Is there a "mandatory" or "recommended" time
cultures should be drawn? If so,is there some sort of documentation?

like in the morning, after the first run, end of day? Anyone.

Guest,

Read tag "CMS - V254".

Cultures before disinfect

"Samples must be TAKEN in the “WORST CASE” scenario .. BEFORE .. disinfection."

There is more, but i'm not sure if I can legally post word for word.

What is conscidered worst case scenerio? I do it right before I disinfect but when I take the actual sample it is usually at the end of our first run. I was told by a new tech I could draw the sample early in the morning after the machines are setup before the patients go on. My question, is there a specific time of day the actual sampling must be done and if so can you show documentation?

We had this discussion as well. Our company decided to have us draw the sample between the 1st and 2nd shifts. The reason being is that you need to let the LAL's freeze before shipping so that would be the latest. You need to draw them after at least the 1st run.

So if they need to freeze, would it not be better to get them earlier?

Guest,

What do you mean by freezing your cultures? Are you not sending your cultures out the day you draw them? From what I am familiar with, if you send to an outside lab, the samples must be sent in a "cool" container. Cultures can be refrigerated up to 24 hrs if you cannot culture the sample within 1 to 2 hours. (CMS, V257).

I apologize, I meant so the LAL's (endotoxin samples) can be frozen before shipping. You need to take them at the worst case so the latest in the day as possible and before disinfection. It depends on when FedEx or whomever you use gets there. The LAL's will usually freeze within 3 hrs.

Last question on this because it is not clear to me and is causing confusion in my work place. Is it in writing somewhere samples cannot be drawn in the early am as opposed to later in the day or is this an interpitation?

It may be an interpitation but the law states that cultures need to be drawn at the "worse case scenerio. If you draw your cultures in the morning the last thing the machine saw was a disinfect (i.e. the day before) this would not be a worse case. You need to draw them as late in the day as possible. One of our units was actually tagged for taking cultures to early in the day. Our company put out a memo stating that in order to satisfy the state we needed to take them at least after the first shift of the day.

Why are you freezing LAL's?

Question, for dialysate samples wouldn't worse case possibly be at anytime? Except maybe right after a disinfect. Isn't there many possible things that can be introduced into the dialysate like bicarb from a mixer or central feed system that may have bacteria or endotoxins in it? I guess my feeling is that for dialysate samples worst case could be almost anytime.

First thing in the morning may be worst case. The machine has been sitting idle with no flow for many hours. Unless someone has done a study to find out when is "worst case", we are all just guessing. I assume worst case to be the day before we disinfect the system.

You guys are so right. In fact, if we're talking bio-film, worst case could very well be right after disinfect.

Ladytech,

If you send LAL's to a lab rather than doing them in-house you have to freeze them.