POLICIES AND PROCEDURES MANUAL

OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS

DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
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SUBJECT: OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS

1. PURPOSE:

Laboratory examination and analysis of stool provides useful information about the
nature of elimination. Stool specimens are collected to determine pathologic
conditions such as tumors, hemorrhage, infection, and mal-absorption problems.
These conditions can be detected by the presence of blood, bile, urobilinogen, fat,
nitrogen content, ova, parasites, protozoa, and bacteria. Guidelines are provided
to aid in specimen collection.

2. POLICY:

1. All laboratory orders are to be transcribed from the physician’s order onto
the “DIAGNOSTIC MAR: LAB” CSHxxxx“(Diagnostic MAR: Lab, Diagnostic
MTR: Consult & Radiology”).

2. Pre-label the specimen container and lab slip. Using Miscellaneous Lab slip
document Individual’s name, CSHxxxx, unit, test requested, nature and source
of specimen, collection date and time, name of the ordering physician,
physician’s diagnosis or suspected diagnosis.

3. Any licensed nursing employee may obtain a stool specimen for

laboratory analysis when ordered by a physician.

4. Nursing personnel, having direct or the potential for contact with exposure to
blood, body fluids, or other potentially infectious material of Individuals, are
expected to practice STANDARD PRECAUTIONS according to guidelines
established by the CSH Infection Control Program. Personal Protective Equipment
(PPE) and engineering controls shall be used as needed.

3. GENERAL INFORMATION:

1. If more than one stool specimen is needed, allow one or two days between
collection and number each stool specimen accordingly on lab slips.
 POLICIES AND PROCEDURES MANUAL
OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS
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NO. *** ***
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2. Place stool for culture in container with C&S preservative (available from lab) and
keep at room temperature. Stool for O&P should always be placed into the
specimen container with O&P fixative (available in lab), cap tightly and mix well.
Specimens obtained for ova and parasites do not need to be refrigerated. Do Not
send fresh stool for culture or O&P.

3. During business hours (TBD) collected specimens are

sent to the designated specimen collection site refrigerator prior to the 0800 pick-
up, and to the main lab if specimens have already been picked up. This should be
done within (30) minutes of collecting the specimen.

4. During non-business hours, weekends, and holidays, contact the NOD so that
arrangements can be made through the ACNS office for the Contract Lab to pick up
the specimen from the Central Sally Port. (Do Not place stool specimen(s) in
refrigerator.)

5. Do not obtain specimen from toilet. Do not use specimen that has been urinated
on. Do Not have Individual pass the specimen directly into the vial.

4. STOOL FOR OVA AND PARASITE (O&P):

1. Collect specimens in a clean, waxed cardboard container or sterile screw-capped

plastic vial that may have a spoon attached to the lid. Transfer to O&P fixative.
Fill to line on vial, Do Not Overfill. Cap tightly and mix well.
2. Collect early in the disease and before antibiotic treatment if possible. Care must
be taken to not contaminate the specimen with urine or any residual soap,
detergent or disinfectant. Those portions of the stool that contain pus, blood or
mucus are best.
3. Specimen should be brought to the lab ASAP.

4. Collect prior to radiology studies, i.e. Barium Sulfate - must wait 5 - 7

days.
5. Individual should not receive laxatives, mineral oil, magnesium, bismuth, and
antidiarrheal meds, certain antibiotics for at least 48 hours prior to collection.
6. Stool must be free of water or urine.
7. Must use fixative kit. Place into O&P Stool Fixative vial ASAP - no more than 30
minutes if liquid or one hour otherwise. Once in kit, its good for an indefinite time.
8. No more than one specimen per day.
9. Never incubate or freeze. Room temperature only.

5. STOOL FOR WBC:

Stool for WBC can also be done from Stool Preservative Kit vial if ordered with an
O&P exam. Otherwise collect specimen in a clean, waxed cardboard container.
 POLICIES AND PROCEDURES MANUAL
OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
00 REVIEW DUE
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6. STOOL FOR PINWORM:

Obtain special pinworm collector from the Lab. Use for perirectal sample.

