REVIEW ON THE INTEGRITY OF SAMPLES RECEIVED AT THE NRL BY: JOHN B.DOGBA REVIEW FROM April 1, 2017 – November 1, 2017 November 17,2017

Outline INTRODUCTION 7months review of NRL sample rejection by county April 1 -1 November Findings

Introduction and Objectives provide a rationale for rejecting unsatisfactory samples; describe a system for sample handling, including collection, transport, storage, and disposal; explain the importance of maintaining sample integrity and assuring that all regulations and requirements are met when transporting samples.

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

The Laboratory’s Responsibilities Provide appropriate containers and supplies Provide sample collection information What- When- How Define a good labeling system Assess all samples - preexamination Sample Management-Module 5

Test Requisition & Collection requirements patient ID tests requested time and date of sample collection source of sample, when appropriate clinical data, where indicated contact information of requesting physician or authorized individual patient preparation patient identification type of sample required type of container needed labeling special handling safety precautions

Use computer-generated bar codes when possible Labeling Each sample should be labeled with: patient’s name patient’s unique ID number test ordered time and date of collection collector’s initials Use computer-generated bar codes when possible Sample Management-Module 5

Outcomes of Improper Collection delays in reporting test results unnecessary re-draws/re-tests decreased customer satisfaction increased costs incorrect diagnosis / treatment injury death

Actions for Rejected Samples inform authorized person request another sample record rejected samples retain rejected sample based on preset criteria extraordinary circumstances may require testing suboptimal samples Actions for Rejected Samples Sample Management-Module 5

FINDINGS Month vs Frequency Month Sample arrived Frequency of sample NRL April 1-30, 2017 249 May 1-31,2017 234 June 1-30,2017 116 July 1-31,2017 71 August 1-31,2017 126 September 1-30,2017 142 October 2-30,2017 118 1-Nov-17 14 Total 1070

Statistics from review for the period covered 1070 sample received at the NRL for the period 31 of the total for the period were rejected 2.89 % of the samples received for the period were rejected 61.3% (19/31) of the rejected samples was due to unlabeled sample tube 22.6% (7/31) of rejected samples were due to samples been collected in the wrong tube Grand Cape mount County is the only county not having rejected sample from the NRL

Rejected samples at NRL for the period April 1,2017 – November 1,2017 by category and frequency Reasons for sample rejection at NRL Frequency Collected in wrong tube 7 Name mismatch sample tube 3 Wrong sample collected 1 Sample spilled out of tube Unlabeled sample tube 19 Total 31

Reason for Rejection at NRL Sample Type Test requested Health facility County Frequency District Reason for Rejection at NRL Sample Type Test requested Health facility Bomi 3 Senjeh Klay Unlabel sample tube Serum Yellow Fever Measles LGH Sackie Town Clinic Sasstown Health Center Bong 4 Jorquelleh Suakoko unlable sample tube Name mismatch sample tube Whole blood Maternal Death Lassa Fever C.B.Dunbar Zeanzue Phebe Gbapolu 1 Bopolu Unlabel sample tube Stool Shigellosis Henry TownClinic Grand Bassa 2 District #3 District #3A Whole Blood stool Compound #3 clinic Grand Gedeh Putu Collected in wrong tube Putu Jarwondee clinic

Reason for Rejection at NRL Sample Type Test requested Health facility County Frequency District Reason for Rejection at NRL Sample Type Test requested Health facility Grand Kru 3 Trehn Jorah Unlabeled sample tube Collected in wrong tube Whole blood Serum CSF Others Yellow Fever Meningitis Behwan Health center Sasstown Hospital Rally Time Hospital Lofa 4 Kolahun Salayea Foya Name mismatch sample tube Measles Kolahun Hospital Gbanway Clinic Foya Borma Hospital Margibi 2 Gibi Kakata Oral swab EVD Worhn Clinic Kakata Health Center Maryland Karluway Collected in wrong tube swab Fleloken town Kaloken Health Center Montserrado Dist 14 Dist.#6 sample spilled out of the tube Carter center Mother's Love Clinic

Reason for Rejection at NRL Sample Type Test requested Health facility County Frequency District Reason for Rejection at NRL Sample Type Test requested Health facility Nimba 3 Tappita Collected in wrong tube Unlabeled sample tube unlabeled sample tube Swab Stool EVD Shigellosis Diallah Town Clinic Rivercess 1 Deodain collected in wrong tube Gozohn Clinic River Gee Webbo Not the right sample for YF testing. Urine Yellow Fever Jimmyville Clinic Sinoe Tarjuowon Unlabeled sample tube Whole blood Measles R.T.M Clinic Total 31

Way forward Need for training on sample collection, labeling, packaging and transport Provide appropriate collection containers to counties for reference sampling Provide Samples collection and transport Hand book to all hospitals and health centers.

Thanks