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					                                                                                                                                                                                                                                                                                                                                                                                 Oxford Radcliffe Hospitals
                                                                                                                                                                                                                                                                                                                                                                                                                                         NHS Trust

                                                                                                          Specimens: Safe Handling and Transport
                          This Poster provides guidance for Managers and Staff on the safe handling and transport of pathology specimens sent from all locations to Trust laboratories.

                       WARNING! Specimens received unlabelled, without a completed request card attached, in incorrect containers, with discrepancies or leaking are unlikely to be processed.
                                                                                                 Please ask the specific laboratory or read the laboratory handbooks on the Clinical Intranet for information if in doubt.

                                                                                                                                                                                                     Wear appropriate personal protective equipment (PPE)
                                                                                                                                                                                                                  Examples of PPE include:

                                                                                                                                                                                                 Gloves                          Goggles                     Respirator              Apron/Gown

                                         Identify the patient and the tests required, and use the correct pathology request card(s) for the test(s). Examples:
                                                                                                                                                                                                                                                                                                                               Dealing with spillages & leakages

                                                                                                                                                                                                                                                              Always wear PPE prior to clean up spillages and                                                           Histological Specimens
                                                                                                                                                                                                                                                              discard PPE after use.                                                          Small Spills (<2.5L)                                    Large Spills (2.5L or more)

                                                                                                                                                                                                                                                                                                                               Wipe up with De-formalizer pad, and then discard it     May require drastic measures i.e.:
                                                                                                                                                                                                                                                               Never use a mixture of                   detergents     and    into a yellow bag for incineration.                     Temporary evacuation of the area and involvement of
                                                                                                                                                                Cellular Pathology                                                                            disinfectants to clean a spill.
                                                                                                            Microbiology, Serology & Virology                                                          Clinical Biochemistry &                                                                                                                           OR                            the Emergency Services.
                         Blood grouping & Transfusion                                                                                                  Separate forms for Histology, Cytology
                                                                            Immunology                          Separate form for MRSA                 and Neuropathology. Check on Clinical          Laboratory Haematology                                                                                                   Cover with Formalin control granules for 15             If the spill is >2.5litres or if the area where the spillage
                                                                                                                       screening                                     intranet                                                                                 Inform other people within the department/ward                  minutes, then scrape up and discard into a clear        occurred is small/poorly ventilated, the Fire Brigade
                                                                                                                                                                                                                                                              of the spillage and what has been spilt.                         plastic bag. Label the bag „Inert mass of urea-         should be notified immediately.
                                                                                                                                                                                                                                                                                                                               formaldehyde. Non-hazardous waste‟.

                                                                                                                                                                                                                                                                                                                                   Biological Specimens (Body fluids)
                                                                                                                                                                                                                                                                                  Non-blood-stained Spills                                                               Blood/Blood-stained Spills
                                                                          Use the correct and sterile container(s) for different test(s) before sampling                                                                                                                            Small & Large Spills                                              Small Spills                                                Large Spills
                                                                                                                                                                                                                                                                 1.Use paper towel to soak up spill, and then discard into a    1.Use paper towel to soak up spill, and then discard into 1. Cover spill with chlorine releasing granules
                                                                                                                                                                                                                                                                 yellow bag for incineration.                                   a yellow bag for incineration.                               for 5 minutes.
                                                                                                                                                                                                                                                                 2.Clean contaminated area with detergent and hot water,        2.Clean contaminated area with strong detergent           2. Clean contaminated area with detergent and
                                                                                                                                                                                                                                                                 and then discard into a yellow bag for incineration.           hypochlorite (1%) solution.                                  hot water, and then discard into a yellow bag
                                                                                                                                                                                                                                                                                                                                                                                             for incineration.

                                                                                                                                                                                                                                                                     Blood-stained/non-blood-stained urine – Never use chlorine releasing agents to clean up the spillage because the resultant fume is a hazard!
                                                                   Vacuum tubes                                Charcoal swab                    25ml plastic universal       Blood culture bottles
                                                          (Remember to check the order of
                                                               collection of tubes)

                                                                       (For more information on other types of containers, please refer to the laboratories‟ handbooks on „Clinical Intranet‟)

