| Purpose |
| To obtain sputum specimens for AFB smear microscopy and culture from a patient who has a productive cough. Ensure that the patient is outdoors or placed in an airborne isolation room or negative-pressure sputum collection booth with the door shut. The air in the negative-pressure room or booth should be drawn out of the space and vented outside of the building. |
| Materials and equipment required |
- Sterile, filtered water or normal saline (150 to 250 mL)
- N95 mask (particulate respirator) for AFB
- Gloves
- Box of tissues
- Sterile specimen container approved by the laboratory for sputum collection and transport
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| Procedure |
| Preparation |
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Instruct the patient to gently brush his/her teeth, gingival margins, tongue, and buccal surfaces using sterile, filtered water or normal saline to rinse. Do not use toothpaste, commercial mouth wash preparations, nose drops, any medications containing alcohol, or oil. Instruct the patient to avoid taking oral antibiotics immediately before the sputum collection procedure. -
Instruct the patient to rinse and gargle several times with sterile, filtered water or normal saline after brushing. Do not use tap water or bottled water, as it may contain nontuberculous mycobacteria that may alter findings. |
| Sputum collection |
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Observe standard airborne isolation protection precautions at all times. NOTE: N95 masks must worn by healthcare personnel for AFB cough-producing procedures. - The patient must be outdoors or in an appropriate negative air pressure room or booth.
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Coach the patient and supervise the first sputum collection, at a minimum, in order to obtain a good quality sputum sample that represents secretions from the lower respiratory tract. NOTE: The patient should understand that sputum is material that is brought up from the lungs and that nasal secretions and saliva or spit are not acceptable. - Instruct the patient to inhale deeply, as far as possible, and then exhale slowly three times.
- After the third breath, direct the patient to inhale completely and try to cough hard to produce sputum from deep in the lungs. The patient may feel a rattle or tickle as the sputum moves up from the lungs into the throat.
- Instruct the patient to expectorate the sputum into a sterile specimen container.
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When there is at least 5 mL (1 teaspoon) of sputum, replace the lid on the container and tighten it so it does not leak. NOTE: High-quality sputum is required for smear, culture, and NAA testing. For AFB NAA testing alone, a minimum of 1 mL of raw sputum (or 0.5 mL of sputum sediment) is needed. It is preferred to collect 5 to 10 mL of raw sputum. - If the patient is in a negative air pressure room or booth, ask the patient remain in the booth or room until cleared to leave.
- Label the specimen with time and date of its collection and place it in a specimen bag. Attach a laboratory request form, if applicable.
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Document the procedure in the appropriate flow sheet or medical record. NOTE: Documentation also is required for unsuccessful procedures. |
