BACHELOR OF SCIENCE IN NURSING:

MICROBIOLOGY & PARASITOLOGY IN NURSING

LABORATORY MODULE LABORATORY UNIT WEEK
10 3 13
Stool Specimen Collection for Different Evaluations

✓ Read course and laboratory unit objectives

✓ Read study guide prior to synchronous class attendance
✓ Read required learning resources; refer to course unit terminologies for jargons
✓ Participate in weekly discussion board (Canvas)
✓ Submit course unit tasks

At the end of this unit, the students are expected to:

1. Understand the importance of correct stool specimen collection in disease detection and medical regiment
2. Demonstrate accurately the skills in collecting stool specimen for different evaluations/test
2.1. Routine Stool Exam
2.2. Fecal Occult Blood Test (Guiac Smear Test)
2.3. Fecal Immunochemical Test (FIT)
2.4. Fecal Fat Test
2.5. Fecal Ova & Parasite Test
3. Enumerate how to properly dispose soiled items used in stool specimen collection
https://www.cdc.gov/dpdx/diagnosticprocedures/stool/specimencoll.html
https://www.nhs.uk/common-health-questions/infections/how-should-i-collect-and-store-a-stool-faeces-sample/

Stool Specimen Collection

Stool specimen has also long been a routine test or source for measuring health and well-being and remains an
important tool for clinical diagnosis. It is most particularly significant during outbreaks of both water and food-borne
diseases. And it can also be an indication of certain disease or condition if certain amounts of blood is present or
presence of parasites-causing diseases.

The clinical information obtained from a stool specimen is influenced by the collection method, timing and handling.
This is why proper collection of stool specimen is important to avoid contamination of the specimen or deterioration
of stool constituents.

OVERVIEW OF STOOL SPECIMEN COLLECTION:

Stool or otherwise known as human feces are defined as waste residue of indigestible materials of the
digestive tract expelled through the anus during defecation.

General Composition Macroscopic Examination

- ¾ water, ¼ solid Volume : <200gms/day
- Undigested and Unabsorbed food Color : clay, brown, green, black, white
- Intestinal secretions, Mucous Consistency
- Bile pigments and salts Odor
- Bacteria and inorganic material Blood (not normal)
- Epithelial cells, leukocytes Mucous (not normal)
Parasites (not normal)

Shades of
Indication Type of Stool Characteristic
Poop
Normal – due to the bile Separate hard lumps, like nuts
Brown Type 1
produced in the liver (hard to pass)
Food may be moving through
your large intestines too quickly.
Green Or you could have eaten lots of Type 2 Sausage-shaped but lumpy
green leafy veggies or green
food coloring
 Greasy foul-smelling yellow
poop indicates excess fats,
Like sausage but with cracks on its
Yellow which could be due to Type 3
surface
malabsorption disorder like
celiac disease
It could mean there is internal
bleeding due to ulceration or
Like a sausage or snake, smooth
Black some form of intestinal cancer. Type 4
and soft
Some vitamins like iron could
cause black poop.
Light-colored, It could mean a bile duct
Soft blobs with clear-cut edges
white or clay- obstruction Type 5
(passed easily)
colored
Fluffy pieces with ragged edges, a
Type 6
Blood-stained It could mean a symptom of mushy stool
or Red cancer Watery, no solid pieces, entirely
Type 7
liquid

GENERAL CONSIDERATIONS:
1 Practice Universal Precautions (hand washing and wearing of gloves, face mask)
2 It should be uncontaminated with urine or any other body secretions.
3 Fresh stool should be examined, processed, or preserved immediately.
4 An exception is specimens kept under refrigeration when preservatives are not available; these specimens
are suitable for antigen testing only
5 Fecal specimens should be collected in the early stages of the diarrhoeal disease, when pathogens are
present in the highest number, and preferably before antimicrobial treatment is started, if appropriate.

SKILL 1: ROUTINE STOOL SPECIMEN COLLECTION

1. Review doctor’s order for stool 3. Label the outer sides of the 4. Before putting the clean plastic
specimen collection. container with the patient’s wrapper, advise patient to urinate
2. Greet and obtain informed name, date and time first
consent and explain the
 procedure to optimize the quality
of the specimen.

5. Place the wrapper around the 6. Place a clean piece of toilet paper on top of the plastic wrapper
toilet seat; make sure not to You may use unused disposable container to catch watery stools
stretch it too much.
Use tape if necessary.

7. With the use of the specimen spoon, scoop pea or 8. Transfer to cup until liquid reaches fill line or
walnut-sized stool sample onto the container walnut-size specimen
9. Remove spoon from lid and discard properly
10. Replace cap on vial tightly.

