Important Note

NOTE:

Determination of acceptability for samples from the lower respiratory tract (sputum) is imperative in minimizing the processing of poor-quality specimens and hence reporting potentially misleading information. The clinical specimen is Gram stained and examined for the presence of squamous epithelial cells (SECs). An evaluation of the ratio of SECs to WBCs is used to determine which specimens are of good quality and thus acceptable for culture, or if the sample will be rejected.                 

1. Criteria will apply to expectorated and induced sputum only.

2. Criteria will not be applied to:   

            A. Suctioned respiratory samples: Bronchoalveolar lavage (BAL)/mini BAL, Bronchial wash (BW), Endotracheal/Tracheal aspirate (ETT/TA)

            B. Sputum from cystic fibrosis patients (should be ordered as CF culture MICR0033)

            C. Samples from patients located in the Intensive Care Units:  ICU, ICN/NICU, CCU

            D. Samples with obvious blood present

3. Specimens submitted that are obvious saliva may be rejected without performing a Gram stain.

4. Acceptable specimen criteria:  An average of <10 SECs per low power field magnification.     

5. Unacceptable specimen criteria:  An average of ≥10 SECs per low power field magnification. 

In the event the specimen has ≥10 SECs/lpf but the WBC count is 10x that amount the sample will not be rejected due to the excessive inflammatory response.