MICROBIOLOGY & PARASITOLOGY

SLIT SKIN
SMEAR TEST
GROUP 1

BSN 1-YB-17
TODAY'S DISCUSSION

TOPIC OUTLINE

01. Introduction: About the Disease

02. Definition: Description of Laboratory Diagnosis Procedure

03. Materials: Equipments

04. Procedure: How to take a Skin Smear Examination

05. Nursing Considerations

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 Leprosy (Hansen's Disease)

SLIT SKIN SMEAR

I. INTRODUCTION: ABOUT THE DISEASE

Slit-skin smear (SSS) is a cytodiagnostic

technique used as a side laboratory
procedure in the diagnosis of various
cutaneous dermatoses.
The skin smear is a valuable, cost-effective
tool in the routine management of the patient
with Hansen's disease. The smear is a means
of estimating the number of acid-fast bacteria
present, reported as the Bacterial Index (BI),
and is important in determining the type and
severity of disease as well as assessing the
response to treatment.
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II. DEFINITION: DESCRIPTION OF LAB DX PROCEDURES

What is Skin-Smear Test?

A skin smear is a test in which a sample of
material is collected from a tiny cut in the
skin and then stained for M. leprae, an
acid-fast bacillus. Skin smears or biopsy
material that show acid-fast bacilli with the
Ziel-Neelsen stain or the Fite stain can
diagnose multibacillary leprosy.

Why take a Skin Smear Test?

• To confirm a diagnosis of skin smear-
positive multibacillary leprosy in a suspect.
• To help diagnose multibacillary relapse
in a patient who has previously been
treated.
• To help with the classification of new
patients.
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DISEASE WHICH SLIT-SKIN SMEAR CAN
BE USED AS A DIAGNOSTIC MODALITY

Leprosy (Hansen's Disease)

In the multibacillary form of Hansen’s

disease, tissue biopsy of various
affected sites may reveal typical
histopathologic changes that show
large numbers of foam cells. Foam cells
are macrophages that have ingested, or
phagocytized, M. leprae bacteria, but
are unable to digest the organisms, who
in turn multiply and use the macrophage
as a method of transport throughout the
body. This is how the bacteria cause the
multiple lesions that may appear in all
parts of the body in MB leprosy patients.
II. DEFINITION: DESCRIPTION OF LAB DX PROCEDURES
Picture (A)
This photomicrograph
reveals some of the classic
histopathologic changes
found in a skin section from
an individual with a case of
the leprosy.
Picture (B)
This photomicrograph
reveals some of the
histopathologic changes in a
specimen of human
testicular tissue, which
included a large number of
“foam cells”. These changes
were attributed to a case of
multibacillary (MB) leprosy.
 II. DEFINITION: DESCRIPTION OF LAB DX PROCEDURES
HOW DOES A SLIT-SKIN SMEAR TEST
WORK? A skin smear is a test in which a sample
of material is collected from a tiny cut in
the skin and then stained for M. leprae,
an acid-fast bacillus.

Select the most active-looking lesion,

but not on the face. 'Active' means
raised and reddish in colour. Take the
smear in the most active area of the
lesion (usually the edge).

Skin smears or biopsy material that

show acid-fast bacilli with the Ziel-
Neelsen stain or the Fite stain can
diagnose multibacillary leprosy. If
bacteria are absent, paucibacillary
leprosy can be diagnosed.

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PROCEDURES OF ACID-FASTING STAINING

Skin smears or biopsy material that show acid-fast bacilli with the Ziel-
Neelsen stain or the Fite stain can diagnose multibacillary leprosy. If

bacteria are absent, paucibacillary leprosy can be diagnosed.

