To remove some indigenous flora from the mouth area, have the patient rinse the mouth with water just prior to obtaining the specimen.

Sputum

1. Collect 10 mL of sputum from first-morning deep cough in a screw-capped, sterile container. Watery and non-viscid specimens are saliva and should not be submitted.
2. Label the container with the patient's full name, date of birth, identification number, date and time of collection, initials of the person collecting the specimen, and the specimen source.
3. Maintain sterility and forward promptly.
4. The specimen source is required on the request form for processing.
5. If nebulization has been used, it must be noted on the request form.

How to guide the patient to collect an acceptable specimen:

- Instruct the patient to rinse mouth with water to reduce sputum specimen contamination with normal oral flora.  
- Avoid having the patient use mouthwash or toothpaste, these products may affect the mobility of organisms in the specimen.
- Instruct the patient to take three slow, deep breaths and then to cough deeply while covering the mouth with a facial tissue. Repeat this step, as necessary, until the patient has produced sputum.
- Allow rest periods between each maneuver, if necessary.
- Inspect the sputum specimen to ensure that it's actually sputum and not saliva/spit. (Sputum appears thick and opaque, while saliva appears thin, clear and watery).
- Document specimen source. Endotracheal aspirate is the source if taken from intubated patient.

1. A 24-hour collection is not acceptable for a bacterial culture.
2. Acid-fast culture of such specimens is discouraged.
3. Unacceptable specimens will be held for 5 days before discarding.

87070 - Culture Sputum (EAP 30060860)
87205 - Gram Stain (EAP 30061200)
87077 - Aerobic identification (if appropriate)
87184 - Susceptibility studies, disk method (if appropriate)
87186 - Susceptibility studies, microdilution or agar dilution (if appropriate)