**5. Specimen collection**

The specimens are collected three times a week, that is, Mondays, Wednesdays and Fridays [4]. Before collecting a specimen, the nurse responsible for the patient should prepare a trolley. Aseptic technique should be maintained at all times to avoid contaminating the specimen. The trolley should be cleaned with a disinfectant using an S shape. A sterile green cloth should be put on top of the trolley. Two 20 ml sterile syringes should be opened from their packaging and thrown on the sterile cloth. A packet of sterile gloves should also be put on the sterile cloth. An alcohol swab should be put on the bottom of the trolley with specimen bottle. If the alcohol swabs are not available, sterile cotton wool swabs drenched in a disinfectant should be used. A nurse who is taking a specimen should have another nurse who will open an alcohol swab for her, so sterile cotton swabs are better if there is no one to open the readymade alcohol swabs.

The nurse must then wash her hands and don gloves. After wearing gloves, would look for the port (Also called suction valve) between the yellow and red pinch clamp. This port should be cleaned thoroughly with an alcohol swab before opening it. The nurse must remove the cap connect the 20 ml syringe and then open the yellow pinch clamp. The red pinch clamp must not be touched at all during the collection of the

#### *Lautenbach Irrigation System DOI: http://dx.doi.org/10.5772/intechopen.103078*

specimen. The nurse must withdraw the first specimen and close the yellow pinch clamp. That specimen must be discarded and a second 20 ml syringe must be connected to the port so as to get a fresh new specimen directly from the wound site. The first specimen must have been sitting there in the tube for a long time and it might give a wrong result, also; using two syringes assists in unblocking of the irrigation system if this is the case . Once enough specimen is collected the yellow pinch clamp must be closed and the port must be closed. It is advisable to clean the cap with the disinfectant before putting it back on the port.

If the patient has more than one tube the same procedure should be repeated on another tube making sure that new gloves and syringes are used. The specimens should be labeled accordingly. The laboratory form should be filled with a patient's name, hospital number, doctor who is in charge of the patient's details, ward number, date and time the specimen was collected, and the diagnosis of the patient. The wound site should also be included in the laboratory form, for example, the right tibia, left humerus, right femur, etc. The specimen type should be marked as Irrigation Fluid, not blood even though it looks like blood a few days postoperatively. The investigation required should be indicated as Microscopy/Culture/Sensitivity in the laboratory form. After that, the specimen should be sent to the laboratory and it would take 24 to 48 hours for the results to come out, depending on the laboratory. If the patient has more than one irrigation tube, a separate laboratory form should be used for each specimen collected on each tube.

A nurse should make a note on the progress notes for doctors that a specimen has been collected. A lab sticker with a reference number for the laboratory should be stuck underneath the signature of the nurse who took the specimen so that it becomes easier for the medical personnel to trace the results for the patient.

Once results are received by the ward a professional nurse can read them and act accordingly. For example, if the patient cultured Staphylococcus Aureas, which is sensitive to Cloxacillin the professional nurse should put 1 g of cloxacillin in 50 ml sodium chloride and remove the one that has gentamycin in it. The doctor should be made aware of this development but there is no need to wait for further instructions to change antibiotics as the protocol allows the nursing staff to do so. Precaution should be taken with penicillin drugs and the patient's allergy should be considered. If the patient has MRSA the irrigations should be changed to vancomycin and the patient should be isolated in a private room or placed next to a window in hospitals where there are no isolation rooms. Universal precautions should be abided by at all times. With patients who have cultured MRSA, the surgeon would prescribe vancomycin to be administered intravenously for a week as well. A nurse is not allowed to administer intravenous antibiotics without a prescription. So, the intravenous antibiotics will be initiated after the prescription has been obtained. The patient might be put on Vancomycin 1 g daily or 1 g twice daily taking into consideration the renal function of the patient. If the patient has some renal dysfunction, the nephrologist will be involved to suggest and give guidance on an appropriate renal dose. Vancomycin is not combined with rifampicin as irrigations are not put on a patient with an implant. The Implants are removed before a DRI procedure is done on a patient. Microbiologists and Infectious Diseases physicians are also involved once a patient cultures and is started on antibiotics.

For a patient to be considered cleared of infection; they should have three consecutive negative culture results. If a patient has two negative specimen results and a third one is positive, the third one will cancel the first two negative ones and the patient will continue with irrigation treatment until they receive uninterrupted three negative specimen results.
