American Society for Clinical Pathology

View all recommendations from this society

September 1, 2020

Do not generally use swabs to collect specimens for microbiology cultures on specimens from the operating room. For optimal recovery of microbes, tissue or fluid samples obtained in the operating room should be submitted, when available and adequate.

Microbiology laboratories recommend that operating room surgeons and staff collect tissue or fluid when submitting specimens, but many laboratories continue to receive swabs instead, even when tissue or fluid samples are available. In some cases, both (tissue and swabs) are submitted with requests to fully evaluate both. Swab specimens are not optimal for microbiology testing because in this setting alternative specimen types have greater specificity and are more likely to reflect the pathologic process being investigated: there is evidence that, in these settings, swabs do not offer benefit, testing increases costs and does not provide higher quality care. Eliminating swabs when possible and only submitting tissue or fluid addresses these issues and results in more effective use of laboratory resources and personnel.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

1-5: The American Society for Clinical Pathology (ASCP) list was developed under the leadership of the chair of ASCP’s Institute Advisory Committee and Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance. The review panel examined hundreds of options based on both the practice of pathology and evidence available through an extensive review of the literature. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and, eliminating it or changing to another test is within the control of the clinician. The final list is not exhaustive (many other tests/procedures were also identified and were also worthy of consideration), but the recommendations, if instituted, would result in higher quality care, lower costs, and more effective use of our laboratory resources and personnel.

6–15: The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Choosing Wisely Ad Hoc Committee. This committee is chaired by an ASCP Past President and comprises subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered an initial list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees, and councils. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and
eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs, and a more effective use of our laboratory resources and personnel.

16-35 The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered a list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. In addition, an announcement was made to ASCP’s newly formed Advisory Board seeking suggestions for possible recommendations to promote member involvement. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel.

ASCP’s disclosure and conflict of interest policy can be found at www.ascp.org.

Sources

Baron EJ. Specimen Collection, Transport, and Processing: Bacteriology*. Manual of Clinical Microbiology, 11th Edition. 2015:270-315. doi:10.1128/9781555817381.ch18.

Miller JM, Miller SA. A Guide to Specimen Management in Clinical Microbiology. Washington, DC: ASM Press; 2017.

Paxton A. Swapping swabs for syringes and scalpels. CAP Today. August 2004.

Stempak LM, Iv CEM, Navalkele B, Leasure JE. How the Pathologist Can Help the Surgeon Collect Better Specimens for Microbiology Culture. Arch Pathol Lab Med. 2020;144(1):29-33. doi:10.5858/arpa.2019-0190-RA