Oxford University Hospitals NHS Trust
Controlled Document DO NOT PHOTOCOPY
Department of Cellular Pathology
Protocol: Specimen Transport Protocol
Protocol serial number: CPP 20
Prepared by: T Chaplin
Authorised by: T Chaplin
Original issue date: 30.8.2006
Reviewed by: S Roberts-Gant
Number & location of copies: 3
1. CSU Electronic Master File
2. Cellular Pathology Policy Master File (Secretaries’ Office
level 1)
3. Cellular Pathology Intranet site
Document review:
Review
Altered Y/N
Date
(Reason for change)
30.8.2006
N New document
21/7/2008
Minor updates
26/5/2010
Major changes
throughout
16/5/2011 No changes made, date
of proper review
extended due to
transport trial being
performed with
laboratory medicine.
Review of policy set for
6 months.
23/6/2012 Format change, updates
to company details and
telephone numbers
27/01/2015 Updated references to
websites
Version
number
V1.0
V2.0
V3.0
No. of
pages
Signed
13
Tony Chaplin
Tony Chaplin
S Roberts-Gant
Next
review
30.8.2007
21/7/2009
26/5/2011
13
S Roberts-Gant
16/11/2011
V4.0
13
S Roberts-Gant
23/6/2014
V5.0
13
27/01/2017
YOU ARE INSTRUCTED TO READ THE FOLLOWING THOROUGHLY
UNDER NO CIRCUMSTANCES ARE THESE INSTRUCTIONS TO BE AMENDED OR
ALTERED IN ANY WAY OTHER THAN BY THE AUTHOR / SIGNATORY OR A REVIEWER
AS IDENTIFIED IN CPP14 DOCUMENT CONTROL.
OBJECTIVE
The Cellular Pathology CSU seeks to ensure that the necessary information is available to
facilitate the safe and correct handling and transport of pathological samples to the Cellular
Pathology laboratories, so that specimens are received in the right condition for testing, and
the health and safety of personnel involved is not compromised.
Specimen Transport Protocol
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Oxford University Hospitals NHS Trust
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Department of Cellular Pathology
URGENT SPECIMENS – Please visit the Cellular Pathology intranet site for instructions
- CPSOP 12 Delivery of urgent samples / frozen sections to Cellular Pathology
Collection & Labelling of Specimens for Transport
1.
The person collecting the specimen must positively confirm the identity of the patient.
2.
All specimens must be collected into containers, recommended for the test requested, as
described on Cellular Pathology intranet and internet sites and in the Cellular Pathology
handbook which is available on the websites.
3.
The person, who sends the specimen, must ensure that the primary container used is the
appropriate one for the purpose; is properly closed and is not externally contaminated by the
contents. (NB: Specimens received leaking or in incorrect containers may not be
processed)
4.
All materials used to collect the specimen must be safely disposed of in accordance with Trust
Waste Management Policy, if the sample has been collected out side of Trust property, local
regulations in force must be followed.
5.
The person sending the specimen must ensure that both specimen and request card are
labelled with adequate information. The minimum requirements for the specimen are full name
(or coded identifier), date of birth and hospital and / or NHS number. The request card should
also give information on the requestor, where to send results and who to contact in the event of
a specimen breakage or leak. The request card must also give relevant clinical information for
the test(s) being requested as well as date and time of specimen collection. (NB: Specimens
received unlabelled or without an attached, completed request card are unlikely to be
processed)
6.
Labels indicating a danger of infection must be used for specimens which are suspected of
containing a hazard group 3 (or 4) pathogen or for specimens from patients known to be of High
Risk. More details on what to label and the labels required can be found on the Oxford Clinical
Intranet
7.
All specimens should be transported in a suitable and timely fashion, so that they are of
acceptable quality for processing on arrival. If transport of specimens is to be delayed please
store specimens as recommended in the laboratory user manuals on the Oxford Clinical Intranet
/ Internet.
See Appendix D: Model Safety Rules for Conveying Specimens.
Packaging of Specimens for Transport
8.
All specimens for transport to hospital laboratories must be packaged to Packing Instruction 650
(Appendix B).
9.
Specimens for transport to the laboratory are put into the bag attached to the completed request
card, which is then sealed. If multiple specimens are placed in the same bag, they should be
cushioned to prevent breakage. These are then placed into a second large, transparent, plastic
bag which should contain sufficient absorbent material to contain the liquid in all the primary
containers. The second bag is sealed by means of an integral sealing strip and is clearly marked
with a biohazard sign and the words ‘pathological specimens’ (available from NHS Supplies,
code KFD028 Large Specimen Bags, box 500).
10.
Histopathology and Cytology specimens should be in separate secondary bags.
11.
These bags are then ready to be transported to the laboratory by suitably trained staff.
Regardless of the method of transportation, specimens must be transported in a rigid transport
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box with a fastened lid and labelled as detailed in Packing Instruction 650. The box must bear a
warning label saying that the box must not be opened or tampered with and states a telephone
number to be contacted if the box is found unattended. The box must be able to be easily
disinfected and cleaned and must retain liquid in the event of leakage of a specimen. The
recognised UN 3373 packaging mark must be clearly displayed on the external surface of the
transport box.
Incidents - Spillages & Breakages
In the case of any spillage or breakage a Trust Incident Form must be completed.
Actions to be taken in the event of a spillage or breakage are outlined below.
Histological Specimens in formaldehyde
If the spillage is the result of a dropped specimen for histological studies DO NOT treat as a
biological spillage as these specimens are in Formaldehyde which must not be mixed with other
chemicals/disinfectants
Large Volume Spills
Large spillages may need drastic measures, including temporary evacuation of the area and
involvement of the Emergency Services, utilising appropriate clothing and respirators. If the spill
exceeds 2.5 litres or if the space wherein the spillage occurred is small and/or poorly ventilated the
Fire Brigade should be notified immediately. The Cellular Pathology department may be contacted
for advice, if required, on 01865 220492 (09.00 – 17.00 Monday to Friday or the on call Biomedical
Scientist for Histopathology via the John Radcliffe switchboard on 01865 741166 outside of these
hours).
Small Volume Spills
A small volume spillage or leakage, although unpleasant, does not normally pose a major hazard,
unless involving pre-sensitised individuals. Small spills should be either 1. Wiped up using a De formalizer pad, available from Leica Microsystems
(www.leica-microsystems.com) telephone 01733 333199, in packets of 25, order code
38007531114 , which is then placed in to a yellow bag for incineration.
or
2. Cover with Formalin control granules, available from Leica Microsystems, in a case of 6x1.5lbs,
order code 3800752E, and leave for 15 minutes. This is then scraped up and placed in a clear
plastic bag. The bag is then labelled as ‘Inert mass of urea-formaldehyde. Non-hazardous waste’.
Contact the Trust Environmental Services Manager on 01865 222538 for instructions on disposal.
Cytological specimens and histological specimens not in formaldehyde.
In general, the use of universal Infection Control precautions will minimise the risk of infection from
spillages to healthcare staff. However, when spill involves blood, the additional use of a
disinfectant will be required. All spillages should be dealt with immediately and an incident
report completed.
1. Spillages of body fluids not visibly contaminated with blood
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
Always wear gloves and a plastic apron.