                                                                                                                                                                                                                                                                                                                                                               Please ensure the following points are checked before packaging
                                                                                                                                                                                                                                                                                                                                           ● Is the lid of the specimen container sealed / tightened properly?
                Label the request card and the specimen container correctly, accurately and legibly                                                                                     Match the patient‟s details on the request card and specimen container with the patient                                                            ● Check for any leakages around the specimen container.
                                                                                                                                                                                                                                                                                                                                           ● Check the correct request card is used for the requested test (i.e. keep specimen(s) for microbiology separately
                                                             ● NAME                                                                                                                                                                                                                                                                        from biochemistry).
                                                             ● DATE OF BIRTH                                                                                                                                                                                                                                                               ● State URGENT on the request card. If necessary inform the laboratory registrars and / or Biomedical Scientists.
                                                             ● SEX                                                 ● NAME                                                                                                                                                                                                                  ● For interoperative specimens (i.e. frozen sections) and urgent fresh/unfixed biopsies - DO NOT place in formalin,
                                                             ● NHS NUMBER (10 DIGITS)                              ● DATE OF BIRTH                                                                                                                                                                                                         make sure they are package separately , deliver directly to cellular pathology and inform the laboratory.
                                                             ● HOSP. NUMBER (7 DIGITS)
                                                             ● LOCATION
                                                             ● PHYSICIAN’S NAME
                                                             ● TYPE OF SPECIMEN
                                                                                                                   ● NHS NUMBER (10 DIGITS)
                                                                                                                   ● HOSP. NUMBER (7 DIGITS)
                                                                                                                   ● TYPE OF SPECIMEN
                                                                                                                                                                                                              =                                                                      =                                                     Check there is no additional risk to laboratory staff if so label accordingly e.g. Danger of Infection (see below)

                                                                                                                   ● TIME OF COLLECTION                                                                                                                                                                                                    Collecting specimens from patients who have had a radioisotope should be avoided. Advice on specimen collection,
                                                             ● CLINICAL DETAILS
                                                             ● TEST(S) REQUIRED                                                                                                                                                                                                                                                            handling and transport for specimens with a Radioactive risk is available from Medical physics on extension
                                                             ● TIME OF COLLECTION                                                                                                                                                                                                                                                          25441.

                                                                                                                                      The standard packaging method
                                                                   (For more information on packaging specimens for transport, please read the Trust policy on „Specimens: Safe Handling & Transport)

               +                                       =                                                                                                +                          =                                                                                                                                                         Label request card and specimen with the „Danger of Infection‟ Sticker if the patient is known or suspected to have
                                                                                                                                                                                                                                                                                                                                                                hazard group 3 or group 4 pathogen(s) and state on the request card the risk.
                                                                                                                                                                                                                                                                                                                                              Some Examples: Hepatitis B virus and Hepatitis C virus, Human immunodeficiency virus (HIV), Creutzfeldt-Jakob
                                                                                                                                                                                                                                                                                                                                                Disease (CJD), Brucella spp., Mycobacterium tuberculosis (TB), Salmonella typhi (Typhoid) and Salmonella
Place the specimen container into the plastic bag attached to the request card and seal it properly.               Specimens are then placed into a second, large, transparent plastic bag. Please add                    The bag of specimens can then be put together with other bags of specimens into a rigid                                               paratyphi, Escherichia coli O157, Taenia solium, Histoplasma capsulatum.
                                                                                                                         sufficient absorbent material to absorb any fluid in case of breakage.                                                              transport box.
 (If multiple specimens are placed into the same bag, please cushion them to prevent breakage)                                                                                                                                                                                                                                                 (For more information on and the name of other hazardous pathogens, please refer to the „Specimens: Safe Handling & Transport Policy‟
                                                                                                                   (Place all specimens for one specific department into the same secondary bag i.e. all                   The Pod on the right hand side is for the Pneumatic (Air) System. A limited number of                                     appendix C for category A organisms, and the „Advisory Committee on Dangerous Pathogens‟ for pathogen hazard groups
                                                                                                                           microbiology specimens in one bag and immunology in another bag)                              specimens can be placed in it. Ensure specimen is well cushioned with absorbent material.                                                               
 For large specimen containers:

                    +                                                                                                                                                                                            
                                                                                                                                                                                                                             Depending on the size of the specimen container used. If it is too large it may not fit

                                                         =                                                                                        +                             =                                             securely into a rigid transport box together with other specimens. The specimen
                                                                                                                                                                                                                              container will need to be placed into another transport box on its own. Ensure the
                                                                                                                                                                                                                                              specimen is well cushioned with absorbent material.

   Adhere the request card to the specimen container and make certain it will not fall off.                        If the specimen container is too large to fit into a transparent plastic bag, please use a
                                                                                                                         larger plastic bag to contain it. Do not send without a secondary plastic bag.

