P 12 Clinical microbiology I To study: Sampling, material transportation (from textbooks, WWW etc.) From spring term: Microscopy Task 1: Indications of microbiological examination For following casuistics, fill in the table. Œ Allways fill in the case description (left collumn) � Then try to find out your solution. Try to structure your answer followingly: Microbiological examination: yes/no v if yes, what type of a specimen(s) v if no, what more steps, e. g. direct treatment – what antibiotic, etc.) Ž After the two minute limit, write down correction made according to teachers explanation. Description of a case Your solution ( 2 minutes) Correction according to teacher explanation a b c d Task 2: Swabs and vessels Observe the swabs on your table and fill in their „identity cards“. Name: Plain swab Stick may be made of plastic, wood or aluminium Swab is made of syntetic cotton Practical use: Name: Amies swab Stick is made of plastic or aluminium Swab is made of syntetic cotton Medium Amies (Stuart, Cary Blair) Note: The medium may contain charcoal (then it is black); without charcoal, it would be colourless. Practical use: variant with aluminium stick is used for Name: Fungi-Quick swab Stick is made of plastic Transport medium colour colourless Cap colour Practical use: Name: C. A. T. swab Stick is made of plastic Transport medium colour colourless Cap colour Practical use: Name: Common test tube for microbiology Sterile? (yes or no) Description made of polystyrene, 16 × 100 mm, 10 ml Practical use: Name: Sputum test tube Sterile? (yes or no) Description made of polystyrene or polypropylene, 26 × 92 mm, 30 ml Practical use: Name: Faeces container Sterile? (yes or no) Description made of polypropylene, 26 × 82 mm, 30 ml Practical use: Name: Sampling vessel for urine Sterile? (yes or no) Description made of polypropylene, 45 × 70 mm, 120 ml Practical use: Task 3: Other sampling methods than swabs and vessels a) Moulage method Perform the moulage method in pairs. Place a sterile filtration paper to your mate‘s forearm. Using forceps, transport it carefully to a Petri dish with agar. After 10 seconds, remove it and throw it away. b) Smears Gram–Giemsa stain ________________________________ ________________________________ In some cases it is recommended to send directly microscopical smear to the laboratory (actinomycosis, gonorrhoea, but also other genital infections). In gynecologic problems, often two specimens of a vaginal smear is sent to the laboratory. After coming to the laboratory, one is stained using Giemsa staining and the other is stained using Gram staining. Observe a result of a vaginal smear, and draw your result to the laboratory report. Write down, whether your slide was Gram or Giemsa stained. Task 4: Sampling in specific types of samples a) Blood cultures Describe use of three types of vessels for blood culture. blue green red Fill in, what data should not be missing on a order form in case of blood culture sending (only „material type/examination type“ field) Explain: Why absolute sterility is necessary in blood culture samples more than in any other blood specimens (e. g. those sent for biochemical examination)? How many blood cultures should be taken and why? Fill in the missing fields in description of process of blood culture examination according to videoclip and teacher explanation. A blood culture vessel comes to the laboratory. Here it is put into a ___________________________________. The positivity is demonstrated by _____________________ and ______________________________. When the cultivation is positive, a smear is prepared and the sample is ____________________ to blood and Endo agar. Also a preliminary _____________________________ test is performed directly from the specimen; as the inoculum is not standardized here, its results are only _________________________. b) Urine According to teacher explanation, tick, what sentences concenrning urine sampling and transportation are true/false. Urine examination is recommended in non-complicated and necessary in complicated cystitis r true r false Microbiologists recommend use of cathetrized urine as a routine way of sampling urine for bacteriology r true r false It is not important, whether prepucium (in men) or labia minora (in women) is in the way of urine stream when sampling urine for bacteriology r true r false External orifice of urethra should be carefully washed and eventually also disinfected before taking sampling urine for bacteriology r true r false The vessel, that the patient urinates in, should be sterile r true r false The test tube used for urine transporation to the laboratory should have yellow cap r true r false The order form should contain information whether urine is „routinelly taken“, cathetrized, punctated, or whether it is a specimen taken from a permanent catheter r true r false Urine from permanent catether has the same value for bacteriological diagnostics as cathetrized urine (just for examination) r true r false Urine specimen should be delivered to the laboratory in 2 hours after sampling, in impossible, it should be kept in refrigeratior r true r false Urine sample is better than urethral swab in gonorrhoea diagnostics r true r false c) Faeces samples for different types of pathogens and toxins For some purposes, it is possible to send rectal swabs. For some other purposes, it is necessary to send a specimen of stool. Sometimes also at refrigerator temperature. Fill in the next table. Stool sent for Type of specimen Stool sent for Type of specimen bacteriology virology – virus isolation mycology parasitology virology – antigen detection detection of toxin of Clostridium difficile Task 5: The order form a) Order form filling in Fill in the following order form with a patient name and data and requested examination related with the disease that is written on a card that was given to you by a teacher. Do not rewrite the story from your card; try to write the request in a form that would be probably used by a real doctor. b) Order form common mistakes To each of following ofder form, write down what is wrong. Some mistakes are mistakes of the order form, but you can also remark inproperly requested examinations.