REQUESTING LAB SUPPLIES

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Exciting news for our valued clients! 

We’ve rolled out a convenient new way to request lab supplies from us.

Order supplies online

As an alternative to requesting supplies over the phone, clients can now request supplies using our new supplies ordering web form.  Simply select which supplies you need on our web form, input your facility/delivery information, and submit your supplies order to us in just a few clicks. 

Join us in embracing simplicity and convenience and start using our new online ordering tool today!

Going forward, clients may choose to request lab supplies either through the online form or by calling 847-509-9779, option 3.

Reminders for all supplies orders:
  • The supplies provided by NICL Laboratories are solely to be used for the collection and preparation of specimens which are being sent to our laboratory for testing.  Type and quantity of items must correlate to the number of specimens submitted to us for testing.
  • Please allow up to 3 business days for delivery of lab supplies.
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Post PHE COVID PCR Testing

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With the Public Health Emergency (PHE) ending on May 11, 2023, there are some important changes coming that impact all COVID testing requests.  Post PHE, any COVID PCR tests requested that do not meet the requirements below and/or that are not covered by a patient’s health plan will be billed to your facility.

REQUIREMENTS FOR REQUESTING

To request any COVID testing, facilities should use NICL’s NEWLY UPDATED COVID Requisition Form.  All requests for COVID testing submitted to NICL must include the following along with the completed Requisition Form:

  • An ordering MD
  • A corresponding order for the testing in the patient medical record
  • All ICD-10 codes reflective of patient condition and symptoms present
  • Any other required documentation as may be required by the payor

PAYMENT FOR COVID TESTING

While specific guidance from CMS regarding medical necessity for testing and the CDC on appropriate circumstances to test are evolving and forthcoming, we anticipate that submitting COVID PCR testing for the following reasons will NOT BE COVERED by Medicare and other health plans:

  • Pre-operative or pre-procedure testing
  • New admissions
  • Asymptomatic exposures
  • Surveillance testing

NICL Laboratories reserves the right to reject any samples or charge the facility for any testing performed where the above requirements are not satisfied or where testing is not covered by a patient’s health plan.

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Proper Swab Type for Testing Respiratory Viral Pathogens

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There are two different types of nasal swabs that may be used for respiratory viral pathogen testing by NICL.  Which is the correct swab type to use depends on the specific test being ordered.

  • The only time when an ANTERIOR NASAL SWAB may be used is for SARS CoV-2 testing.  This type of swab cannot be used for Influenza, RSV, or other Respiratory Viral Pathogen testing.
  • A NASOPHARYNGEAL SWAB must be used for all other respiratory viral pathogens, including influenza, RSV, and others.
Please use the above guide for easy reference.   For collection instructions for each type of swab, please see related NICL Lab Notes:  Respiratory Viral Pathogens Collection.
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Blood Culture Collection Guidelines

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This procedure will guide you through indications, timing, number of sets, volume of draw per set, and PICC line collection.

INDICATION

Routine blood cultures should be performed on patients with suspected bacteremia or candidemia. 

TIMING

Blood cultures should be drawn prior to the administration of antibiotics whenever possible, or as soon as possible after administration begins.  There is no data to support that timing in relationship to febrile state or chills will improve yield or detection.

VOLUME

Literature suggests that the volume of specimen collected is directly proportional to the positivity rate.  It also shows that low volume collections contain a higher number of contaminants.   Two to three (2-3) sets of cultures should be used to rule out bacteremia or candidemia.

COLLECTION

PICC line collection (should be performed only when absolutely necessary):

  • 1. Make sure you are wearing proper personal protection equipment (PPE), including gown and gloves.
  • 2. Gather the required equipment:
    • Blood culture bottles
    • 4 alcohol preps
    • 1 3-5 cc  syringe
    • 10 cc syringes with a sterile needle
  • 3. It is essential to AVOID DRAWING FROM LINES WITHIN AN HOUR OF COMPLETION OF ANTIMICROBIAL AGENT ADMINISTRATION, as the antimicrobial agent may be passed into the blood culture bottles and prohibit growth.
  • 4. Using two separate alcohol preps wipes (70% alcohol), scrub catheter hub connection for 15 seconds with each wipe.  Let it air dry.
  • 5. Using the last two alcohol preps carefully wipe the tops of the blood culture bottles for 15 seconds each.
  • 6. Disconnect the tubing from the cap of the catheter and attach the small syringe to collect discard blood.  The suggested amounts for adults are 3 ml and 0.2 ml for pediatric patients.  This blood is used to wash the line, and it is not used for culture.  The entire syringe and contents can be discarded into a biohazard container.
  • 7. Using a new syringe, collect blood for culture through the hub. 2-4 ml is required for each of two blood culture vials.  When enough blood has been obtained for the two vials, detach the syringe from the catheter and reconnect the tubing to the cap of the catheter. 
  • 8. Place a sterile needle on the syringe, and transfer the blood, using sterile technique into the blood culture vials.   Sterile technique requires that you DO NOT touch the top of the alcohol cleaned vials with anything but the tip of a sterile needle, and that you do not touch the syringe head with anything but the sterile needle.
  • 9. Gently mix the blood culture vials thoroughly to prevent clotting. 
  • 10. Label each specimen with the patient’s name, date of birth, date and time of collection, and collection site, and place them with a completed requisition at room temperature for pickup by laboratory personnel.