Use paper towels to soak up the spill.

Discard paper towels into a yellow plastic bag for incineration.

Clean contaminated area with detergent and hot water.

Discard gloves and plastic apron into a yellow bag for incineration.
2. Blood spills or body fluids containing blood
For small spills of blood or other body fluids visibly containing blood the following actions should be
taken:

Wear gloves and a plastic apron.

Liberally cover blood spill with chlorine releasing granules ands leave for at least 2 minutes.
If the spill is urine visibly contaminated with blood do not use chlorine releasing agent (see
urine spills below)

Clear up spillage with paper towels or, if available, a plastic scoop which should be
discarded after use.

Wash contaminated area with detergent and hot water.

Aprons, gloves paper towels etc must be put into a yellow bag for incineration.
For large spills, for example in theatre, follow instructions as in 3b below.
3. Urine spillages
Do not use any chlorine releasing agent eg Domestos, Titan, Presept granules when cleaning
up the spillage. The resultant fumes are considered a hazard.
a) If not visibly contaminated with blood, follow guideline 1 above.
b) If visibly contaminated with blood

Wear gloves and a plastic apron

Use paper towels to soak up the spill the discard into a yellow plastic bag for incineration.

Clean the contaminated area with strong detergent hypochlorite (1%) solution (10,000 ppm
av. Chlorine).

Discard gloves, plastic apron and waste into a yellow bag for incineration
For further information bleep the Infection Control Nurse in the respective hospital or contact the
Infection Control Doctor via the John Radcliffe Hospital switchboard.
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Spillages in Vehicles Transporting Specimens
Specimens being transported by road will be packed according to Packing Instruction 650 (Appendix
B). The packages should be restrained in a safe way within the vehicle to prevent shaking. Following
these guidelines will reduce the possibility of a specimen spilling or breaking in transport.
If the driver suspects a leak they should contact the Infection Control Doctor via the John Radcliffe
Hospital switchboard on 01865 741166. The driver will need to give clear instructions about the events
and their location so the appropriate arrangements can be made by the Infection Control Doctor to
clear up the spill.
Spillage or leakage of formalin occurring in the enclosed environment of transport vehicles is of
particular concern. The Histopathology department may be contacted for advice, if required, on 01865
220492 (09.00 – 17.00 Monday to Friday or the on call Biomedical Scientist for Histopathology via the
John Radcliffe switchboard on 01865 741166 outside of these hours).
Method of Transport
1.
A patient may take a specimen via public transport as this is outside the “The Carriage of
Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2004 ('Carriage
Regulations')”.
2.
A member of staff transporting clinical specimens as part of their work would be expected to
comply with the 'Carriage Regulations'.
Specimens Transported from a Collection point (e.g. GP Surgery or between Hospital Sites)
3.
Laboratory audits have shown that the best means of transporting specimens from a known
collection point to a known delivery point is by using the South Central Ambulance NHS Trust
(SCAT) non-patient transport service which includes the carrying of patient specimens. It is the
responsibility of SCAT to maintain a regular transport service, thus ensuring that specimen
quality is not compromised through any excessive delay.
4.
Outside of SCAT transport services’ normal working hours, i.e. after 16.30hrs, ‘urgent’
specimens will need to be sent by Taxi.
URGENT SPECIMENS – Please visit the Cellular Pathology intranet site for
instructions -CPSOP 12 Delivery of urgent samples / frozen sections to Cellular
Pathology
Transport of Specimens within Trust Sites
5.
Portering Staff
5.1
5.2
All sites have a Portering Service that can be contacted to deliver histology and cytology
specimens. There is no air tube station in Cellular Pathology.