11. Complete the 12. Bring the specimen to 13. If in case lab tech is 14. Wash hands.
specimen request the laboratory. unavailable, place the
form and send to urine specimen inside
laboratory the body of the
refrigerator max of 2 hrs.
SKILL 2: FECAL OCCULT BLOOD TEST (FOBT)
▪ A non-invasive way to screen your feces, or stools, for blood that's not visible to the naked eye, known as
occult blood.
▪ To check for bleeding due to hemorrhoids, ulcers, colon colitis, polyps, diverticulosis, colorectal cancer
▪ NOT A DIAGNOSTIC test but would serve as an impetus for additional testing
▪ It will not show where the bleeding if present, is coming from or what’s causing it.
▪ Most commonly used as a screening tool to look for blood in the stool of people who are 50 years or older
who are at average risk of developing colorectal cancer

2.1. GUIAC SMEAR TEST

▪ Uses a chemical that changes color when there's blood present.
▪ Typically, collect three stool samples on three different days (usually lasting to 10 days) and send them to a
lab for analysis.
▪ Requires that you abstain from certain foods and medications for a period of time beforehand to help
ensure accuracy

Drugs/Medicines to Avoid Food and drinks to Avoid

- Non-steroidal anti-inflammatory drugs (NSAIDs), such
as aspirin, Aleve (naproxen), or Motrin/Advil
(ibuprofen), can cause bleeding in your stomach or
intestines, which may cause a false-positive on your
test
- Avoid NSAIDs for (7) seven days before your FOBT
- Colcrys (colchicine), which is used to treat gout, and
oxidizing drugs like iodine supplements, often used for
thyroid disease, and boric acid, which may be used to
treat fungal infections, can also create a false-positive
result by reacting with the chemicals in the test.
- Vitamin C supplements can affect the chemicals in the
test and may create the opposite problem—they can
cause a false-negative
- Red meat, like beef, lamb, and
pork, and other foods like
broccoli, turnips, horseradish,
and cauliflower should be avoided
for (3) three days before your test
and throughout the testing process
- Juices with added vitamin C, or
any amount of fruit that will give
you more than 250 mg of vitamin
C per day, should be avoided for (3)
three to seven days before your
FOBT and during the testing
process.

DOING THE TEST:

1. Same stool specimen collection steps 1 to 7
3. Fresh stool is needed. Using the stick
provided, get a small amount of the stool and
smear it on the space test. 2 smears from
different parts of the same stool is needed.
2. A total of 3 cards are needed, which means 3
stools from 3 different days
4. All 3 cards must be done within 10 days of
starting.
SKILL 2: FECAL IMMUNOCHEMICAL TEST (FIT):
▪ newer test for evaluating fecal occult blood
▪ uses antibodies to detect blood and may be more sensitive than the gFOBT.
▪ doesn't require any special dietary restrictions and can be done at any time
▪ With this test, you may collect one to three stool samples as your doctor instructs and send them to lab

DOING THE TEST

1. Same stool specimen collection steps 1 to 7 5. Place the probe with stool sample back in the
sampling bottle and close it. Do not reopen it.
2. Open the sampling bottle 6. Wrap the sampling bottle in the small
absorbent pad and place it in the biohazard
bag
3. Use the probe to scrape the surface of the 7. Seal the biohazard bag and place it in the
stool return mailer envelope.
4. Cover the grooved portion of the sample probe NOTE: The stool sample is perishable. Please
completely with stool. return the kit as soon as possible within 48
hours.

SKILL 3. FECAL FAT TEST:

▪ measures the amount of fat in your feces or stool
▪ usually spans 24 hours, but it can sometimes last for 72 hours
▪ collect each stool sample with a special testing kit
PREPARATION:
✓ high-fat diet (100 GRAMS) each day for three days prior to the test

SKILL 4. FECAL TEST FOR OVA & PARASITE TEST:

▪ microscopic evaluation of a stool sample that is used to look for parasites that may infect the lower
digestive tract, causing symptoms such as diarrhea
▪ avoid taking:
- Laxatives
- antidiarrheal medications
- antibiotics
- contrast dyes, which are used in imaging studies and X-rays
 MICROBIOLOGY LABORATORY
Lab Report # 10 ( STOOL SPECIMEN COLLECTION )

NAME: ___________________________________ Date: ____________

Year and Section:___________________________

I. The attending physician ordered routine fecalysis on his patient. How will you instruct your patient regarding
proper stool collection. You can use “Filipino or Tagalog “ to instruct your patient.

II. Explain the result of routine fecalysis for:

1. viral gastroenteritis
2. bacterial gastroenteritis
3. amebiasis
Describe the microscopic findings of fecalysis for these infections.

III. Give instances and explain when fecalysis results will be erroneous.
IV. What are some factors which can affect the results of fecalysis?
V. Before stool analysis, what are some nursing interventions and instructions that can be given to the patient?
VI. What are some nursing interventions and instructions that should be given to the patient after stool collection?

https://www.cdc.gov/urdo/downloads/SpecCollectionGuidelines.pdf
https://www.hamad.qa/EN/Hospitals-and-services/Hamad-General-Hospital/Hospital-Services/Clinical-
Departments/Documents/Urine Collection Procedure Manual 202018-2020 guide.pdf