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Specimen collection and shipment strategy Georgina Tzanakaki and Aftab Jasir European Public Health Microbiology training program (EUPHEM)

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Presentation on theme: "Specimen collection and shipment strategy Georgina Tzanakaki and Aftab Jasir European Public Health Microbiology training program (EUPHEM)"— Presentation transcript:

1 Specimen collection and shipment strategy Georgina Tzanakaki and Aftab Jasir European Public Health Microbiology training program (EUPHEM)

2 Why collection of specimens is important? Why transportation is important?

3 Learning objective At the end of this part of the presentation, you should be able to understand the: Procedures, preparation, processing and transport of specimens 3

4 Procedures Collecting specimens Marking and labeling Handling Packing Package labeling Necessary documents following the transporting sample

5 Procedures Collecting specimens Marking and labeling Handling Packing Package labeling Necessary documents following the transporting sample

6 Specimen collection: key issues Consider differential diagnoses Decide on test(s) to be conducted Decide on specimen/s to be collected to conduct these tests consultation between microbiologist, clinicians and epidemiologist 6

7 7 The result of any laboratory examination is only as good as the sample received in the laboratory

8 8 Sample Management PH events Outbreaks Surveillance Complex Emergency situations

9 Procedures Collecting specimens Marking and labeling Handling Packing Package labeling Necessary documents following the transporting sample

10 Labeling specimens 1.Name (unique identifier) 2.Clinical specimen 3.Specimen type 4.Date, time and place of collection 5.Name/initials of the person responsible for collection 10

11 11 Criteria for rejecting samples Mismatch of information on the label and the request Inappropriate transport temperature Excessive delay in transportation Inappropriate transport medium -specimen received in a fixative -dry specimen -sample with questionable relevance Insufficient quantity Leakage

12 12 Case investigation form Clinicians/test requester send: Personal information –age (or date of birth), sex, complete address Clinical information –date of onset of symptoms, clinical and immunization history, risk factors or contact history where relevant, anti-microbial drugs taken prior to specimen collection Laboratory information –acute or convalescent specimen –other specimens from the same patient Line listing – if large number of patients

13 13

14 Procedures Collecting specimens Marking and labeling Handling Packing Package labeling Necessary documents following the transporting sample

15 Biosafety Principles To protect: – the patient – yourself – the environment ------- (FILM) 15

16 16 Biosafety: protect the people Use single use equipment Disinfect Work in a clean, dedicated area

17 17 Biosafety: protect yourself Use personal protective equipment (PPE): disposable gloves laboratory coats / gown mask protective eyewear

18 Biosafety: protect yourself Collect sharps immediately to prevent needle-stick injury Have first aid kit readily accessible Do not reuse contaminated equipment 18

19 19 Biosafety: protect others, the environment Package samples appropriately for transport Decontaminate spills Disinfect working areas for future use Soak contaminated non-disposable material Place waste in leak-proof biohazard bags Ensure safe final management of waste Protect cleaning personnel with PPE

20 20 Sample Handling Handle all samples as if infectious

21 Procedures Collecting specimens Marking and labeling Handling Packing Package labeling Necessary documents following the transporting sample

22 22 Where do they come from? Who develops them? United Nations Economic and Social Council National transport regulations ICAO/IATA transport regulations rail, road, and sea traffic agencies postal services private couriers Transport Regulations

23 Class 2: Non-flammable non-toxic gases Liquid nitrogen (refrigeration) Class 3: Flammable liquids Ethanol (preservation) Class 6: Toxic and infectious substances Division 6.1 addresses toxic substances Division 6.2 addresses infectious substances Class 9: Miscellaneous dangerous goods Dry ice Genetically modified microorganisms and organisms (not classified under 6.2) Dangerous Goods Classes

24 Class 2: Non-flammable non-toxic gases Liquid nitrogen (refrigeration) Class 3: Flammable liquids Ethanol (preservation) Class 6: Toxic and infectious substances Division 6.1 addresses toxic substances Division 6.2 addresses infectious substances Class 9: Miscellaneous dangerous goods Dry ice Genetically modified microorganisms and organisms (not classified under 6.2) Dangerous Goods Classes

25 Substance Categories (Division 6.2) Category A (Infectious Substances) –e.g. Ebola virus, Bacillus anthracis (culture only) Category B (Biological Substances) –e.g.Bacillus anthracis (patient specimen), Highly pathogenic avian influenza virus (patient specimen) Exempt –Medical assessment has determined a minimal likelihood that pathogens are present –e.g. Pregnancy test, Drug screening

26 Category A: Infectious substances An infectious substance which is transported in a form that, when exposure to it occurs, is capable of : causing permanent disability, life-threatening or fatal disease in otherwise healthy humans or animals.

27 An infectious substance which does not meet the criteria for inclusion in Category A and has not been determined by a medical professional to have a minimal likelihood that pathogens are present. e.g. serum, CSF, blood etc Category B – Biological Substances

28 Exempt –Medical assessment has determined a minimal likelihood that pathogens are present e.g. Pregnancy test, Drug screening

29 What is the difference between cultures and patient specimens?

30 Cultures and Patient Specimens Cultures are incubated samples (with purpose of multiplying pathogens) Patient specimens are collected directly from humans/animals These differences are important for the classification of infectious substances This classification will affect the choice of packaging

31 Categorization and Identification Proper Shipping Name CategorizationSituation Sending a culture of Mycobacterium tuberculosis to a reference laboratory. Patient presents with suspected case of Hepatitis B virus and blood samples are sent. Medical professional declares human drug test as minimal likelihood for containing pathogens. The Ebola virus has been found in bats and samples which have not been cultured are being shipped. Category B Biological Substance, Category B Category A Infectious Substance, Affecting Humans Category A Infectious Substance, Affecting Humans Exempt Exempt Human Specimen

32 What are the requirements for packaging Category A and B substances? 2009 World Health Organization

33 Triple Packaging Primary container Secondary container Outer container Absorbent and cushioning material Triple packaging provides three layers of containment to protect the substances being shipped. These layers are primary, secondary, and outer containers. The following diagram shows the basic concept of triple packages.

34 Procedures Collecting specimens Marking and labeling Handling Packing Labeling packages Necessary documents following the transporting sample

35 Markings and Labels Infectious Substance Label

36 Markings and Labels Orientation Labels Mandatory on opposite sides when primary container exceeds 50 ml

37 Markings and Labels Shippers and Receiver's Address

38 Markings and Labels Emergency Contact Name and Number (Cat A)

39 Markings and Labels Proper Shipping Name and UN Number

40 Markings and Labels UN Specification Marking (Cat A)

41 Markings and Labels

42 Procedures Collecting specimens Marking and labeling Handling Packing Package labeling Necessary documents following the transporting sample

43 Documentation for Shipping Infectious Substances

44 Overview Air Waybill : goes with any shipment made by air shipper or courier must complete the form Completing the Shippers Declaration for Dangerous Goods

45 Take home messages Follow carefully sample collection information Label samples with all necessary information Respect biosafety principles to protect the patient, yourself and the environment Handle all samples as if infectious Use appropriate packaging according to the category of sample Respect norms and regulations for transport 45 For a good sample management and thus a good laboratory diagnosis you need to:

46 Sources Department of Epidemic and Pandemic Alert and Response of the World Health Organization European Program for Public Health Microbiology (EUPHEM) 46 This presentation used some information of the training package Laboratory issues for epidemiologists put in place by the:

47 Thank you for your attention 47 ?


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