5.1.1
At the John Radcliffe Hospital, the helpdesk can be contacted by telephoning
Ext. 40404 or the porters’ desk Ext. 31531
5.1.2
On the Churchill Hospital site the duty portering staff can be contacted by
telephoning Ext. 35353
5.1.3
On the Horton Hospital site the duty Portering Staff can be contacted by
bleeping 502 or 514.
Specimens collected by the Porters on a regular specimen collection route must conform
to Packing Instruction P1650 (Appendix B). Urgent specimens must conform to the
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double bagged system, with adequate absorbent material in the primary sealed bag to
absorb any leakage or spill. This package must then be put into a designated, non seethrough, carriage container that is clearly labelled with the laboratory destination and
clearly marked ‘Urgent’. This will ensure specimens are delivered to the correct
laboratory, identified as urgent and protect the confidential information of the patient.
Transport of Specimens through the Post
6.
Royal Mail Group plc will not accept a package that contains UN2814 or UN2900 infectious
substances, Category A, as classified at 6.2 of the Technical Instructions for the Safe Transport
of Dangerous Goods by Air published by ICAO.
6.1
Category A Specimens (Appendix A) for transportation need to be transported by the use
of specific Couriers that meet 6.2 of the Technical Instructions for the Safe Transport of
Dangerous Goods by Air published by ICAO. They must be packaged in accordance with
PI620 as described in Appendix B and applies to known cases as described in Appendix
A. The majority of these specimens will be sent by or in conjunction with the Microbiology
Laboratory who have staff trained in handling these types of specimens. Cellular
Pathology specimens do not fall into this category.
6.2
Royal Mail Group plc will accept Category B diagnostic specimens provided they are
packaged to PI650 requirements as described in Appendix B. The majority of these
specimens will be sent by laboratory staff who will have access to the correct packaging
and be trained in sending specimens in accordance with current postal regulations
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Appendix A: Category A Specimens
UN Number and Name
UN 2814
Infectious substances
affecting humans
Micro-organism
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Bacillus anthracis (cultures only)
Brucella abortus (cultures only)
Brucella melitensis (cultures only)
Brucella suis (cultures only)
Burkholderia mallei – Pseudomonas mallei – Glanders
(cultures only)
Burkholderia pseudomallei – Pseudomonas pseudomallei
(cultures only)
Chlamydia psittaci – avian strains (cultures only)
Clostridium botulinum (cultures only)
Coccidioides immitis (cultures only)
Coxiella burnetii (cultures only)
Crimean-Congo hemorrhagic fever virus
Dengue virus (cultures only)
Eastern equine encephalitis virus (cultures only)
Escherichia coli, verotoxigenic (cultures only)
Ebola virus
Flexal virus
Francisella tularensis (cultures only)
Guanarito virus
Hantaan virus
Hantaviruses causing hanatavirus pulmonary syndrome
Hendra virus
Hepatitis B viris (cultures only)
Herpes B (cultures only)
Human immunodeficiency virus (cultures only)
Highly pathogenic avian influenza virus (cultures only)
Japanese Encephalitis virus (cultures only)
Junin virus
Kyasanur Forest disease virus
Lassa virus
Machupo virus
Marburg virus
Monkeypox virus
Mycobacterium tuberculosis (cultures only)
Nipah virus
Omsk hemorrhagic fever virus
Poliovirus (cultures only)
Rabies virus
Rickettsia prowazekii (cultures only)
Rickettsia rickettsii (cultures only)
Rift Valley fever virus
Russian spring-summer encephalitis virus (cultures only)
Sabia virus
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UN Number and Name
UN 2900
Infectious substances
affecting animals only
Micro-organism
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Shigella dysenteriae type 1 (cultures only)
Tick-borne encephalitis (cultures only)
Variola virus
Venezuelan equine encephalitis virus
West Nile virus (cultures only)
Yellow fever virus (cultures only)
Yersinia pestis (cultures only)

