virus transport media) atau di dalam cairan fisiologis (misal NaCl 0,9 % atau Phosphate buffer saline) minimal 250 µL.
Swab suspek infeksi bakteri (nasofaring/ orofaring/ketiak/anal/rektal/dasar vesikel/endoserviks)	Cairan fisiologis (misal NaCl 0,9 % atau Phosphate buffer saline) minimal 250 µL.
Isolat kultur	Botol kultur darah positif.

Specimen Transportation

Agent / Etiology : Bacteria

Specimen	Medium Transport
Feces	Carry-blair, sterile container
Blood	Blood culture bottle
Body fluids other than cerebrospinal fluid	Blood culture bottle
Cerebrospinal fluid	Sterile tube at room temperature
Nasal swab, throat swabs, ear, rectal, vesicular fluid	Amies with or without charcoal
Aspiration for aerobic culture	Sterile tube
Aspiration for anaerobic culture	Thioglycolate medium or sterile tube In anaerobic bag (anaerogen kit)
Urine	Without transport medium, if >2 hours, refrigerated (4-8 degrees Celsius)
Respiratory tract (sputum, BAL), pleural fluid	Without transport medium, cold temperature (4-8 degrees Celsius)

Agent / Etiology : Virus

Spesimen	Medium Transport
Nasal swab, throat, rectal, vesicle fluid, urine	Virus-TM
Blood	EDTA tube
Cerebrospinal fluid, pleural/pericardial fluid, BAL	Sterile tube
Ear swab	Sterile container

Agent / Etiology : Micology

Spesimen	Medium Transport
Feces	Sterile container
Nail, skin, and hair	Sterile containers, or special envelopes for fungi samples.
Other specimens	Same as bacteriological specimens

Penyebab : Bakteri

Spesimen	Medium Transpor
Feses	Carry-blair, kontainer steril
Darah	Botol kultur darah
Cairan tubuh selain cairan serebrospinal	Botol kultur darah
Cairan serebrospinal	Tabung steril dalam suhu kamar
Swab hidung, tenggorok, telinga, rektal, cairan vesikel	Amies dengan atau tanpa charcoal
Aspirasi untuk biakan aerob	Tabung steril
Aspirasi untuk biakan anaerob	Medium tioglikolat atau tabung steril dalam kantong anaerob (anaerogen kit)
Urin	Tanpa medium transpor, bila >2 jam didinginkan (4-8 derajat celcius)
Saluran napas (sputum, BAL), cairan pleura	Tanpa medium transpor, suhu dingin (4-8 derajat celcius)

Penyebab : Virus

Spesimen	Medium Transpor
Swab hidung, tenggorok, rektal, cairan vesikel, urin	Virus-TM
Darah	Tabung EDTA
Cairan serebrospinal, cairan pleura/perikardial, BAL	Kontainer steril
Swab telinga	Kontainer steril

Penyebab : Jamur

Spesimen	Medium Transpor
Feses	Kontainer steril
Kuku, kulit dan rambut	Wadah steril, atau amplop khusus untuk sampel jamur.
Spesimen lain	Sama dengan spesimen bakteriologi

Specimen classification according to critical level

CRITICAL	CITO	ROUTINE
Blood	Diphtheria staining from throat swab	Other than critical and cito specimens
Sterile body fluids (pleural fluid, pericardial fluid, joint fluid, brain fluid)	Microscopic examination of the specimen
All specimens from the intensive care unit (ICU, HCU, ICCU, PICU, Intermediate room, isolation room)	All specimens sent with CITO request by the doctor
Eye specimens (cornea, vitreous, aqueous fluid)
Diphtheria Culture
RT PCR Bordetella pertussis
Stamped "CRITICAL" on the examination request form and the examination sheet	Stamped "CITO" on the examination request form and the examination sheet	Stamped "ROUTINE" on the examination request form and the examination sheet
CRITICAL RESULTS: - Examination results from the critical specimen above - MDR bacteria - All results of nosocomial infections - Sputum with AFB positive in hospitalized patients - All the microbes that included in the outbreak law and potentially outbreak (C.diphtheriae, B.anthracis, Y.pestis, V.cholerae, Yellow fever, virus Influenzae, H5N1, H1N1, Measles) - Results are reported as soon as available	CITO RESULTS: - The results of the examination of the cito specimen above - Results are reported as soon as available	ROUTINE RESULTS: - Results of the routine examination.

