All recommended PPE should be worn when collecting a specimen from a person with suspected or confirmed monkeypox.
Only sterile, synthetic swabs (including but not limited to polyester, nylon, or Dacron) with plastic, wood, or thin aluminum (wire) shafts should be used to collect suspected or confirmed monkeypox specimens for diagnostic testing. Do not use cotton swabs.
Skin lesion material, including swabs of lesion surface, exudate, or lesion crusts are the recommended specimen types for laboratory testing of monkeypox virus specimens. Procedures and materials used for collecting specimens may vary depending on the phase of the rash (e.g., swabs from lesion surface or crust from healing lesion). Collect two swabs from each lesion, preferably from different locations on the body or from lesions that differ in appearance (e.g., a pair of swabs for each lesion with a total of 2-3 lesions). Vigorously swab each lesion, avoiding contamination of gloved hands, to ensure adequate viral DNA is collected. Unroofing or aspiration of lesions (or otherwise using sharp instruments for monkeypox testing) before swabbing is not necessary, nor recommended due to the risk for sharps injury. Place swabs from lesions, crusts, and exudate in separate tubes. See Tips for Adequate Collection of a Lesion Specimen from a Suspect Monkeypox Virus Case for additional support on specimen collection.
The type of acceptable specimen (dry swab or wet swab in transport media) for diagnostic testing may vary depending on the laboratory. Contact the appropriate laboratory facility to determine the specimen types accepted. At CDC, only dry swabs or swabs in viral transport media (VTM) from lesions, or lesion crusts are currently accepted for testing. Swabs in media designated for bacterial preservation may cause PCR inhibition and are not recommended.
Insert each swab into a sterile container such as a sterile tube or urine container. Glass containers are not recommended. Carefully bend to break the swab’s shaft to fit inside the sterile container (if applicable, or place the entire swab into the container) . After completely securing the lid, wipe the container with an EPA-approved disinfectant for emerging viral pathogens. Placing parafilm around the lid of the container is recommended for additional leak-proof protection, but not required. Remove gloves, wash your hands (hand hygiene), and don a new pair of gloves.
Wound cultures are obtained from wounds suspected to be infected. Results are used to determine treatment options. Wound culture results indicate the type and number of bacteria present, as well as the antibiotics to which bacteria are susceptible. When performing a wound culture, it is vital for the nurse to avoid contamination and to use evidence-based techniques to obtain a good specimen that the patient’s treatment plan will be based upon.[1] Use
the checklist to review the steps to “Perform a Wound Culture.” Disclaimer: Always review and follow agency policy regarding this specific skill. Steps
- Gather supplies: sterile wound swab, sterile normal saline, sterile irrigation kit with 30-60 mL syringe, and sterile 2″ x 2″ gauze.
- Perform
safety steps:
- Perform hand hygiene.
- Check the room for transmission-based precautions.
- Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Explain the process to the patient and ask if they have any questions.
- Be organized and systematic.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.
- Ensure the patient’s privacy and dignity.
- Assess ABCs.
- Prepare the environment, position the patient, adjust the height of the bed, and turn on the lights. Ensure proper body mechanics for yourself and create a comfortable position for the patient. Ensuring proper lighting allows for good visibility to assess the wound. Premedicate if indicated and ensure patient’s comfort prior to and during the procedure.
- Place a clean, dry barrier on the bedside table or create a sterile field per agency policy. Pour sterile saline into the irrigation tray.
- Perform hand hygiene and apply nonsterile gloves.
- Remove the dressing and expose the patient’s wound. Dispose of the soiled dressing according to agency policy.
- Remove gloves and perform hand hygiene.
- Put on a new pair of nonsterile or sterile gloves, depending on the patient’s condition and the type, location, and depth of the wound.
- Irrigate the wound with sterile normal saline solution to remove surface debris or exudate and to prevent specimen contamination. Alternatively, cleanse the wound with a commercial wound irrigation device.
- Wipe the surface of the wound with a sterile gauze pad moistened with normal saline solution to remove surface contaminants.
- Gently blot excess normal saline solution from the wound bed with a dry sterile gauze pad.
- Remove gloves and perform hand hygiene.
- Put on new nonsterile gloves.
- Open the swab specimen collection and transport system. Prepare the contents as needed following the manufacturer’s instructions.
- Use the culture swab(s) to collect the specimen according to agency policy.
- Note that some agencies use swab collection and transport systems that contain specific swabs designed for anaerobic and aerobic specimen collection.
- If the wound bed appears dry, moisten the swab with normal saline solution.
- Identify a 1-cm2 area of viable wound tissue at or near the center of the wound.
- Note: The culture must be obtained from the cleanest tissue possible and not from pus, slough, eschar, or necrotic tissue.
- Rotate the tip of the swab over the identified 1-cm2 area of the wound for 5 seconds, applying sufficient pressure to express fluid from the wound.
- Remove the swab from the wound.
- Immediately insert the swab into the appropriate
transport system following the manufacturer’s instructions for use. Use caution to avoid contaminating the swab when placing it into the transport system:
- Clinical alert: Note that the culture must come from the cleanest tissue possible and not from pus, slough, eschar, or necrotic material. Never collect exudate from the skin.
- Remove gloves and perform hand hygiene.
- Put on a new pair of nonsterile or sterile gloves depending on the patient’s condition and the type, location, and depth of the wound.
- Apply a new sterile dressing to the patient’s wound using a sterile, no-touch technique.
- Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
- Label the specimen in the presence of the patient (such as name, date, time, location of the wound, and site and source of the specimen) to prevent mislabeling:
- Note the patient’s recent or current antibiotic therapy on the laboratory request form because it might affect test results. If possible, obtain a culture specimen before starting antimicrobial therapy.
- Ensure safety measures when leaving the room:
- CALL LIGHT: Within reach
- BED: Low and locked (in lowest position and brakes on)
- SIDE RAILS: Secured
- TABLE: Within reach
- ROOM: Risk-free for falls (scan room and clear any obstacles)
- Immediately send the specimen to the laboratory in a laboratory biohazard transport bag with a completed laboratory request form.
- Document the procedure and related assessments in the patient’s chart. Report any concerns according to agency policy.