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Laboratory: Clinical Microbiology
Test Name:
Test Code: WS, TIS, TIAN
Clinical Information:
Test Indications:
Clinically infected decubitus ulcer.  Clinical infection is suspected when there is cellulitis surrounding the ulcer or purulent discharge from the ulcer.

1.  Prior to the collection of any specimen, remove all exudate, purulent material and necrotic tissue from the wound or ulcer.  Wash the wound or ulcer thoroughly using normal saline.  Wound base should be visible and free of exudate, pus and necrotic tissue before sampling.  Specimens should be taken before antibiotic treatment.
2.  For complicated ulcers, the specimen of choice is a tissue biopsy of the infected ulcer base or edge.  Using a scalpel or punch biopsy instrument, aseptically obtain a 3-5 mm tissue sample from the base or edge of the ulcer.  If pelvic, sacral or coccygeal osteomyelitis is suspected, obtain a bone biopsy of the affected bone.  Submit the tissue or bone for aerobic and anaerobic culture in a sterile container.  If the biopsy is small (<3 mm) add a small amount of saline to prevent desiccation of the sample.
3.  If a swab is used, wash the wound or ulcer as above and place the swab tip on the base of the lesion.  With firm pressure, rotate the swab on the base several times until a small amount of bleeding occurs.  Place the swab in the transport tube and request aerobic cultures.  Anaerobic cultures should not be requested on swabs of superficial wounds or ulcers as they are frequently contaminated with anaerobic organisms which do not reflect the infectious process.  Do not use a swab for the diagnosis of a suspected pelvic, sacral or coccygeal osteomyelitis underlying a decubitus ulcer.

Patient Preparation Instructions:
Accurate patient identification must be made prior to sample collection.
Samples and requisitions must be labeled/completed in accordance with the Shared Health Specimen Acceptance Policy.  Prepare wound bed as described in recommendations above.
Collection Devices:
Specimens received in non-sterile containers (aspirates and tissues) or other collection devices will not be processed.
Specimen Required: Wound: Swab, Tissue or Aspirate (Adult and Pediatric)
Ulcer:  Tissue (preferred), Ulcer swab (Adult and Pediatric)
Reference Values:
A descriptive report will be provided.
See Also:
More Information:
Specimen Handling:
Specimens must be delivered to the laboratory as soon as possible and should be received within 24 hours of collection.  Samples >96 hours old will not be processed.  Ensure specimens are sent using appropriate packaging in accordance with Transportation of Dangerous Goods Regulation.