Picture (A) Picture (B)

This acid-fast-stained
This photomicrograph of a
photomicrograph of a tissue
skin tissue sample from a
sample extracted from a
patient with leprosy shows a
patient with leprosy shows a
cutaneous nerve, which had
chronic inflammatory lesion
been invaded by numerous
known as a granuloma,
M. leprae bacteria (shown in
within which numerous red-
red).
colored M. leprae bacteria are
visible.
 SLIT SKIN SMEAR
III. MATERIALS (EQUIPMENT)

GLOVES SPIRIT SWABS CLEAN SCALPEL SAFE DISPOSABLE

HANDLE WITH BLADES FOR USED BLADES

DRESSING STRIPS SPIRIT LAMP CLEAN GLASS SLIDES

MICROBIOLOGY AND PARASITOLOGY

 HOW TO TAKE A SKIN SMEAR
IV. PROCEDURE
1 Wash your hands (1) and put on gloves.
Take a new, clean, unscratched
2
microscope slide. Using a slide marker,
write the patient identification (ID)
number at the bottom of the slide (2).
This number must be on the request
form.
3 Clean the skin at the smear sites with a
cotton wad drenched in alcohol. Let it
dry.
4 Light the spirit burner.
5 Put a new blade on the scalpel handle. If
you put the scalpel down, make sure the
blade does not touch anything.
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6 Pinch the skin firmly between your
thumb and forefinger; maintain pressure
to press out the blood.
7 Make an incision in the skin about 5 mm
long and 2 mm deep (3). Keep on
pinching to make sure the cut remains
bloodless. If bleeding, wipe the blood
away with cotton wad.
8 Turn the scalpel 90° and hold it at a right
angle to the cut. Scrape inside the cut
once or twice with the side of the
scalpel, to collect tissue fluid and pulp.
There should be no blood in the
specimen, as this may interfere with
staining and reading.
 HOW TO TAKE A SKIN SMEAR
IV. PROCEDURE

9 Stop pinching the skin and absorb any 14 Dress the wounds and thank the patient
bleeding with a wad of cotton.
10 Spread the material scraped from the Let the slide dry for 15 minutes at room
15
incision onto the slide, on the same side temperature, but not in direct sunlight.
as the ID number. Spread it evenly with
16 Fix the smears by passing the slide, with
the flat of the scalpel, making a circle 8
the smears upwards, slowly through the
mm in diameter (4).
flame of a spirit burner, 3 times (5). Do
11 Rub the scalpel with a cotton wad
not overheat. The slide should not be
drenched in alcohol. Pass the blade
too hot to touch.
through the flame of the spirit burner for
17 Put the slide in a slide box and send to
3 to 4 seconds. Let it cool without
the laboratory with the skin smear
touching anything.
request form.
12 Repeat the steps above for the second
site. Spread this smear next to, but not
touching, the first one.

13 Discard the scalpel blade safely.

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 NURSING CONSIDERATIONS

After collecting the skin smear and

obtaining results from staining the
sample, The nurse's responsibility
is to deliver results to the client
and secure nurse-patient
confidentiality. Inspect for other
skin lesions and ask if the patient
is undergoing procedures like
chemotherapy. Any questions or
fears from the patient must be
answered by the nurse.

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 REFERENCES
https://www.ijpd.in/article.asp?issn=2319
7250;year=2019;volume=20;issue=4;spage=341;epage=344;aulast=G
autam#:~:text=Slit%2Dskin%20smear%20(SSS),and%20examined%20u
nder%20a%20microscope.
https://www.hrsa.gov/hansens-disease/diagnosis/skin-smears.html
https://www.slideshare.net/MamoonYounas1/slit-skin-smears
https://ilepfederation.org/wpcontent/uploads/2020/02/LG3.pdf
https://www.ijpd.in/article.asp?issn=2319-
7250;year=2019;volume=20;issue=4;spage=341;epage=344;aulast=G
autam
https://www.cdc.gov/leprosy/health-care-workers/laboratory-
diagnostics.html
https://www.practo.com/tests/slit-skin-smear-test-skin-smear/p?
city=delhi
https://www.researchgate.net/figure/Slit-aspirate-collection-using-slit-
scrape-technique-a-Cleansing-of-skin-lesion-of_fig4_234031254

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 THANK YOU FOR LISTENING!

SLIT SKIN
SMEAR TEST
Group Members:
Brinio, Zachary
Casinto, Czarina
Corpuz, Ian Christopher
Dabay, John Nicole
Dalman, Jhaziel

BSN 1-YB-17