Sputum is the routine specimen that as laboratory practitioner you must know how to collect it and how to transport it. Let continue to discuss this Sputum collection.
In this article you will learn:
- Introduction to sputum collection
- Spot sputum Collection (Immediate Specimen)
- Early Morning Sputum Collection (Next Day)
- Sputum collection container
- Transporting of Sputum Specimen
- Sputum is a substance that is brought up from the lungs and airway when a person coughs or spits. It is usually a mixture of saliva and mucus.
- A sputum specimen is needed for identifying pathogens causing infection in the respiratory tract.
- The sputum is collected by coughing up, and is therefore contaminated with a small number of commensal micro-organisms from the upper respiratory tract and mouth.
- The commensal micro-organism has to be differentiated from the pathogens causing infection.
- A sputum sample is best collected in the morning after waking up.
- A clean container with a wide mouth is used to collect sputum.
The health worker needs to instruct the patient to collect two sputum specimens:
- Spot collection.
- Early morning sputum collection the next day.
Spot sputum Collection (Immediate Specimen)
Instructions when collecting spot sputum specimen;
- Advise patient to rinse mouth.
- Coach the patient from behind.
- Instruct the patient to cough sputum into the container (This exercise should take place in a well ventilated environment preferably in the open air/outdoors).
- Verify that sample should contains sputum and not saliva.
- Send the specimen to the laboratory.
- Send patient home with a container for a first morning sputum the next day.
Early Morning Sputum Collection (Next Day)
- Early morning sputum sample usually has the highest yield of Acid Fast Bacilli.
- Instruct the patient to produce early morning sputum just like it has been done today on the spot collection.
- Emphasize that the patient brings morning specimen to health unit within 24 hours after producing the sample.
Instruct the patient on how to go about collecting a sputum sample at home, outside of the clinic. Demonstrate giving the following instructions to the patient;
- Drink plenty of fluid/water the night before collection if possible.
- Sit upright to collect sputum of the first cough in the morning.
- Rinse mouth with water (if possible), but do not brush teeth before collecting sputum.
- Unscrew the lid and hold the container very close to mouth.
- Take a few deep breaths and on the third breath cough deeply from within the chest.
- Do not contaminate the rim of the container with sputum.
- Do not expectorate any saliva or postnasal discharge.
- Close lid tightly and return sample to the laboratory.
Precautions during Collection of Sputum Specimen
- The patient who is coughing is of a greater danger to staff than the specimen.
- When collecting and receiving the specimen be sure to adhere to infection prevention and control standards.
- Collect specimen in a well-ventilated area, preferably outdoors in the sunlight.
- Ensure that no one stands in front of the patient while producing sputum.
- Ensure container is labelled and closed firmly with lid after the specimen is collected.
- Wash your hands with antiseptic after collecting specimen.
Sputum collection container
Use an appropriate container,
- Wide mouthed.
- Leak proof with a screw cap.
- Should be transparent.
- Single use / disposable.
- 30-50 ml capacity.
- Sides and walls that allow easy labelling.
When I was working as volunteer at Magereza Health center found at Ukonga Dar es salaam I was used to collect Spot sputum with container I show below:
for Early Morning sputum I was used this container below:
Transporting of Sputum Specimen
- Receive the specimen from the patient.
- Assess for its quality.
- Sputum specimen can have various colors and aspects.
- If the sample is liquid and clear without streaks of mucous materials, process the sample but ensure that the poor quality of the sample is reported on the result form. When possible, encourage the patient to collect the specimen again.
- Label the container with infectious hazard marks and cover it well with a lid.
- If the health facility does not have the diagnostic capacity, sputum samples should be transported to the nearest diagnostic Centre as soon as possible, within four days.
- Transportation of sputum samples should be an immediate process.
- Samples should be well packed and protected from direct light.
- Samples should be accompanied by a well filled out laboratory record.
- Carter J, Lema.O. (1994). Practical laboratory manual for health centres in Eastern Africa. AMREF.
- Cheesbrough M. (1998). District Laboratory Practice in Tropical Countries. Part 1. Tropical Health Technology, Gapson Papers Ltd, NOIDA, India.
- Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2. Tropical Health Technology, Cambridge University Press UK.
- Cheesbrough M. (1987). Medical Laboratory Manual for Tropical Countries. Volume 1 2nd Ed. ELBS Butterworth, Heinemann Ltd, Oxford.
- NACP, NTLP (2007).In-service training on collaborative TB/HIV care and treatment. Ministry of Health and Social Welfare-Tanzania.