Module 3:

Collection and Transportation

of Tuberculosis Specimens

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 Learning Objectives
Describe specifications of suitable containers for

sputum collection

Explain the collection strategy: spot/spot

Describe and demonstrate safe and correct

collection of sputum

Describe options for specimen collection,

2 handling and transport

 Content Overview
 Suitable specimen containers

 The number and timing of specimen collection

 How to collect a specimen

 Specimen handling and referral

 Assessing specimen quality

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 Specimen Collection Container:
Specifications

50 ml capacity
Translucent or clear
material
Single-use
combustible material
Screw-capped with a
water-tight seal
Easily-labeled walls

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 Specimen Collection
Two (2) spot specimens optimal for
identifying infectious cases of tuberculosis

Make collection convenient and efficient for

both patient and laboratory worker

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Timing of Specimen Collection

Spot–Spot
WHO/IUATLD Recommendation

Spot initial visit to the clinic

Spot after 30’-1hr 1st spot
Collection on the same day

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 Spot-Spot
Advantages Disadvantages
· Greatly reduce the work · Very minor losses in

load of the laboratory

the number of case
detected
· Have the potential to

offering the same day result

· It is better for patients

because it reduces the

number of visits while
largely maintaining

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sensitivity
 Collection Considerations

Yield decreases rapidly after two specimens

One positive examinations confirm the

diagnosis

Follow NTP guidelines for exact specimen

collection strategy
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 Follow-up Specimens for
Monitoring Treatment

Collected during and at the

end of treatment
Spot specimen
Consult NTP guidelines for
exact collection frequency

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 Country NTP
 Follow-up sputum examination is a tool to monitor

treatment effectiveness

 For sputum positive patients, sputum will be routinely

examined at the end of 2nd, 4th and 6th month.

 Dates and results of direct sputum examination must

be entered in registers

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Specimen Collection: Safety
 The patient is a greater danger to staff than the specimen!

 Instruct patient to cover the mouth when coughing

 Never collect sputum in the laboratory!

 Collect OUTSIDE

 Collect away from other people

 Do not stand near patient during specimen collection

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Advantages of Open Air Collection

Rapidly dilutes aerosols

UV light rapidly
inactivates the bacilli

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Specimen Collection Guidelines
 Explain clearly to patient
 Why sputum is needed
 Two samples required
Spot –spot
 What is a good sample and how to obtain it
 Opening and tight closing of containers
 Not to soil the exterior of the container
 Transport of sputum containers

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 Patient Education: Collection
Best specimen comes from the lung
Saliva or nasal secretions are unsatisfactory
Remove dentures and rinse mouth with water
Need for two sputum samples for optimal
diagnosis

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 Patient Instructions: Collection
Inhale deeply 2–3 times, breathe out hard
each time
Cough deeply from the chest
Place the open container close to the
mouth to collect the specimen

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 Optimum Collection Location:
Microscopy Centre

Specimen is fresh
Collection supervised
Immediate recollection, if
necessary

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 Microscopy Not Performed at Health posts:
Referral Options

Patient Referral

Specimen Referral

Smear Referral
 Current practice is patient referral (specimen
referral will be a good option)

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 Patient Referral: Disadvantages

Expense of travel to diagnostic centre

Family and work commitments
Reluctant to seek help
Diagnosis may be delayed

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 Specimen Referral
Health post staff supervises patient in
collection of specimen.
Specimen then forwarded to a
microscopy centre.
Consider:
Frequency of transportation and
packaging
Potential for leakage and breakage
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Specimen Referral: Disadvantages
· The microscopy centre has no direct control
over the specimen collection process
· Higher risk with transporting specimens
· Requires a safe, fast and regular transport
system for specimens and results
· Follow-up and quality assurance of the
process may be needed

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 Slide Referral
Smears require less safety precautions for
packaging
Peripheral centres must be trained in
collection and smear preparation

Disadvantages
Risk of poor specimen and poor smear
Slides are more fragile

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 Request for Sputum Examination
Form Should Include:

Patient’s name, sex, age, and address

Date of collection

Name of Health Institution

Reason for examination

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 Request for Sputum
Examination Form

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 Labeling Specimen Container

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Specimen Receipt at Laboratory
Check specimens for quality:
Volume (at least 3–5 ml)
Describe sputum consistency (mucoid,
purulent, bloody, or watery)
Register the specimen and allocate a
laboratory serial number

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 Specimen Quality

Purulent Mucoid

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 Specimen Quality

Saliva or Induced sputum (?) Blood stained

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 Obtaining adequate
Obtaining adequate good
good
quality specimens
quality specimens is
is critical
critical
to ensure
to ensure accurate
accurate and
and
reliable AFB
reliable AFB microscopy
microscopy
results
results

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 Role Play: Sputum Collection
Purpose Process
 To practice educating TB  Work in groups of 3
suspect patients on the  Decide roles: (1) health
importance of a properly worker, (2) TB suspect
collected sputum patient, (3) observer
specimen  The health worker
 To practice providing
instructs the TB suspect
instructions on how to patient while the
collect a sputum observer provides
specimen to a TB suspect feedback.
patient.  Switch roles and repeat
Total Time the process until
 30 Minutes everyone has taken on
each role once.
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 Role Play Debrief
Did the healthcare worker follow procedure:
COMPLETE a Request for Sputum Examination form.
LABEL sputum containers.
EXPLAIN to the TB suspect how to collect sputum
and the importance of a properly collected
specimen.
ASK the TB suspect to produce a sputum sample.
ASK the TB suspect to collect another sample after
30minutes and then bring it to the diagnostic centre.
Did the TB suspect understand instructions?
What suggestions for improvements did the
30 observer note?
 Summary
 What is the significance of spot–spot collection?

 Why is sputum never collected in the laboratory?

 What are the three options for handling sputum

specimens at peripheral health centers not performing
microscopy?

 What are the features of a good quality specimen?

 How should you label a sputum container?

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