TB/HIV Co-Infection: Sputum Collection

Learning Objectives:

  • Collect sputum properly and safely
  • Package specimens according to requirements

  • Observation

    Tell your mentee you would like to assess their knowledge related to proper sputum collection by observing him or her collect sputum from a patient. Inform your mentee that the purpose of this activity is to support him or her in their learning and guide him or her in how they can improve their practice.

    Following the observation, provide feedback to your mentee and give mentorship as needed.

    Observation Checklist

    Did the mentee label the container before specimen collection with...


    Did mentee use a container that is...


    Did the mentee...


    Did the mentee give instructions to patients to ensure good sputum quality including:

    • Role Play

      Explain to the mentee that you are going to engage in a role play to help him or her learn how to properly collect sputum. He or she will play the role of health care provider, and you will be the patient.

      Show the mentee the instructions below for the health worker. Then, tap on the box for the patient instructions. Do not show this to the mentee.


      You are seeing a patient who you have determined is a presumptive TB case. Your task now is collecting his/her sputum for examination. You will speak with the patient to enlist his/her cooperation and obtain the information that you need. You will also ask about his/her HIV status and, if it is not known, recommend HIV testing.

      Steps:

      • Explain to the patient that he/she needs a sputum examination and enlist his/her cooperation.
      • Describe to the patient how to collect sputum.
      • In the Register of TB Suspects, list the date and the presumptive TB case’s name, age, sex, and address.
      • Label the sputum containers.
      • Fill out a Request for Sputum Examination form.
      • Collect a sputum sample.
      • Ask the presumptive TB case to collect an early morning sample tomorrow and then bring it to you.
      • Ask the presumptive TB case whether he/she knows his/her HIV status.
      • If HIV test is refused, document refusal to ensure that the need and importance of HIV testing is discussed at the follow-up visits.

      • Your task is to act the role of a typical presumptive TB case.

        You do not know much about TB or sputum examination.

        When you are asked to cough up sputum, cough and pretend to spit into the container. You do not know your HIV status, and refuse the HIV test.

        Your job is to listen carefully during the role play so that you can comment on what was done well and what could be improved.

        Check the boxes below to indicate whether the mentee asked the appropriate questions. At the end of the role play, review any problem areas with the mentee.

        Did the mentee

        Feedback

        Ask follow up questions:
        • How many sputum samples should be taken?
        • When should the 2 samples be collected?
        • What if a patient cannot return to the clinic in the morning?
        Answer feedback:

        Two sputum samples should be taken. One should be taken at the health facility where the patient was identified as a presumptive TB case. The other should be taken in the morning as soon as the patient wakes. If necessary, two samples can be taken within 2 hours of each other on the same day.

    • [activity type]

      Ask your mentee to walk around the clinic and show you places that would be appropriate sputum collecting spots. Ask them to explain why.

      Answer feedback:
      • Sputum sample should be collected outside or in a well-ventilated area, away from other patients and with sufficient privacy.
      • Ventilation can be cross ventilation but stack effect is ideal.
      • Direct sunlight is a positive.
      • Waiting areas in open air areas are favored over enclosed corridors, however, crowded waiting areas should be avoided.

    • [activity type]

      Ask your mentee to reflect on collecting sputum:

      • What are the benefits of proper sputum collection?
      • What are questions you still have about sputum collection?
      • What are some barriers to correctly collecting sputum?
      • How can you overcome these barriers?
      • How can I support you in properly collecting sputum?

    • [activity type]

      Review the sections of the Request for Sputum Examination together and discuss questions. Tap to reveal answer feedback for some questions.

    • [activity type]

      Show the mentee the following table. Ask the mentee to use the information to organize data on TB cases in the previous quarter.

      Smear Positive Smear Negative Total
      New 18 5 23
      Retreatment 4 0 4
      Total 22 5 27

      Next, ask your mentee to calculate sputum containers the health facility will need for diagnosis. Do not reveal the answers until he or she has completed their calculation.
      Tap each row to reveal correct answers.

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      Ask your mentee to calculate sputum containers the health facility will need for culture and DST. Do not reveal the answers until he or she has completed their calculation.
      Tap each row to reveal correct answers.

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      Ask your mentee to calculate the total number of sputum containers the health facility will need. Do not reveal the answers until he or she has completed their calculation.
      Tap each row to reveal correct answers.

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