Specimen type

B. Bronchoalveolar lavage (BAL) - and associated specimens

Optimal time of specimen collection

Before antimicrobial therapy where possible

Correct specimen type and method of collection

Use a 60ml sterile leak-proof plastic container. Ensure BAL containers are sealed, one per sample bag.

Traps containing a specimen should be sealed using the screw cap enclosed with the collection kit. Do not transport samples with trap tubing still attached.

Quantity and number of specimens

It is difficult to be specific on volume required; in principle as large a volume as possible is preferred.

Laboratory analysis

The BAL will be examined for acute pathogens, fungi, anaerobes and Mycobacterium species - not NBLs
Culture for legionella species may still be successful after antimicrobial therapy has been started.

All lower respiratory tract specimens are examined for Mycobacterium species by microscopy and culture.
(see algorithms 1, 2 and 3 )

Transport

Specimens should be transported to the laboratory as soon as possible

Turnaround time

Routine culture: Negative report at 48hrs. Positive report 48-72hrs.
Specimens from cystic fibrosis patients: - Negative report at 72hrs. Positive report 72hrs-6 days. B. cepacia positive report may take more than 5 days to report.
Legionella spp. culture report at 10 days. Urine antigen tests for L.pneumophila serogroup 1 may be available immediately during routine working hours.
Mycobacteria: Microscopy is available on the following day or on the same day if urgent. Positive cultures are notified by telephone. Negative reports are issued after 6 weeks (incubation continues but further negative reports are not made).

	Specimen type	B. Bronchoalveolar lavage (BAL) - and associated specimens
	Optimal time of specimen collection	Before antimicrobial therapy where possible
	Correct specimen type and method of collection	Use a 60ml sterile leak-proof plastic container. Ensure BAL containers are sealed, one per sample bag. Traps containing a specimen should be sealed using the screw cap enclosed with the collection kit. Do not transport samples with trap tubing still attached.
	Quantity and number of specimens	It is difficult to be specific on volume required; in principle as large a volume as possible is preferred.
	Laboratory analysis	The BAL will be examined for acute pathogens, fungi, anaerobes and Mycobacterium species - not NBLs Culture for legionella species may still be successful after antimicrobial therapy has been started. All lower respiratory tract specimens are examined for Mycobacterium species by microscopy and culture. (see algorithms 1, 2 and 3 )
	Transport	Specimens should be transported to the laboratory as soon as possible
	Turnaround time	Routine culture: Negative report at 48hrs. Positive report 48-72hrs. Specimens from cystic fibrosis patients: - Negative report at 72hrs. Positive report 72hrs-6 days. B. cepacia positive report may take more than 5 days to report. Legionella spp. culture report at 10 days. Urine antigen tests for L.pneumophila serogroup 1 may be available immediately during routine working hours. Mycobacteria: Microscopy is available on the following day or on the same day if urgent. Positive cultures are notified by telephone. Negative reports are issued after 6 weeks (incubation continues but further negative reports are not made).

Algorithm 2: BAL for TB