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Procedure ⬇

  1. Observe standard precautions (see Appendix A) when procuring and handling specimens to avoid infectious pathogens (e.g., hepatitis A, Salmonella, and Shigella).

  2. Collect stool sample in a dry, clean, urine-free container that has a properly fitting cover. If unsure of how to collect the specimen, contact the laboratory before collection is begun.

  3. The fresh specimen should not be contaminated with urine or other bodily secretions such as 
menstrual blood. Stool can be collected from the diaper of an infant or incontinent adult. Samples can be collected from temporary ostomy bags.

  4. Accurately label all stool specimens with the patient’s name, date, and tests ordered on the 
specimen. Keep the outside of the container free from contamination and immediately send the sealed container to the laboratory.

  5. Place the specimen in a biohazard bag.

  6. Post signs in bathrooms that say “DO NOT DISCARD STOOL” or “SAVE STOOL” to serve as reminders that stool sample collection is in progress.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose of test, procedure for stool collection, and interfering factors using a culturally competent and culturally sensitive approach. Because the specimen cannot be obtained on demand, it is important to provide detailed instructions before the test so that the specimen is collected when the opportunity presents itself. Provide written instructions if necessary.

  2. Provide proper containers and other collection supplies. Instruct the patient to defecate in a large-mouthed plastic container, bag, or clean bedpan. Provide for and respect the patient’s privacy.

  3. Instruct the patient not to urinate into the collecting container or bedpan.

  4. Do not place toilet paper in the container or bedpan because it interferes with testing.

  5. If the patient has diarrhea, a large plastic bag attached by adhesive tape to the toilet seat may be helpful in the collection process. After defecation, the bag can be placed into a container.

  6. Specimens for most tests can be produced by a warm saline enema or Fleet Phospho-Soda enema.

  7. Tests for both ova and parasites and cultures for enteric pathogens may be ordered together. In this case, the specimen should be divided into two samples, with one portion refrigerated for culture testing and one portion kept at room temperature for ova and parasite testing. Commercial collection kits that require the stool to be divided and placed into separate vials for better recovery of ova and parasites and enteric pathogens are available. (See Chapter 7, Microbiologic Studies.)

  8. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Provide patient privacy and the opportunity to cleanse perineal area and hands. Assist as necessary.

  2. Review test results; report and record findings. Modify the nursing care plan as needed.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

  1. Any stool collected may harbor highly infective pathogens. Observe standard precautions and proper handling techniques at all times.

  2. Instruct patients in proper handwashing techniques after each use of the bathroom.

Interfering Factors ⬆

  1. Stool specimens from patients receiving tetracyclines, antidiarrheal medications, barium, bismuth, oil, iron, or magnesium may not yield accurate results.

  2. Bismuth found in paper towels and toilet tissue interferes with accurate results.

  3. Do not collect or retrieve stool from the toilet bowl or use a specimen that has been contaminated with urine, water, or toilet bowl cleaner. A clean, dry bedpan may be the best receptacle for defecation.

  4. Inaccurate test results may result if the sample is not representative of the entire stool evacuation.

  5. Lifestyle, personal habits, travel, home and work environments, and bathroom accessibility are some of the factors that may interfere with proper sample procurement.

  6. Prompt transport of the specimen is necessary for accurate results. Trophozoites (protozoa in the early growth stage) in liquid stool disintegrate rapidly after defecation; therefore, the specimen needs to be examined 30 minutes from start of collection of specimen, not 30 minutes from end of collection. Semiformed stool should be examined within 60 minutes after defecation. No trophozoites are seen in formed stool.