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Paper II — 2022 February (2019 Scheme) — Q22

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Paper II
2022 February (2019 Scheme) · 100 marks · 180 min

Question

Sample, from the respiratory tract, received for Ziehl Neelsen stain is found to be mainly saliva. Discuss the correct decision and the appropriate action to be taken.

Q221 marks

Answer

The correct decision is to reject the sample — a respiratory sample that is mainly saliva rather than genuine lower respiratory tract secretion is an unsatisfactory, poor-quality specimen for Ziehl-Neelsen staining (a saliva-dominant sample risks a false-negative result, since the specimen does not adequately represent material from the site of infection, and would not meet standard sputum-quality criteria such as Bartlett’s grading).

Appropriate action:

  1. Do not process/report on the unsatisfactory sample.
  2. Document the specimen quality issue as per laboratory protocol.
  3. Communicate with the ward/clinician, requesting a fresh, properly expectorated (or induced) sputum sample, with clear instruction to the patient on proper deep-cough sputum collection technique (ideally an early-morning sample, after rinsing the mouth with water to reduce oral contamination) — or, if the patient is genuinely unable to produce adequate sputum, consideration of an alternative collection method (e.g., sputum induction, or bronchoalveolar lavage if clinically warranted).
  1. 1Hospital Acquired Infections

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