11. Principles of infection control
obtaining swabs
CHAPTER CONTENTS
Role and responsibilities of the midwife87
Summary87
Self-assessment exercises87
References88
LEARNING OUTCOMES
Having read this chapter the reader should be able to:
• describe how a swab is obtained from the eye, ear, nose, throat, umbilicus, vagina, wound and placenta
• discuss the role and responsibilities of the midwife in relation to obtaining swabs.
The midwife might be required to obtain a swab from the woman or the baby when infection is suspected. By culturing the microorganisms obtained by the swab, specific antibiotics can be prescribed to prevent them multiplying and so stop the infection. Swabs might be required even if there is no evidence of infection (e.g. a pregnant woman with a history of vaginal group B streptococcus infection) to help inform care. This chapter focuses on obtaining swabs from the more common sites of the eye, ear, nose, throat, umbilicus, vagina, wound and placenta.
Obtaining the swab
To increase the likelihood of isolating a microorganism, it is important that the swab is coated all over and an aseptic technique used to prevent the risk of cross-contamination. This can be achieved by rotating the swab around the area to be swabbed. Different organisms thrive and die in different cultures, thus it is important to use the correct swab stick and transport medium. For the majority of swabs, a dry swab and transport medium is sufficient. It is important to check that the swab is still sterile and has not expired, as this may affect the results. It is also important to ensure that alternative swabs and mediums are used where indicated; for example, Trichomonas vaginalis, Chlamydia spp. and Bordetella pertussis need charcoal-based swabs and medium. Thus, the midwife should be aware of which microorganisms are being considered as the causative organism for the presenting symptoms in the woman or baby and, if unsure, the midwife should verify with the doctor in order to use the correct swabs, media and bottles. The woman should also be aware of why several swabs are undertaken.
In some situations, the midwife might need to collect pus, exudates, moisture, etc. from the woman or baby (e.g. from the umbilical stump). These may need collecting via a swab stick, although where pus is being collected, a sterile spatula or syringe can be used to collect the pus and place it in a specimen container.
Once obtained, the swab should be placed in the transport medium, the lid secured and it should be correctly labelled, including the woman’s name, hospital number, date of birth, specimen taken, time and date, all of which should correspond with the pathology form (this should also indicate if the woman is taking antibiotics). The swab should be placed in a transport bag that is sealed to prevent spillage and contamination with the pathology form.
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