7. STOOL FOR OCCULT BLOOD:

To reduce both false positive and false negative results the following
guidelines should be observed.

I. The individual to be tested should:

1. Be placed on a meat-free, high bulk diet two days prior to the test and
continue through the test period
2. Avoid all blood-containing foods (meats)
3. Avoid foods rich in peroxidase-like substances (turnips, horseradish)
4. Be restricted, for 48 hours prior to the test, from some medications which may
cause false positives: aspirin, iron preparations, Butazolidin, as well as drugs that
may be associated with increased GI blood loss (steroids, colchicine,
indomethacin). Discuss with physician.
5. Not take more than 500 mg of Vitamin C per day, as this may cause false
negative results.
6. Not be tested if bleeding hemorrhoids are present or, for females, during
menstrual periods.
7. Not be tested if diarrhea is present.

II. The licensed nursing staff obtaining the stool specimen should:
1. Consult with the physician if any of the above (in I.) are applicable.
Follow orders as directed.
2. Inform the dietician of the testing so any foods that may affect testing can be
avoided.
3. Obtain and test three (3) consecutive stool specimens to increase
probability of detection of occult blood.
4. Collect specimen in a clean, waxed cardboard container, or sterile,
screw-capped plastic vial that may have a spoon attached to the lid.

8. STOOL CULTURE:

Stool culture is for Shigella, Salmonella and Campylobacter. Any other

bacterial pathogen needs to be indicated with the physician’s order.

Leave at room temperature and transport ASAP to lab for processing. Use C&S
(culture and sensitivity)media as preservative. Specimen still needs to be processed
promptly for best results. Shigella, in particular, is difficult to recover if delays occur.
Shigella is delicate. They will not survive the drop in pH that occurs when the stool is
refrigerated and therefore the specimen should be left at room temperature.
 POLICIES AND PROCEDURES MANUAL
OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
00 REVIEW DUE
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9. PRECAUTIONS:

Medical aseptic technique should be followed during collection of any stool

specimen. Feces contain a variety of microorganisms that can easily be
transmitted if specimens are handled incorrectly.

1. The fluid blood and moist body substances of all Individuals shall be treated
as though they were infectious. Refer to Administrative Directive 3 “Standard
Precautions”.

2. Hand Hygiene before and after procedure. Follow Biohazardous Waste Procedure
for proper disposal.

3. The Solutions in the vials are poisonous. Keep out of reach of Individuals.

10. EQUIPMENT:

1. Sanopan stool collection pan (also called Pilgrim’s Hat);

2. Clean disposable gloves;
3. Waxed cardboard or plastic specimen bottle with lid, or sterile culture
transport tube with swab for cultures (C&S collection, culture swabs are obtained
from the Lab);
4. Other personal protective equipment as required;
5. Tongue blades (Use sterile tongue blades for cultures);
6. Toilet paper and bag;
7. Completed laboratory requisition form “Miscellaneous Lab Slip
8. Stool Preservative Kit for ova and parasites; pinworm collectors (obtain
from Lab).
9. Appropriate receptacle. See Biohazardous Waste Procedure.

11. ASSESSMENT:

NURSING ACTION KEY POINTS

A. Determine purpose of stool specimen
and correct method of obtaining and
handling specimen.
A. Prevents collection of specimen at
time when laboratory cannot test it.
Consult with the CSH Laboratory or
Contract Lab for any questions
regarding collection procedures.

B. Determine if Individual should have B. Prevents invalid test results on stool

dietary modifications or restrictions specimen. Appraise the dietician of the
before test. testing so that dietary modifications can
occur.
 POLICIES AND PROCEDURES MANUAL
OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
00 REVIEW DUE
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C. Assess Individual’s understanding of C. Reveals Individual’s ability and

reason for collection of stool specimen. willingness to cooperate in collection of
specimen.

D. Determine normal defecation pattern D. Allows for more effective planning.

of Individual.

E. Assess Individual for gastrointestinal E. May indicate specific physical

dysfunction, such as abdominal pain, problem.
nausea, vomiting, excessive flatus,
diarrhea.

