TABLE 2.
Tracheal aspirate specimen collection, processing, and Gram staining
| Laboratory process | No. (%) |
|---|---|
| Specimen collection and receipt | |
| Labs that are aware if a tracheal aspirate specimen has been diluted with saline upon receipt in the laboratory (n = 71) | 5 (7) |
| Labs with rejection criteria for tracheal aspirate specimens based on time from collection to delivery in the microbiology laboratory (n = 72) | 32 (44) |
| Criteria of laboratories with time rejection criteria (n = 31) | |
| >2 hours after collection if refrigerated OR >24 hours after collection | 24 (75) |
| After 30 min to 1 hour of collection | 3 (9) |
| >4 days after collection | 1 (3) |
| Same day | 1 (3) |
| Other | 3 (9) |
| Labs with rejection criteria for tracheal aspirate specimens based on container type (n = 72) | 27 (38) |
| Labs performing surveillance tracheal aspirate cultures (n = 73) | 4 (5) |
| Labs that process tracheal aspirate specimens for culture in-house (n = 73) | 61 (84) |
| Tracheal aspirate Gram staining | |
| Labs that prepare a tracheal aspirate Gram stain by selecting the most purulent area of the specimen and spreading it on to a slide (n = 61) | 60 (98) |
| Labs that reject tracheal aspirate specimens for culture based on Gram stain criteria (n = 61) | 14 (23) |
| Criteria for rejection based on Gram stain (n = 14) | |
| Rejection based on number of epithelial cells seen | 7 (50) |
| Rejection based on Q score | 1 (7) |
| Rejection based on a combination of epithelial cell, PMN, and organism quantities | 6 (43) |
| Microscope objective used to observe human cells in tracheal aspirate Gram stains (n = 61) | |
| 10× | 39 (64) |
| 40× | 6 (10) |
| 100× | 14 (23) |
| 10× for epithelial cells, 100× for PMNS | 2 (3) |
| Labs using the 100× microscope objective to view organisms on tracheal aspirate Gram stains | 60 (98) |
| Labs using minimum Gram stain field review criteria | 34 (56) |
| Criteria used for minimum field review (n = 34) | |
| 5–15 fields | 8 (23) |
| 20–40 fields | 19 (56) |
| 50–100 fields | 4 (12) |
| "several" | 2 (6) |
| 1/2 of the slide | 1 (3) |
| Gram stain quantitative methods (n = 61) | |
| Quantitatively (e.g., X number of organisms or cells per high power field) | 3 (5) |
| Semiquantitatively (e.g., rare, few, moderate, heavy) | 57 (93) |
| No form of quantitation (organisms or cells are listed) | 1 (2) |
| Labs culturing tracheal aspirate specimens in-house (n = 60) | 60 (100) |
| Lab plating methods for tracheal aspirate cultures (n = 61) | |
| Semiquantitative: quadrants are streaked on the plate and growth is reported as either a version of rare, few, moderate, heavy, or 1+, 2+, 3+, 4+ | 56 (92) |
| Quantitative: colonies are counted and multiplied by a dilution factor | 3 (5) |
| Other | 2 (3) |