KRITIS	CITO	RUTIN
Darah	Pewarnaan difteri dari usap tenggorok	Selain spesimen kritis dan cito
Cairan tubuh steril (cairan pleura, cairan pericardial, cairan sendi, cairan otak)	Pemeriksaan mikroskopik dari spesimen
Semua spesimen yang berasal dari ruang rawat intensif (ICU, HCU, ICCU, PICU, Ruang intermediet, ruang isolasi)	Semua spesimen yang dikirim dengan permintaan CITO oleh dokter pengirim
Spesimen mata (kornea, cairan vitreus, cairan aqueous)
Kultur Difteri
RT PCR Bordetella pertussis
Diberi stempel “KRITIS” pada formulir permintaan pemeriksaan dan lembar tanda pemeriksaan	Diberi stempel “CITO” pada formulir Permintaan pemeriksaan dan lembar tanda pemeriksaan.	Diberi stempel “RUTIN” pada Formulir permintaan pemeriksaan dan lembar tanda pemeriksaan
HASIL KRITIS: - Hasil pemeriksaan dari spesimen kritis tersebut di atas - Bakteri MDR - Semua hasil infeksi nosokomial - Sputum dengan BTA positif pada pasien rawat inap - Semua mikroba yang termasuk dalam undang-undang wabah dan berpotensi wabah (C.diphtheriae, B.anthracis, Y.pestis, V.cholerae, Yellow fever, virus Influenzae, H5N1, H1N1, Measles) - Hasil dilaporkan secepatnya setelah ada hasil	HASIL CITO: - Hasil pemeriksaan dari spesimen cito tersebut di atas - Hasil dilaporkan secepatnya setelah ada hasil	HASIL RUTIN: - Hasil pemeriksa an dari sampel rutin

General criteria of a good quality specimen:

Good Quality Specimen:

Label is include the identity, time of collection, and accompanied by a fully filled request.
The container is suitable and does not leak.
The type of specimen according to the site of infection.
The amount is sufficient.
The time of collection is appropriate.
Delivery within < 2 hours, in case of delay, specimens are received in the appropriate transport medium. Cerebrospinal fluid and anaerobic specimens should be sent immediately.
The patient has not received antibiotics or is free of antibiotics for at least 3 days. If the patient is already taking antibiotics, the patient is asked to return to the laboratory after being free of antibiotics for 3 daysm, except for patients who are sent for evaluation of therapy, such as patients on antituberculosis drug therapy, specimens can still be accepted.
For anaerobic bacteria, specimens are sent in thioglycolate liquid medium or sterile tubes in an anaerobic bag (anaerogen kit).

Spesimen yang Baik:

Label yang mencantumkan identitas, dan waktu pengambilan, dan disertai formulir permintaan yang terisi lengkap.
Wadah yang sesuai dan tidak bocor.
Jenis spesimen sesuai lokasi infeksi.
Jumlah cukup.
Waktu pengambilan yang tepat.
Pengiriman dalam waktu < 2 jam, bila terjadi penundaan, spesimen diterima dalam medium transpor yang sesuai. Spesimen cairan otak dan anaerob harus dikirim segera.
Penderita belum mendapat antibiotik atau bebas antibiotik minimal 3 hari. Jika pasien sudah mengonsumsi antibiotik, maka pasien diminta untuk kembali lagi ke laboratorium setelah bebas antibiotik 3 hari. Pengecualian bagi pasien yang dikirim dalam rangka evaluasi terapi, seperti pasien dalam terapi obat antituberkulosis, maka spesimen masih dapat diterima.
Untuk bakteri anaerob, spesimen dikirim dalam medium cair tioglikolat atau tabung steril dalam kantong anaerob (anaerogen kit).

Location Address

Jl. Pegangsaan Timur no. 16, Cikini
Jakarta Pusat, 10320

Phone : (021) 3160491-2, 31922850, 3100806
email: lmk.fkui.rscm[at]gmail.com

Service Hours

Monday-Friday:
08.00 to 18.00

Saturday:
08.00 to 12.00

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