INTRO TO SALIVA SAMPLINGPrepared By: Rachel Klimmek, RN

Doctoral Student & Research NurseLast Updated: November 14, 2009

Purpose of this Training Module

• To provide basic information on how and why saliva samples will be collected as part of this study

• To explain why this spit is so valuable to the success of the study and this research

LEARNING OBJECTIVES• Upon completion of this training module,

trainees will be able to:– Explain WHAT SALIVA can tell us in this study– Describe WHEN saliva will be collected, and from

WHO– Describe INSTRUCTIONS that should be given to

study participants before collecting saliva at home

– Demonstrate the PROPER TECHNIQUES for saliva collection

What can we learn from SALIVA?

• ANSWER: A WHOLE LOT!• Saliva contains many things,

including chemicals called “BIOMARKERS”• There are over twenty (!) different biomarkers

that can be detected in human saliva• Among these biomarkers is “CORTISOL”• Cortisol is what the saliva samples in this

study will measure

What does CORTISOL tell us?

• CORTISOL is commonly used to measure the amount of STRESS a person is experiencing, and how well their body reacts to that STRESS

• It can show when someone might be at risk for infection because they are IMMUNO-SUPPRESSED

• Levels of CORTISOL have also been associated with DEPRESSION, ANXIETY, & PTSD

What do we need to know about measuring CORTISOL?

• When someone is experiencing STRESS, their body produces extra CORTISOL

• This can also happen when they are WORKING HARD (like exercising or doing physical labor)

• This CORTISOL can be measured in their saliva (although some things, like the food they have been eating, can affect this)

• Natural levels of CORTISOL in someone’s body change over the course of the day, so it’s important to measure the level several times during the day to get an accurate measurement

The Physiology of Cortisol(For the medically curious)

BRAIN SENSES EVENT & TELLS BODY TO MAKE

CORTISOL!!!STRESSFUL EVENT

SEES EVENT

GLANDS PRODUCE MORE

CORTISOLCORTISOL S

HOWS UP

IN SALIV

A

When Will We Sample Saliva?IN THE BEGINNING• Right after participants have

enrolled in the study, the CHW will instruct elders and their support persons on how to collect their own saliva samples for the study at home

AT THE END • One month following

completion of cancer treatment, the CHW will instruct the elder and their support person to collect a second set of saliva samples

Who will we collect Saliva from?African American Elders receiving treatment for Cancer Support Persons of Elders

Saying that cancer can be a stressful experience for patients and those who support them is an understatement. This study is designed to help reduce some of that stress for participants who receive Patient Navigation Support. Measuring the levels of CORTISOL in SALIVA SAMPLES from these participants will give us information about how much stress participants are experiencing, and how well the support is working.

SO – HOW DO WE DO IT?Step-by-Step Tutorial in Spit Sampling

The old-fashioned way

The MODERN Way

WHAT SUPPLIES ARE NEEDED?

• 6 SALIVETTES (plastic tubes with cotton)• 2 large Ziploc bags (one with salivettes to

be collected, the other for completed salivettes)• 6 SALIVETTE LABELS • SALIVA SAMPLE LOG sheet for participants • Pen to record time & date on labels and log• Clock or Watch to know time of saliva collection• PRE-PAID MAILER to send completed salivettes

back to lab

What’s Involved?

• Participants will carefully remove a piece of sterile cotton from the inside of a plastic container called a “salivette” and place it in their mouths

• Participants will keep the cotton in their mouths until it is well saturated with saliva

• Then participants will spit the cotton back into the plastic tube and cap it tightly

Salivette (in pieces)

WHOLE SALIVETTE

STERILE COTTONINSIDE

HOW LONG SHOULD PARTICIPANTS KEEP THE COTTON SWABS IN THEIR MOUTHS?

– About 3 minutes or until swab is COMPLETELY WET

Don’t Forget the Time & Date!!

• Recording the date and time each sample is collected is extremely important

• This information should be recorded on the label of each salivette once it has been completed

• Participants should also answer questions on their “Saliva Sampling Log” for each sample collected

HOW MANY SAMPLES WILL EACH PARTICIPANT COLLECT?

– 3 samples each day X 2 days in a row = 6 samples– FIRST DAY OF SAMPLING:

• 1st Sample: When Participant WAKES UP before they even get out of bed

• 2nd Sample: 30 minutes later

• 3rd Sample: When Participants goes to bed

– SAME PATTERN REPEATED ON SECOND DAY OF SAMPLING for 3 more samples

WHAT IF THEIR MOUTH IS TOO DRY TO GET A GOOD SAMPLE?

– If the participant’s mouth is TOO DRY when they first wake up to get a good sample, they SHOULD• Take a sip of water• Wait 10 minutes and TRY AGAIN with the extra

salivette provided in the sampling kit• Make a note of this on their sampling log

WHERE SHOULD COMPLETED SAMPLES BE STORED?

– Participants should place saturated cotton swabs back into the plastic salivette containers and place the caps back on the containers

– Salivette containers with saturated swabs should then be placed into the Ziploc bag marked “Completed Samples”

– This Ziploc bag should be kept in the participants’ refrigerator (NOT FREEZER) until all samples have been collected and are ready to be mailed back to the lab

WHAT SHOULD WE TELL THEMNOT TO DO ON THE DAYS THEY COLLECT THEIR SAMPLES?

– Avoid eating, drinking, or brushing teeth within 15 minutes before collecting a saliva sample

– Avoid drinking or eating dairy products within 1 hour before collecting a saliva sample

– Avoid eating chips within 1 hour before collecting a saliva sample

– Avoid Exercising within 1 hour before collecting a sample– Make note of ANY OPTIONAL MEDICATIONS taken on

these days– Avoid drinking alcohol on sampling days

(These activities could affect the quality of the samples!)

WHAT SHOULD BE DONE WHEN ALL THE SAMPLES ARE COLLECTED?

– Completed samples should be sealed within the Ziploc bag provided for “Completed Samples”

– Participants should double-check that all samples have labels with the time & dates the samples were collected

– Participants should place their Sampling Logs in the Pre-Paid Mailer provided, along with the Ziploc bag containing ALL 6 completed samples

– The Pre-paid Mailer can be placed in any mailbox to be returned to the lab, free of charge.

WHY ARE WE DOING THIS?• ANSWER:– To collect valuable data

for the study that will tell us about the amount of stress participants are experiencing, and how receiving navigation support might be associated with changes in this stress (hopefully for the better!)

YOU’VE MADE IT THROUGH!SO…

(Don’t forget to take the post-test after you’re finished reviewing the material in this module)