J Clin Microbiol. 2009 Nov;47(11):3482-5. doi: 10.1128/JCM.02107-08. Epub 2009 Sep 30. Effects of volume and site of blood draw on blood culture results. Gonsalves WI, Cornish N, Moore M, Chen A, Varman M.

Clin Microbiol. 2007 September; 45(9): 2765–2769.  Published online 2007 June 13. doi:  10.1128/JCM.00140-07 PMCID: PMC2045273. Is the Volume of Blood Cultured Still a Significant Factor in the Diagnosis of Bloodstream Infections? Emilio Bouza,1,*Dolores Sousa,2Marta Rodríguez-Créixems,1Juan García Lechuz,1 and Patricia Muñoz1

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Specimen Labeling & Adequacy

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Specimen collection and labeling are essential steps to assuring reliable results.   The Joint Commission for Accreditation of Hospitals, CLIA, and other inspecting agencies require all specimen to have two patient identifiers.  The following guidelines apply to all specimen, routine laboratory, microbiology, cytology, and anatomic pathology.

DO NOT label the specimen tubes prior to collection.   24-hour urine containers, however, should be labeled prior to giving the container to the patient for collection.

  1. Write the patient’s full first and last name on the specimen.
  2. Write the patient’s date of birth on the specimen.
  3. Write the date and time of collection and your initials on either the specimen or the accompanying requisition.

Unlabeled or mislabeled specimen will not be accepted if  labeling is not accurate and complete, as in the following scenarios:

  • First or last name or both on the specimen do not match those on the requisition.
  • The specimen is unlabeled, even though it arrives at the laboratory in a plastic specimen bag with the requisition.
  • The patient’s complete name is not on the specimen.  Initials are not acceptable.

Irretrievable specimens may be an exception.  These include spinal fluids and biopsy materials.  In these cases, the physician or staff involved must sign the lab mislabeled/unlabeled documentation form before results can be reported.

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In-Service Lectures

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NICL Laboratories provides scheduled lectures and question-and-answer sessions to clients on  relevant topics, including:

Infection Control Report

  • Facility-specific statistics on infection instances and types
  • Report overview and discussion

Laboratory Results

  • Reporting of Laboratory Values
  • Discussion on handling abnormal laboratory result

Review of the Advanced Standing Order System

  • Laboratory forms and computer printouts
  • Maintenance of the ASOS system/ordering laboratory test(s)
  • Chart Audit and review procedure

Specimen Collection / Infection Control

  • Procedures for collection of specimens for microbiology
  • Optimum times for routine specimen collection
  • Transcaddy specimen collection systems

Bloodborne Pathogens

  • Discussion on OSHA’s Bloodborne Pathogen Standard
  • Exposure Control Plan
  • Identification of potentially infectious items and materials
  • Methods for preventing transmission of disease
  • Universal Precautions

Handwashing for Infection Control

  • Discussion of epidemic transmission of microbes
  • Handwashing indications – CDC Guidelines
  • Handwashing techniques – CDC Guidelines
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Respiratory Viral Pathogens Collection

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NOTE: Wear a gown, gloves, mask (N95 preferred), and eyewear when collecting these specimen.

1. Obtain specimen using only the mini-tip swab provided in the kit. Due to supply shortages, please use one swab per patient, please!

  • When collecting just a SARS CoV-2 sample, you may use an anterior nasal swab.
  • All other viral pathogen tests require a thin-tipped nasopharyngeal swab.
Swab TypeCollection Procedure
Nasopharyneal (N/P) swab

Has a very thin swab end; diameter of swab end is not much larger than swab handle		Push forward using gentle downward pressure to keep the swab on the floor of the nasal cavity until the tip reaches the posterior wall of the nasopharynx. Gently rub and roll the swab, and leave in place for several seconds to absorb fluid.*

It is not necessary to swab both sides if the swab is fully saturated from one side, but if both sides are collected, use a single swab on both the left and right nasal cavity.

A single swab may be used for SARS-CoV-2 and Influenza/RSV or Respiratory Viral Panel.
Anterior nasal swab

Swab end resembles a Q-tip.
Do not attempt to collect a nasopharyngeal specimen using this type of swab.		Insert the swab at least one-half inch inside the nostril (naris) and firmly sample the nasal membrane by rotating the swab and leaving in place for 10 to 15 seconds.

Sample both nostrils with the same swab.

This type of swab can only be used for SARS-CoV-2 testing. It cannot be used for Influenza, RSV or other Respiratory Viral Pathogen testing.
*For a demonstration of N/P specimen collection please go to http://www.youtube.com/watch?v=DVJNWefmHjE (NEJM | Collection of Nasopharyngeal Specimens with the Swab Technique).

