BERKSHIRE HEALTH SYSTEM LABORATORIES Berkshire Medical Center Fairview Hospital Specimen Transport Diagnostic specimens: A diagnostic specimen is defined as any human material including but not limited to, excreta, blood and its components, tissue and tissue fluids collected for the purpose of diagnosis, but excluding live infected animals. Diagnostic specimens resulting from medical practice and research are considered a negligible threat to the public health. Diagnostic specimens obtained from patients with suspected infectious diseases may contain limited quantities of an infectious agent. There are very few agents that may be the source of an infection as a result of a transport mishap. If exposure to the specimen due to transport mishap could result in an infection, the diagnostic specimen must be packaged, labeled and transported as an infectious substance. Diagnostic specimens collected during an investigation of an outbreak of a serious disease of unknown cause must be handled as infectious substances. Local Surface Transport Examples include transport of specimens from a doctor’s office/surgery to a laboratory, from a hospital to a diagnostic laboratory or from one laboratory to another. Such courier services may be operated by a hospital, a laboratory, a health service or other approved agency or organization. The principle of safe transport by this means is the same as for air or international transport – the material should not have any possibility of escaping from the package under normal conditions of transport. The following practices should be observed: 1. All laboratory specimens should be transported in biohazard bags to the core lab. Vacutainer tubes Blood culture bottles Urine specimens Stool specimens Body fluid specimens Cytology & Pathology specimens Place in zip-lock biohazard specimen transport bags. Specimen containers should be watertight and leak-proof. 2. Place the requisition in the pocket of the biohazard bag. 3. Fold the requisition so that the patient information is to the inside and not visible from the outside for confidentiality reasons. 4. Specimens should be stored at the proper temperature (See User Notes in the test dictionary for specifics with regard to specimen collection and transport). Specimens should be kept at Room Temp, Refrigerated or Frozen prior to pickup by the lab courier. 5. Couriers will gather specimens from the collection stations and transport them to the main lab. A hard-sided cooler is used to transport the specimens. Cold packs are used to keep the specimens cool for transport. Freezer packs are used for frozen specimens. Room temperature specimens are transported at ambient temperature. 6. The transport box should be secured in the transport vehicle 7. Each transport box should be labeled appropriately consistent with its contents 8. A spill kit containing absorbent material, a chlorine disinfectant, a leak-proof waste disposal container and heavy-duty reusable gloves should be kept in the transport vehicle. Infectious Substances: Transport according to the Basic Triple Packaging System The system consists of three layers as follows: 1. Primary receptacle. A labeled primary watertight, leak-proof receptacle containing the specimen. The receptacle is wrapped in enough absorbent material to absorb all fluid in case of breakage. 2. Secondary receptacle. A second durable, watertight, leak-proof receptacle to enclose and protect the primary receptacle. Several wrapped primary receptacles may be placed in one secondary receptacle. Sufficient additional absorbent material must be used to cushion multiple primary receptacles. 3. Outer shipping package. The secondary receptacle is placed in an outer shipping package that protects it and its contents from outside influences such as physical damage and water while in transit. Specimen data forms, letters and other types of information that identify or describe the specimen ad also identify the shipper and receiver should be taped to the outside of the secondary receptacle. In Case of Accident of Spill: In case of an accident or spill: lab personnel should notify a laboratory supervisor. an incident investigation and report will follow. a lab accident form will be completed. Packaging and Labeling of Lab Specimens for Identification of Materials Specimens are transported in clear LAB-LOC (zip-lock) SPECIMEN BAGS. They are marked with the biohazard label and are watertight and leak-proof. Confidentiality of Transported Specimens: Specimens collected from physician offices and from our collection stations are transported by lab couriers and/or by transport personnel employed by the health system. All employees of the health system are educated in and bound by confidentiality rules. Specimens are transported in transport bags and are accompanied by a requisition that is folded so that patient information is not visible from the outside of the container. Specimens Transported Outside the Hospital System: Refer to attached World Health Organization (WHO) guidelines for transporting specimens outside the health system. See documentation from the commercial courier services (i.e., Fed Ex) regarding issues related to transport of biohazardous material. TRACKING OF SPECIMENS: When specimens are collected and received at the collection stations, the specimens qualify for a lab “batch list”. This batch list is the tracking mechanism built into the Meditech system that follows or tracks specimens from one collection station to the core lab for testing. The batch list is checked against the specimens received at the core lab. Specimens are “received” in the system to show that the specimen is now located at the main lab for testing. The tracking system shows date, time of collection, person who collected and received specimens and location at any point in time. If a specimen is not included in the batch, main lab will call the collection station for resolve. Couriers are not involved in the specimen tracking. If there are occurrences with specimen transport from the offices to the main lab, a lab liaison is employed to investigate these instances and resolve any issues. This would involve problems with transport of the specimen or improper collection and handling of specimens. The central processing desk and the section chiefs are in contact with the lab liaison to educate offices on best practice issues. Requisitions and Specimen Receipt/Assessment Following HCFA regulations, to ensure documentation of physician orders, requisition forms are sent to the physician offices to accompany outpatients to the laboratory. If the practice prefers sending their "face sheet” from their practice with all pertinent patient documentation noted, and the lab tests noted on this form, we will accept this type of order. If a patient arrives without the form or other hard copy requisition, the physician’s office is called and requested to FAX to the laboratory a completed BHS lab requisition form for our records. All of the following elements are included in the requisition: 1. Patient name 2. Sex 3. Date of Birth 4. Physician/Provider 5. Tests requested 6. Time and date of specimen collection when appropriate 7. Source of specimen, when appropriate 8. Diagnosis Once received, this requisition is registered in the Admitting module of the hospital computer system. The patient account number is used to order tests in the lab module. This ensures appropriate specimen identification and accessioning. Approved by: Medical Director: R. L. Johnson, MD Approved by: Technical Director: T. Bills, FIMLS Prepared by: Technologist: Cheryl Jenks MBA, MT(ASCP) Adopted: 4-20-06 Revised: Reviewed: 2-13-12