This chapter presents information on specimen collection, common point-of-care (POC) tests and provider-performed microscopy (PPM), and other procedures.
POC testing is defined as medical testing at or near the site of patient care. POC tests are performed outside a central clinical laboratory using portable and hand-held devices and test kits or cartridges. PPM procedures are microscopic examinations performed by a healthcare provider during the course of a patient visit. PPM procedures typically involve specimens that are labile and not easily transportable, or for which delay in performing the test could compromise the accuracy of the test result.
POC testing is considered an integral part of clinical laboratory service and is under the direction of the central laboratory. Physician interpretation of PPM findings (eg, direct wet-mount preparation and KOH preparation) requires appropriate clinical privileges and competency assessments.
In the United States, test results can be used for patient care only when the tests are performed according to the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA’88). These include personnel training and competence assessment before any test or procedure can be performed, following standard operating procedures and/or manufacturer instructions, performance and documentation of quality control for all tests, and participation in a proficiency testing program, if available.
1. OBTAINING & HANDLING SPECIMENS
Specimens should be collected and handled according to the institution’s policies and procedures.
General Safety Considerations
All patient specimens are potentially infectious and are regarded as biohazardous materials, so precautions should be universally observed. The Blood Borne Pathogens Standard, developed by the Occupational Safety and Health Administration (OSHA), identifies standard precautions and protective equipment needed for the handling of biohazardous material. The Joint Commission and OSHA require training on the prevention of occupational exposure to blood (and tuberculosis) as part of initial and annual training of potentially exposed medical personnel.
Universal body fluid and needle stick precautions must be observed at all times. Safety needle devices should be used.
Disposable medical gloves, gown, and, if appropriate, mask, goggle, and face shield must be worn when collecting specimens.
Gloves must be changed and hands washed after contact with each patient.
Care should be taken not to spill or splash blood or other body fluids. Any spills should be cleaned up with a freshly made 10% bleach solution.
Handling and Disposing of Needles and Gloves
Do not resheath needles.
Discard needles in a sharps container and gloves in a designated biohazard container.
Do not remove a used needle from a syringe by hand. The entire assembly should be discarded as a unit into a designated sharps container. Accidental needle stick injuries should be immediately reported.
When obtaining blood cultures, it is unnecessary to change venipuncture needle when filling additional culture bottles.