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African horse sickness virus
African swine fever virus
Avian paramyxovirus Type 1 – Newcastle disease virus
Bluetongue virus
Classical swine fever virus
Foot and mouth disease virus
Lumpy skin disease virus
Mycoplasma mycoides – Contagious bovine
pleuropnemonia
Peste des petits ruminants virus
Rinderpest virus
Sheep-pox virus
Goatpox virus
Swine vesticular disease virus
Vesticular stomatitis virus

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

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
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Appendix B: Packaging Instructions
PACKAGING INSTRUCTION PI620 – for Category A Specimens
This instruction applies to UN 2814 and UN 2900.
The following packagings are authorized provided the special packing provisions are met (see below).
Packaging should be UN-type approved and consist of:
a. Inner packaging comprising:
(i)
(ii)
(iii)
leak-proof primary receptacle(s);
a leak-proof secondary packaging;
other than for solid infectious substances, an absorbent material in sufficient quantity to absorb the
entire contents placed between the primary receptacle(s) and the secondary packaging; if multiple
fragile primary receptacles are placed in a single secondary packaging, they shall be either
individually wrapped or separated so as to prevent contact between them.
b. A rigid outer packaging of adequate strength for its capacity, mass and intended use. The smallest external
dimension shall be not less than 100 mm.
Additional Requirements:
1.
Inner packaging containing infectious substances shall not be consolidated with inner packaging
containing unrelated types of goods. Complete packages may be over-packed, such an over-pack may
contain dry ice.
2.
Other than for example consignments, e.g. whole organs which require special packaging, the following
additional requirements shall apply:
3.
2.1
Substances consigned at ambient temperatures or at a higher temperature - Primary
receptacles shall be of glass, metal or plastics. Positive means of ensuring a leak-proof seal shall
be provided, e.g. a heat seal, a skirted stopper or a metal crimp seal. If screw caps are used, they
shall be secured by positive means, e.g. tape, paraffin sealing tape or manufactured locking
closure.
2.2
Substances consigned refrigerated or frozen - Ice, dry ice or other refrigerant shall be placed
around the secondary packaging(s) or alternatively in an over-pack with one or more complete
packages marked in accordance with regulatory requirements. Interior supports shall be provided
to secure secondary packaging(s) or packages in position after the ice or dry ice has dissipated. If
ice is used, the outer packaging or over-pack shall be leak-proof. If dry ice is used, the outer
packaging or over-pack shall permit release of carbon dioxide gas. The primary receptacle and the
secondary packaging shall maintain their integrity at the temperature of the refrigerant used.
2.3
Substances consigned in liquid nitrogen - Plastic primary receptacles capable of withstanding
very low temperatures shall be used. The secondary packaging shall also be capable of
withstanding very low temperature, and in most cases will need to be fitted over the primary
receptacle individually. Provisions for the consignment of liquid nitrogen shall also be fulfilled. The
primary receptacle and the secondary packaging shall maintain their integrity at the temperature of
the liquid nitrogen.
2.4
Lyophilized substances may also be transported in primary receptacles that are flame-sealed
glass ampoules or rubber-stoppered glass vials fitted with metal seals.
Whatever the intended temperature of the consignment, the primary receptacle or the secondary
packaging shall be capable of withstanding without leakage an internal pressure differential of not less
than 95 kPa and temperatures in the range -40°C to +55°C
Special packing provisions for infectious substances (Division 6.2)
Consignors of infectious substances shall ensure that packages are prepared in such a manner that they arrive
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at their destination in good condition and present no hazard to persons or animals during transport. Liquids
shall be filled into packaging, including IBCs, which have an appropriate resistance to the internal pressure that
may develop under normal conditions of transport.
For UN 2814 and 2900, an itemised list of contents shall be enclosed between the secondary packaging and
the outer packaging. When the infectious substances to be transported are unknown, but suspected of meeting
the criteria for inclusion in Category A and assignment to UN 2814 or UN 2900, the words “suspected Category
A infectious substance” shall be shown, in parentheses, following the proper shipping name on the document
inside the outer packaging.
Before an empty packaging is returned to the consignor, or sent elsewhere, it shall be thoroughly disinfected or
sterilized and any label or marking indicating that it had contained an infectious substance shall be removed or
obliterated.
PACKAGING INSTRUCTION P1650
This packing instruction applies to UN 3373
1.
The packaging shall be of good quality, strong enough to withstand the shocks and loadings normally
