Specimen Collection
Collecting a Specimen for Wound Culture
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Take the Review Test:
Safety
- Deliver specimens to the laboratory within the recommended time, or ensure that they are stored properly for later transport.
- Know your agency’s policy regarding infection control practices for the transport of all specimen containers containing body substances.
- Be alert for localized inflammation, tenderness, and warmth at a wound site with purulent drainage, indicating that the wound has become infected.
- Observe for redness and bleeding around the edges of a wound, which may indicate wound trauma.
- Instruct the patient to inform you if the procedure causes pain. Stop if the patient is unable to tolerate the pain.
Equipment
(Roll cursor over items to see labels)
Culture tube with swab and transport medium for aerobic culture
Anaerobic culture tube with swab
5- to 10-mL syringe
Clean gloves
Sterile gloves
Protective eyewear (optional)
Antiseptic swabstik
Sterile gauze 4x4 dressing
Tape
Specimen biohazard bag
Specimen identification labels
Laboratory requisition form
Small plastic biohazard bag
PrintableDelegation
The skill of obtaining a wound drainage specimen may not be delegated to nursing assistive personnel (NAP). Be sure, however, to inform NAP of the following:
- Advise NAP to report to you any foul odor, increase in drainage, increase in body temperature, or complaint of discomfort by the patient.
Preparation
- Assess the patient’s understanding of the need for a wound culture and his or her ability to cooperate with the procedure.
- Assess the patient for fever, chills, and excessive thirst. Check laboratory results to see if the patient’s white blood cell (WBC) count is elevated.
- Ask the patient to report the extent and type of pain at the wound site, using a scale of 0 to 10. If the patient requires an analgesic before dressing changes, wait 30 minutes before beginning the procedure so that the medication can begin to take effect.
- Determine when the dressing change is scheduled. Perform the wound assessment as part of that procedure.
- Review the health care provider’s orders for an aerobic or an anaerobic culture.
- Apply clean gloves, and remove any soiled wound dressings. Apply sterile gloves to palpate the wound gently, noting any tenderness or drainage, inflammation, or separation at the wound edges.
Follow-up
- Obtain the laboratory report to review the results of any cultures.
- Observe the character of the wound drainage.
- Observe the edges of the wound for redness and bleeding.
- Ask the patient about the purpose of a wound culture.
Documentation
- Record the types of specimens obtained, the source, and the time and date sent to the laboratory.
- Describe the appearance of the wound and the characteristics of any drainage.
- Report any evidence of infection to the charge nurse and the health care provider.
- Record the patient’s tolerance of the procedure and response to any analgesics provided.
Review Questions
1. The health care provider writes an order for a culture specimen to be collected from a patient with a dog bite wound. What would the nurse do first?
Explain the purpose of the test to the patient. - Assess the level of the patient’s pain at the wound site.
- Assess the patient for signs and symptoms of infection.
Review the order to determine the type of specimen to be collected.
INCORRECT. The nurse would explain the purpose of the test only after determining the type of specimen to be collected.
INCORRECT. The nurse would assess the patient’s pain only after determining the type of specimen to be collected.
INCORRECT. The nurse would assess for signs and symptoms of infection when assessing the wound before the specimen is collected; first, however, the nurse must determine the type of specimen to be collected.
CORRECT. The nurse would first review the health care provider’s order for specimen collection, because the equipment needed and the technique selected depend on whether anaerobic or aerobic bacteria are to be cultured from the wound.
2. Which action would the nurse take to reduce the risk for wound infection when collecting a specimen for culture?
- Collect the specimen while wearing sterile gloves.
- Collect the specimen after washing the wound with sterile water.
- Collect the specimen before cleansing the wound.
- Collect the specimen after administering prescribed pain medication.
CORRECT. The nurse would wear sterile gloves during specimen collection in order to reduce the risk for wound infection.
INCORRECT. Washing the wound with sterile water is not appropriate procedure.
INCORRECT. To remove old exudate, the nurse would cleanse the wound before taking the specimen.
INCORRECT. Medicating the patient for pain has no bearing on the risk for wound infection.
3. Which question might the nurse ask the patient when an aerobic wound culture has been ordered?
- “Do you have any pain at the wound site?”
- “Have you ever collected a specimen from your wound before?”
- “Have you had any trouble breathing?”
- “Have your blood counts been high recently?”
CORRECT. The nurse might assess the patient for pain at the wound site, since medications can be given to ease his or her discomfort.
INCORRECT. The patient would not collect a specimen from his or her own wound.
INCORRECT. If the patient has sign and symptoms of dyspnea, the nurse might ask if he or she is having trouble breathing. Breathing difficulties are irrelevant, however, to a wound culture or its results.
INCORRECT. No aspect of the specimen collection procedure relies on checking blood counts.
4. Which instruction might the nurse give to the NAP to help ensure that a wound culture specimen will be transported properly?
- “Wear sterile gloves when holding the specimen.”
- “Take this specimen to the lab immediately.”
- “Borrow a specimen collection kit from another unit if we’re out of them.”
- “Keep the specimen tube horizontal.”
INCORRECT. It is not necessary to wear sterile gloves while holding the specimen.
CORRECT. The nurse is likely to ask the NAP to transport the specimen to the lab immediately in order to help ensure accurate test results.
INCORRECT. Although borrowing a kit may be necessary, this statement does not pertain to specimen transport.
INCORRECT. It is not necessary to keep the specimen tube in a specific position during transport.
5. Which nursing action demonstrates proper procedure in the collection of a wound culture specimen?
- Wearing clean gloves to remove soiled dressings
- Using a circular motion to cleanse the wound before collecting the specimen
- Completing the lab requisition form in a timely manner after collecting the specimen
- Sending the specimen to the lab within 30 minutes of collecting it
CORRECT. Wearing clean gloves to remove soiled dressings minimizes the risk of cross-contaminating the wound.
INCORRECT. The proper procedure is to wipe away old exudate by swabbing outward from the wound.
INCORRECT. The proper procedure is to complete the lab requisition form (including date, time, name of test, patient identification, and source of culture) in the patient’s presence when the specimen is collected.
INCORRECT. The proper procedure is to send the specimen to the lab immediately.
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