12. PROCEDURE:

NURSING ACTION KEY POINTS

A. Check physician's orders. A. To prevent error.

B. Hand hygiene with soap and water. B. Reduces spread of infection.

C. Identify Individual by photo ID and C. Provides basis to determine need for

explain the procedure to Individual.
Assess Individual’s
understanding of purpose and
to cooperate.
D. Assemble equipment needed.
health teaching and need for
assistance. Individual teaching assists
ability with gaining Individual’s cooperation.

E. Label specimen container with date E. This is recorded on Miscellaneous Lab

and time of collection, Individual name, slip (MH 6075). Contract Lab requires
CSH number, and unit location. Pre- that the source of the specimen, and
label Lab slip to include date and time physician’s diagnosis or suspected
of collection, Individual name, diagnosis needs to be identified on the
CSH number, unit, test requested, lab slip including the name of the
nature and source of specimen, name ordering physician.
of the ordering physician,
physician’s diagnosis or suspected
diagnosis.

F. Instruct Individual to void into toilet F. Feces should not be mixed with urine
before defecating. or toilet tissue. Urine inhibits fecal
bacterial growth. Toilet tissue contains
bismuth, which interferes with test results.
 POLICIES AND PROCEDURES MANUAL
OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
00 REVIEW DUE
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G. Place collection pan on toilet. G. Collection pan must be clean.

H. Put on disposable gloves and remove H. Follow appropriate hand hygiene

a small portion of feces (2 cm X 2 cm) protocols.
from the bedpan with the tongue blade
and place in C&S preservative
specimen container. Fill to line. Do Not
Overfill. Cap tightly and mix well.

I. Ova and parasites: Use The spoon I. Specimen must be taken to specimen
built into the vial cap and transfer small collection site.
samples from areas that appear bloody,
slimy, or watery. Continue adding
samples until the liquid level in the vial
reaches the red fill line. Avoid over or
under filling. Mix specimen in the
solution using the spoon provided.
Recap the vial, making sure the lid is
tight. Shake the vial until the contents
are well mixed.

J. Using a new single glove to handle
specimen, place it into a specimen
transport bag using the clean hand to
handle the bag. Follow by thorough
hand washing.
J. Outside of bag should not be touched
by the hand contaminated by
specimen prior to handwashining.

K. Cleanse all equipment or dispose K. Refer to A.D. Biohazardous

appropriately, in Biohazardous waste Waste” procedure.
container.

L. Leave area clean and neat. Use L. To provide for unit comfort and dispel
aerosol-deodorizing spray in area if odor.
necessary.

M. Note character of stool while preparing
specimen for lab. Document in IDN, lab
slip, and on Individual’s Diagnostic MAR
LAB. Document Individual teaching on
the “Wellness and Recovery Individual
and Family Health Education Record”
CSHxxxx
M. Staff member who collected the
specimen will record on the Lab slip
and the Diagnostic MAR: LAB the exact
date and time the specimen was
collected. Its disposition will also be
reflected in the ID notes.

N. Place completed lab slip in pouch of N. Send specimen in specimen transport

 POLICIES AND PROCEDURES MANUAL
OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
00 REVIEW DUE
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the specimen transport bag. bag to designated specimen

 POLICIES AND PROCEDURES MANUAL
OBTAINING STOOL SPECIMENS FOR LABORATORY ANALYSIS
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
00 REVIEW DUE
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collection site within 30 minutes.

O. Immediate evaluating, sorting, ands
logging begins when the lab reports
arrive on the unit. Promptly report
significant test results to physician.
Provide all lab results to the Med/Surg
physician for review.
O. As the lab report arrives on the unit,
the Med Room person and/or Shift Lead
is responsible for notifying the RN of its
arrival. The RN is expected to promptly
review all incoming lab results then
date and initial the Diagnostic MAR:
LAB. If the results of the lab are out of
therapeutic parameters, the RN shall
notify the physician off these results
and reflect this on the Diagnostic MAR:
LAB by checking the YES box, followed
by identifying same action in the IDN
including action taken.