Sputum collection

Clinical description

• Sputum sample collection strategy shall now be Spot – spot. To reduce diagnostic and

treatment initiation delays; to reduce loss to follow up and continuing transmission in the community; in keeping with the Sustainable Development Goals and the End TB Strategy to minimise the transfer of costs to the patient.

• Only two sputum specimens should be collected using the two-sample approach.(both

adult and children)

• The first specimen should be collected at the time when the patient presents to a

facility.

• A second labelled sputum container should be given to the patient and/ or guardian so

that his or her sputum can be collected 45 minutes to an hour after the first sample.

Before collecting sputum

• Patients should be well informed about the diagnostic process and the reason for

collecting sputum.

• Sputum collection should be done in the open air (or ventilated room) away from other

people to avoid infecting them.

• Patients should clean their mouths if they have been eating.
• A health worker should demonstrate how to cough and how to open and close the

sputum container.

• The laboratory request form should be filled out accurately and completely.
• Clearly label the sputum container with the patient’s name and the date of collection.

Label the container itself, not the lid.

• Make sure that the patient’s details have been recorded in the presumptive TB register.

How to collect a quality sputum

• Tell the patient that the best specimens come from deep inside the lungs after

coughing, not from saliva.

• Demonstrate how to cough deeply.
• Ensure that no one is standing in front of a patient producing sputum.

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• Instruct the patient to:

o Inhale deeply 2 to 3 times and to breathe out hard each time, o Followed by a deep inspiration and COUGH deeply from the chest, o Place the open container close to the mouth to collect the sputum, and o Screw the lid tightly.

• Avoid contaminating the outside of the sputum container with sputum. If the outside

is contaminated, discard the container and repeat the collection with a new container.

• The volume of the sputum should be 3-5 ml.

After collecting a sputum specimen

• Double check to ensure that the container is labelled properly
• Ensure that the container is firmly closed and wash your hands with soap and clean

water.

• The two sputum specimens should be sent to a microscopy site within 24 hours.
• Store sputum specimens for culture, preferably in a refrigerator or in a cool, safe

and dark place.

• Sputum specimens for culture should be received by the culture laboratory within

4 days of collection.

• Do not use laboratory request forms for wrapping specimens.

Who should collect sputum specimens

• It is the responsibility of health workers and community volunteers to collect sputum

specimens from presumptive TB cases.

• For in-patients, the ward nurse should check with the patient and/or guardian each

morning to encourage sputum production and to collect samples for submission to the laboratory.

• At health centre and community levels, health surveillance assistance (HSAs) and

community volunteers should follow up with presumptive TB cases to ensure sputum specimens are collected.

• Should the patient not return after submission of the first spot specimen, the HSA,

community volunteer or DTO must follow up with the patient immediately Transportation of sputum specimens

• Every health worker is responsible for sending sputum specimens to the laboratory

as soon as possible to ensure examination is done and results received within 24-48 hours of collection. However, should this be impossible, a maximum allowance of 4 days in which the sample should have reached the lab is given for sputum collection points).

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• Use any available means of transport.
• The specimens should be packed carefully, preferably in a transport box.
• Make sure that every specimen goes to the laboratory with a laboratory request form.
• A cold chain should be maintained throughout the transportation process, especially

when sending samples for culture.

Trained health workers and community volunteers may prepare smears at peripheral sites prior to transportation to the microscopy centre. To do so, health workers must have been trained in how to properly prepare and fix sputum smears as well as how to safely package fixed slides for transportation.