                 There are two main methods of transportation within the hospital                                                                                          Taxis are used for URGENT                              There are four different transportation methods between hospital sites and to/from locations outside hospitals
                                                                                                                                                                           specimens outside the normal
                                      Highly reliable system that                                  Please use the porter-                                                  working hours of SCAS trans-                          Royal Mail Group plc will not accept a package that contains UN2814 or UN2900                                             It is the SCAS responsibility                                                      A patient may take their          own
                                      allows rapid transport of                                    ing service in the event                                                port services.                                        infectious substances/Category A infectious substances. They only accept                                                  to maintain a regular trans-                                                       specimen(s) to laboratory via public
                                      specimens from wards to                                      of a breakdown or for                                                                                                         packages that contain Category B infectious substances that are packaged to                                               port service and to ensure                                                         transport as this is outside the “The
                                                                                                                                                                           Specimen must be double
                                      laboratories.                                                any     specimens not                                                                                                         Packing Instruction PI650 in appendix D of „Safe Handling & Transport Policy‟                                             specimen quality is not                                                            Carriage of Dangerous Goods and
                                                                                                                                                                           bagged and the outside bag
                                      (See Estates & Facilities                                    suitable for transport by                                                                                                     requirements.                                                                                                             compromised due to any                                                             Use of Transportable Pressure
                                                                                                                                                                           clearly labeled „URGENT‟
                                      Intranet Site for the Standard                               the pneumatic (air) tube                                                                                                                                                                                                                                excessive delay.                                                                   Equipment       Regulations      2004
                                                                                                                                                                           before placing in the transport
                                      Operating Procedures)                                        system.                                                                                                                                                                                                                                                                                                                                    („Carriage Regulations‟)”.
                                                                                                                                                                           box. Please read the Packing                          Category A specimens need to be transported by specific couriers that meet 6.2
                                (See      Infection     Control                                                                                                            Instruction PI650 in appendix                         of the Technical Instructions for Safe Transport of Dangerous Goods by Air                                                                                                                                   A member of staff transporting clinical
    Pneumatic (air) tube system Intranet Site for dealing with             Portering staff                                                               Taxi              D of „Safe Handling &                 Post/Courier    published by ICAO. These specimens must be packaged and sent by trained                   South Central Ambulance                                                           Public Transport                 specimens via public transport as
                                spillages within the system)                                                                                                               Transport Policy‟.                                    laboratory staff who have access to correct packaging and specialist Couriers.               Service NHS Trust                                                                                               part of their work must comply with
                                                                                                                                                                                                                                 Please contact the laboratory prior to sending Category A specimens.                        (SCAS) non-patient                                                                                               the „Carriage Regulations‟.
                                                                                                                                                                                                                                                                                                                               transport service

       Contact Numbers:                                                                                                                                             Web Links:                                                                                                                                                                                         References:
    Porter‟s desk extensions:                                   The following links can only be accessed within the hospitals‟ computers.                                National Health Service (NHS) –                                                                          Health & Safety at Work Act 1974.
    • On the John Radcliffe Hospital site – 40404
                                                                Clinical Intranet:                                                                                       Pathology Transport Bags & Packs –
    • On Churchill Hospital site – 25024                                                                                                                                                                                                                                                            The Management of Health & Safety at Work Regulations 1999.
    • On Horton General Hospital site – 59000                   • Microbiology Handbook -                    Pathology Specimen Transport Packaging –
                                                                • Haematology Handbook -
    Laboratory telephone numbers:                               • Immunology Handbook -
                                                                                                                                                                                                                                                                                                    The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2004 ('Carriage Regulations').
                                                                                                                                                                         Safety Pack –
    • Biochemistry – 018652 20336                               • Cellular Pathology Handbook -
    • Cytology – 018652 20509                                   • Biochemistry Handbook -                               Royal Mail –                                                                                      The Control of Substances Hazardous to Health (COSHH) Regulations 2004.
    • Haematology – 018652 20336
    • Histology – 018652 20490/20491                                                                                                                                     Health & Safety Executive (HSE) –                                                                    “Working with ADR: An Introduction to the Carriage of Dangerous Goods by Road” (Department of Transport 2005) - ISBN 1-
    • Immunology – 018652 25995                                 Infection Control Intranet site -
    • Microbiology – 018652 21918
                                                                                                                                                                         Health Protection Agency (HPA) –
    • Virology – 018652 20877                                   Estates & Facilities Intranet site -
                                                                                                                                                                         World Health Organisation (WHO) –                                                                       Patient Sample and Request Form Identification Criteria (Institute of Biomedical Science).
                                                                                                                                                                         Dangerous Goods Regulation (DGR) & International Air Transport Association (IATA) –
                                                                                                                                                                                                                                                                                                    Transport of Infectious Substances – Best Practice Guidance for Microbiology Laboratories (Department of Health - June 2007).
                                                                                                                                                                         South Central Ambulance Serivce NHS Trust (SCAT) –
                                                                                                                                                                                                                                                                                                    Transport of Infectious Substances (Department of Health – Revision 3 – November 2006).
                                                                                                                                                                         Advisory Committee on Dangerous Pathogens (ADCP) –
                                                                                                                                                                                                                                                                                                    Infection at Work: Controlling the Risks (Advisory Committee on Dangerous Pathogens – 2003).
                                                                                                                                                                                                                                                                                                    Safe Handling and Transport Version 1: Date Issued 22nd September 2010

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