0
Communications to the Editor |

Does Rinsing the Mouth Before Expectoration Improve Sputum Specimen Quality? FREE TO VIEW

D. J. Flournoy, PhD; Louis A. Galarza, BS
Author and Funding Information

University of Oklahoma Health Sciences Center, Oklahoma City, OK

Correspondence to: D. J. Flournoy, PhD, Microbiology Section, Pathology and Laboratory Medicine Service, 921 N.E. 13th St, Veterans Affairs Medical Center, Oklahoma City, OK 73104



Chest. 2002;122(1):382-383. doi:10.1378/chest.122.1.382
Text Size: A A A
Published online

To the Editor:

Obtaining useful Gram stain and culture results begins with procurement of an acceptable specimen. Theoretically, the collection of a sputum specimen for Gram stain and culture should include an explanation of the procedure to the patient, brushing teeth or removal of dentures, and/or rinsing of the patient’s mouth prior to expectoration of an early morning bolus.1 Brushing teeth or removing dentures along with rinsing the mouth are attempts to decrease nasopharyngeal flora, which tend to coat the specimen bolus during expectoration.

In 1994, we retrospectively (within 24 h of specimen collection) queried 160 patients to determine the influence of oral hygiene on sputum specimen quality.2 Specimen quality (based on Gram stain) was compared between two groups of patients, those who said they had performed oral hygiene vs those who said they had not performed oral hygiene prior to expectoration. There was no significant difference in specimen quality regardless of stated prior oral hygiene. However, the data were based on patient response vs direct observation. One criticism might be that the patients responded to the queries incorrectly.

As a follow-up study, we performed a subsequent prospective analysis in 1999, based on direct observation. The purpose of the study was to determine if rinsing the mouth prior to expectoration influenced sputum specimen quality, based on Gram stain analysis.3 For this study, patients expectorated, rinsed their mouths three times with tap water, then expectorated again. Patients were observed (by L.A.G.) during rinsing and collections, and both specimens (before and after rinsing) were promptly delivered to the Microbiology Section, where Gram stains were performed (by D.J.F.) and the results were evaluated. Specimens were graded as good ( < 10 squamous epithelial cells [SECs]), fair (11–19 SECs), poor ( > 20 SECs, > 10 WBCs), and inadequate ( > 20 SECs, < 10 WBCs), per objective magnification (100×).

Nineteen patients were tested. Five patients (26%) had higher quality specimens (eg, good is better than fair) after rinsing, 2 patients (11%) had lower, and 12 patients (73%) had specimens of the same quality. There was no significant difference between the number of good sputum specimens collected before and after rinsing the mouth with tap water three times (p = 0.16; χ2 0.05 level of significance). We surmise that rinsing the mouth with tap water prior to sputum collection does not improve specimen quality. It is possible that brushing the teeth and/or removing dentures might yield more favorable results. However, it may be virtually impossible to prevent external “contamination” of the sputum bolus during expectoration.

Introduction to microbiology, guidelines for the transport, processing, analysis, and reporting of cultures from specific specimen sources. Koneman, EW Allen, SD Janda, WM eds.Color atlas and textbook of diagnostic microbiology 5th ed.1997,121-170 Lippincott-Raven. Philadelphia, PA:
 
Flournoy, DJ, Adkins, LJ, Laughlin, KJ Value of oral hygiene before expectoration of sputum for routine bacterial culture [letter]. Chest. 1994;;105 ,.:1923
 
Flournoy, DJ Interpreting the sputum Gram stain report.Lab Med1998;29,763-768. [CrossRef]
 

Figures

Tables

References

Introduction to microbiology, guidelines for the transport, processing, analysis, and reporting of cultures from specific specimen sources. Koneman, EW Allen, SD Janda, WM eds.Color atlas and textbook of diagnostic microbiology 5th ed.1997,121-170 Lippincott-Raven. Philadelphia, PA:
 
Flournoy, DJ, Adkins, LJ, Laughlin, KJ Value of oral hygiene before expectoration of sputum for routine bacterial culture [letter]. Chest. 1994;;105 ,.:1923
 
Flournoy, DJ Interpreting the sputum Gram stain report.Lab Med1998;29,763-768. [CrossRef]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543