Patient Instructions:
. Before testing, stop using topical or systematic antifungal medications for at least 1 - 2 weeks, unless otherwise instructed by your doctor.
. Avoid using vaginal creams, lubricants, douches, or spermicides for at least 24 hours before the test.
. Refrain from sexual intercourse for 24–48 hours before the test.
. Avoid collecting samples during menstruation.
. Wash the external genital area with water only before the test, if needed, and avoid using antiseptics or cleansers.
. For urethral swab: avoid urinating for at least 1–2 hours before sample collection to prevent washing away the organism from the urethra.
. Do not store the sample in formalin.
**.Note to the nurse: **
**Guidelines on specimen collection methods and rejection criteria:**
- **Pus: **Use a sterile needle and syringe to aspirate from an undrained abscess, then into a sterile tube. If the sample is small and difficult to collect, a sterile cotton swab may be used. If the abscess has been incised, squeeze the pus into a sterile test tube.
Dry sample on a swab, sample contained in a non-sterile container, or materials from an opened wound are rejected.
- **Biopsy**: Take tissue from the center and edge of the lesion, then place it between sterile gauze, in a sterile petri dish, or in a tube containing 2–3 mL of saline or BHI broth.
Samples stored in formalin (kills fungi), dried-out samples, or samples collected in thioglycolate broth or normal saline are rejected.
- **Body fluids**: Collect into a sterile tube or a heparinized syringe.
Clotted samples or samples with volume < 1 mL are rejected.
- **Bone marrow**: Aspirate 0.2–0.3 mL into a sterile heparinized syringe, cap tightly, and transport immediately.
Clotted samples or samples without an anticoagulant are rejected.
- **Urine**: Collect 25–50 mL of an early-morning, midstream urine sample in a sterile container. Suprapubic aspirate or catheterized specimens may be collected when indicated.
Urine kept for more than 2 hours at room temperature, samples taken from a stagnant urine bag, or 24-hour urine collections are rejected.
- **Stool**: Collect directly into a clean container, primarily for the detection of Candida.
Samples contaminated with urine or toilet paper, or samples that are too dry, are rejected.
- **Sputum**: Collect 5–10 mL of deep morning sputum after oral hygiene and store in a wide-mouth sterile container.
Samples containing only saliva or 24-hour collections are rejected (Single samples in separate containers are preferred).
- **Bronchoalveolar lavage (BAL)**: Collect via fiberoptic bronchoscopy into a sterile container.
Samples with insufficient volume or contamination from unclean equipment are rejected.
- **Vaginal /Urethral swabs**: Vaginal discharge is collected using a sterile cotton swab from the posterior vaginal wall; urethral specimens are collected using a sterile cotton swab inserted 3–4 cm into the urethra and gently rotated. Place swabs in Stuart/Amies transport medium (if available) and send them to the laboratory.
Dry samples on swabs are rejected.
- **Skin**: Scrape skin scales at the edge of the lesion (the boundary between diseased and healthy skin). Use adhesive tape to fix the scales onto a slide, then place it in a petri dish.
Samples consisting only of crusts (dried blood or old keratin) or lesions concurrently infected with pus are rejected.
- **Nails**: Scrape crumbly keratin from beneath the nail or cut keratin at the free edge; if paronychia is present, scrape scales from the nail groove.
Samples containing only the clean upper nail surface or an insufficient amount of crumbly keratin are rejected.
- **Hair**: Use forceps to pluck the entire hair shaft, including the root/bulb, selecting broken, dull (lost their shine), or white-sheathed hairs.
Hair cut across the shaft (without root) or hair treated with harsh chemicals is rejected.
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