51
Specimen collection – stool specimen
Specimens are taken to support decision making with regard to treatment; in maternity care common specimens include blood, urine, faeces, sputum and wound, umbilical or ‘screening’ swabs.
The quality of the specimen collected has a direct impact on the accuracy of laboratory results. This can impact on treatment decisions; therefore it is important that the midwife:
- Is assured that there is a definite clinical need for the specimen.
- Gains consent to take the specimen and explains why the specimen is being taken, and the possible consequences/ treatment.
- Collects the specimen at the appropriate time (some specimens are time dependent).
- Advises the woman on how to collect the specimen.
- Collects the specimen in a way that avoids contamination – see Chapter 5 (aseptic technique).
- Arranges transportation to the laboratory in a timely way or stores appropriately if necessary.
- Checks and acts on all results once they are available.
- Documents results of all specimens.
Collecting a faeces specimen from an adult
Specimens are usually requested due to the presence of diarrhoea or suspicion of a gastrointestinal infection such as Clostridium difficile, Salmonella, Campylobacter or the presence of parasites. The specimen may be collected by a midwife or the woman if appropriate (Figures 51.1 and 51.2). See Box 51.1 for the equipment required for specimen collection.
If a specimen is requested due to the reporting or confirmation of diarrhoea then a stool chart should be instigated to capture the frequency and type of stool being passed. Each organisation has its own documentation; however, most stool charts are based on the Bristol Stool Chart (Figure 51.3).
Some women may find the procedure embarrassing. Use language that is appropriate to suit the woman’s understanding.
Collection in a healthcare setting
- Be familiar with and adhere to local policy and procedure.
- Positively identify the woman.
- Explain the procedure.
- Ensure privacy and promote dignity.
- Provide the woman with either a commode and bedpan, or a foil tray to collect the faeces if a toilet is used.
- Encourage the woman to urinate first; however, a small amount of urine in the pan should not affect processing of the sample.
- Ask the woman to inform you once they have opened their bowels.
- Record on a stool chart if used.
- Put on gloves and undo the screw top on the faeces specimen container (Figures 51.1 and 51.2).
- Taking care not to contaminate the outside of the container, using the spatula provided in the pot place a small amount of faeces into the pot and tighten the lid. Do not attempt to fill the pot – a small amount only is required, for example a quarter of the pot.
- Discard gloves and perform hand hygiene.
- Ensure the woman is comfortable.
- Complete the identification details on the pot and laboratory form.
- Place the specimen in the dedicated collection point – inform the laboratory if notice is required.
- Document in the notes.
Collection in the home setting
- Positively identify the woman.
- Explain the procedure and provide any information available.
- Provide the faeces sample pot (the woman may require the laboratory request form and bag).
- The following may be used to collect the sample:
- a commode or bedpan (if used)
- a disposable plastic or foil container, e.g. take away container placed in a toilet (this does not have to be sterile just clean).
- a commode or bedpan (if used)
- Demonstrate to the woman how to transfer a small amount of the stool into the container (as above) and to perform hand hygiene afterwards.
- Place any remaining stool in the toilet and flush.
- Place the container used to collect the sample in a plastic bag, seal and place in household waste.
- Inform the woman about where to take the specimen and timescales required for this (some samples require rapid transfer to the laboratory to prevent degradation of pathogens, e.g. amoebic dysentery).
Storing a stool sample
After the faeces sample is collected it needs to be transported to the microbiology laboratory for processing. In the hospital environment each clinical area usually has a sample collection point where specimens can be left for collection. In community settings such as the home the woman will need to take the specimen to either the laboratory reception (usually at the local hospital) or GP reception. Where to take the specimen should be explained at the time of requesting the specimen in line with local procedures.
Collecting a faeces specimen from a neonate
Stool specimens can be requested from neonates. Indications for the need to collect a specimen include investigating for the presence of blood or infection.
The same principles apply as with adults; however, neonatal stool specimens are frequently collected from nappies. Always check local policies as, for example, some organisations advise the use of a non-absorbent liner to avoid liquid stools soaking into the nappy. Semiformed stools can be transferred from the nappy to the specimen pot using the integral spatula.
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