encountered during carriage, including trans-shipment between vehicles and containers and between
vehicles or containers and warehouses as well as any removal from a pallet or over-pack for subsequent
manual or mechanical handling. Packaging shall be constructed and closed to prevent any loss of
contents that might be caused under normal conditions of carriage by vibration or by changes in
temperature, humidity or pressure.
2.
The packaging shall consist of three components:
(a) a primary receptacle
(b) a secondary packaging; and
(c) an outer packaging.
3.
Primary receptacles shall be packed in secondary packaging in such a way that, under normal conditions
of transport, they cannot break, be punctured or leak their contents into the secondary packaging.
Secondary packaging shall be secured in outer packaging with suitable cushioning material. Any leakage
of the contents shall not compromise the integrity of the cushioning material or of the outer packaging.
4.
For transport, the recognised label, diamond in shape stating UN3373, shall be displayed on the external
surface of the outer packaging on a background of a contrasting colour and shall be clearly visible and
legible. The width of the line shall be at least 2mm; the letters and numbers shall be at least 6mm high.
5.
6.
The completed package shall be capable of successfully passing the drop test set out in the regulations
except that the height of the drop test shall not be less than 1.2m. The smallest external dimension of the
outer packaging shall not be less than 100mm.
For liquid substances:
7.
(a) The primary receptacle(s) shall be leak-proof
(b) The secondary packaging shall be leak-proof.
(c) If multiple fragile primary receptacles are placed in single secondary packaging, they shall be either
individually wrapped or separated to prevent contact between them.
(d) Absorbent material shall be placed between the primary receptacle(s) and the secondary packaging.
The absorbent material shall be in quantity sufficient to absorb the entire contents of the primary
receptacle(s) so that any release of the liquid substances will not compromise the integrity of the
cushioning material or of the outer packaging.
(e) The primary receptacle or the secondary packaging shall be capable of withstanding, without
leakage, an internal pressure of 95 kPa (0.95 bar).
For solid substances:
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(a) The primary receptacle(s) shall be sift-proof.
(b) The secondary packaging shall be sift-proof
(c) If the multiple fragile primary receptacles are placed in a single secondary packaging, they shall be
either individually wrapped or separated to prevent contact between them.
8.
Refrigerated or frozen specimens: Ice, dry ice and liquid nitrogen:
(a) When dry ice or liquid nitrogen is used to keep specimens cold, all applicable requirements of these
Regulations shall be met. When used, ice or dry ice shall be placed outside the secondary packaging
or in the outside packaging or an over-pack. Interior supports shall be provided to secure the
secondary packaging in the original position after the ice or dry ice has dissipated. If ice is used the
outside packaging or over-pack shall be leak-proof. If carbon dioxide, solid (dry ice) is used, the
packaging shall be designed and constructed to permit the release of carbon dioxide gas to prevent a
build-up pressure that could rupture the packaging and shall be marked “Carbon dioxide, solid” or
“Dry ice”.
(b) The primary receptacle and the secondary packaging shall maintain their integrity at the temperature
of the refrigerant used as well as the temperatures and the pressures that could result if refrigeration
were lost.
9.
Infectious substances assigned to UN 3373 and are packed and marked in accordance with this packing
instruction are not subject to any other requirement in these Regulations.
10.
Clear instructions on filling and closing such packages shall be provided by packaging manufacturers and
subsequent distributors to the consignor or to the person who prepares the package (e.g. patient) to
enable the package to be correctly prepared for transport.
11. If any substances has leaked or has been split in a vehicle or container, it may not be reused until after it
has been thoroughly cleaned, and, if necessary disinfected or decontaminated. Any other goods or
articles carried in the same vehicle or container shall be examined for possible contamination.
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Appendix C: Useful Websites
NHS Website
www.nhs.uk
Pathology Transport Bags and Packs
www.versapak.co.uk
Pathology Specimen Transport Packaging
www.dgpgroup.com
Safety Pack
www.saftpack.com
Royal Mail
www.royalmail.com
Health and Safety Executive
www.hse.gov.uk HPA Transport of Specimens to
the Laboratory
www.hpa.org.uk
Health Protection Agency
World Health Organisation
www.who.int
Dangerous Good Regulations (DGR). International Air
Transport Association (IATA)
www.iata.org/cargo/dg/
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Appendix D: Model Safety Rules for Conveying Specimens
The following guideline should be followed wherever staff are working and required to handle and/or
transport specimens.