2. Break the shaft at the molded mark so that it can be placed in the tube without restricting the cap, and replace the cap tightly to prevent leakage and specimen rejection.

3. Label the vial with patient information (Name, DOB, collection date & time, specimen source and the test requested). Refrigerate it immediately.

4. Store the specimen refrigerated, and send it to the lab as soon as possible.

5. Complete the requisition. Indicate the swab type, and if the patient is symptomatic or if testing is for preoperative procedures. Race and ethnicity are also required by Health and Human Services. This is essential!

A sterile swab is passed gently through the nostril and into the nasopharynx

The above are M4RT media and other Viral transport media (check the label to see if the media should be kept refrigerated prior to collection). They are appropriate for Influenza, RSV, Respiratory Viral Panels and SARS-CoV-2 testing. NICL requires the use Viral transport media for its viral pathogens testing.

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Patient Identification Verification

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The keystone to the laboratory’s ability to provide accurate test results is the proper identification of the patient from whom the specimen is collected. Therefore it is crucial to ensure that the specimen being collected, processed and tested is correctly associated with a positively identified patient. Acceptable methods of positive patient identification are described below.

For patients capable of active communication and wearing arm bands, they will be asked to state their full names and date of birth. This will be compared to the information documented on the requisition form. If the information received corresponds with the information on the requisition form, the specimen collection will proceed. If the information received does not correspond with the information on the requisition form, Nursing staff will be sought to confirm the identity of the patient.

For patients NOT able to personally participate in the confirmation process and who are wearing arm bands, the information on the arm band (name and date of birth) will be compared to the information on the requisition form. If the information on the arm band corresponds with the information on the requisition form, the specimen collection will proceed. If the information on the arm band does not correspond with the information on the requisition form, Nursing staff will be sought to confirm the identity of the patient. The name of nurse confirming the identity of the patient will be documented.

For patients who are NOT able to personally participate in the confirmation process and NOT wearing arm bands, nursing staff will be sought to provide the identity of the patient. The name of the nurse providing the identity of the patient will be documented.

NICL Laboratories reserves the right to defer specimen collection if there is reasonable doubt in the proper identification of the patient or lack of support in attempting to confirm identity of patient.

Your cooperation in this critical patient safety concern is vital.

3/5/2020 NICL Laboratories, Ltd All Rights Reserved

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Catheter Tip Culture Collection

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Cultures of central venous catheter tips are frequently ordered to help determine the source of bacteremia. Correct collection and submission are essential for accurate results and personnel safety.

The intracutaneous segment and distal tip of long catheters should be submitted, but in practice the catheter tip is usually received and should be accepted. The catheter tip must be in a sterile container and must not remain at room temperature for more than 4 hours.

Catheter tips should be requested only if there are signs of infections, i.e. inflammation at the site of insertions, fever, signs of sepsis, or documented bacteremia in which source is not apparent. The routine culture of catheter tips without signs and symptoms is discouraged.

COLLECTION OF CATHETER TIP BY NURSE OR PHYSICIAN

  1. Thoroughly cleanse skin around the insertion site with 70% alcohol. Allow to dry.
  2. Using sterile forceps, carefully withdraw the catheter keep externalized portion directed upward and away from the skin surface.
  3. Holding the distal end of the catheter over a sterile container, cut the tip with sterile scissors, dropping the last 2-3 inches into the sterile container. Avoid contact with the outside of the container. Avoid drying of the specimen.
  4. Inspect the catheter exit site and note if any purulence can be expelled.
  5. If pus can be expelled from the catheter exit site, swab drainage with a culturette swab and send to the laboratory requesting a routine wound culture. Label the source as: Drainage from (location of) IV exit site, (e.g. drainage from Right IJ exit site).
  6. Send the catheter segment(s) to the laboratory requesting a routine culture. Label the source as: Location/type of IV catheter, (e.g. Right IJ swan).
  7. Send the accompanying blood cultures to confirm bacteremia.

SPECIMEN STORAGE

Store in refrigerator (must not remain at room temperature for more than 4 hours). Must arrive within 24 hours.

REJECTION CRITERIA

  1. Do not send Foley catheter tips.
  2. Do not send catheter tips in saline or transport media.
  3. Do not send the whole catheter line.
  4. Catheter received in a nonsterile container.
  5. Unlabeled specimen (always have Patient’s name, date of birth, and source)

References:

Linares J, Sitges-Serra, Grarav J, Percex JL, Martin R: Pathogenesis of catheter sepsis: a prospective study with quantitative and semi-quantitative cultures of catheter hub and segments. J Clin Microbiology 1985;21:357-360

Maki, D.G., Wise CE, Safarin H.W. : A semiquantitative culture method for identifying intravenous catheter-related infections. New Engl J Med 1977;296:1305-1309.

3/5/2020 NICL Laboratories, Ltd All Rights Reserved

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