Wear protective clothing properly fastened, especially when carrying specimens. Keep this
clothing separate from your outdoor clothing and not in your locker. Never wear protective
clothing in the staff room or canteen as this could spread infection.

Do not eat, drink or smoke while handling or transporting specimens

Cover any cuts or grazes on your hands with a waterproof dressing.

Carry all specimens in the trays or boxes provided, not in your hands or pockets.

Touch specimen containers as little as possible. If you do touch them, wash your hands as
soon as practicable afterwards.

Always wash your hands before meal breaks and at the end of a spell of duty.

If a specimen leaks, tell the laboratory reception staff and ask them to make it safe.

If you drop or break the specimen report it to your supervisor immediately and take
appropriate action to clear the spill as soon as possible according to the recommended
spillages and breakages procedure.

If you spill the specimen on to your overall, you must remove it at once and then wash your
hands and put on a clean overall. Report the accident to your supervisor as soon as
possible and make sure the contaminated overall is dealt with appropriately.

If you drive the specimen van, make sure that you have a spills kit on board that is
approved by the Laboratories and have had training in the dealing with spills from
specimens.

If a vehicle transporting specimens breaks down or is involved in an accident do not let
anyone touch the specimens unless that person knows the correct procedures for handling
specimens. Inform your supervisor and the Laboratories immediately of the event.

Handle specimen containers gently at all times.

Only enter areas of the Laboratories where you are allowed to go.
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