Specimen Management Dr.KHODAVERDIAN

Objectives At the end of this module, you will be able to: Describe the importance of specimen management. Define the specimen management process for receipt, rejection, identification, transport, storage, inventory and disposal. Identify policies and procedures needed to support specimen management. Present objectives for the module.

A Systems Approach to Laboratory Quality Organization Personnel Equipment Purchasing & Inventory Process Control (QC & EQA) & Specimen Management Information Management Documents & Records Occurrence Management Assessment Process Improvement Customer Service Facilities & Safety

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

importance of specimen management Why is specimen management important? Transition to next section. Note that we will try to answer this question. 5

Essential to accurate laboratory diagnosis Influences laboratory efficiency Directly affects patient care and outcome Influences therapeutic decisions Essential to accurate laboratory diagnosis Good sample management Good sample management Impacts patient length of stay, hospital costs, and laboratory costs 6

Specimen Management Means… 2005 Specimen Management Means… Policies, procedures and infrastructure to support the safe handling and treatment of biological specimens Module 10: Inventory 7

Pitfalls Saying “Yes” to everything Accepting every specimen Afraid to say “No” to physicians Someone with sufficient authority MUST support laboratory policy Good lab practice – Patients first! Having no boundaries for technical issues Often times it will be necessary to work with the Medical Director to establish laboratory policies. The Medical Director must be a supporter of the laboratory.

Components Labeling Transport Information needed Retention, storage, disposal Assessing, processing, tracking Labeling Collection, preservation Laboratory Handbook Policies & Practices

The Laboratory Handbook contains information needed by those who collect samples available to all sample collection areas must be understood by all laboratory staff referenced in the quality manual

Laboratory Handbook Contents name and address of laboratory contact names and telephone numbers hours of operation list of tests that can be ordered sample collection procedures sample transport procedures expected turn around times (TAT) how urgent requests are handled

Test Requisition Patient identification Clinical data, where indicated Contact info for requesting physician or authorized individual Tests requested Time and date of specimen collection Source of specimen, when appropriate

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

Outcomes of improper collection Delays in getting test results Unnecessary re-draws/re-tests Decreased customer satisfaction Increased costs Incorrect diagnosis / treatment Injury Death Specimen collection errors lead to incorrect test results (e.g. contaminated specimens), patient discomfort (e.g. redraws), and in a few cases, death (e.g. mis-identified transfusion patients). Specimen errors significantly reduce the quality of care in an institution and increase costs. Because specimen errors cause fewer deaths and malpractice suits than medication errors, they are less well-studied and researched.

Specimen Collection Procedures Should include instructions for: Positively identifying the patient before collecting a specimen Required specimen for each requested test Preparation of patient Type of collection container, required volume, timing Preservation of specimen, e.g., transport media Proper specimen labeling Special handling instructions, e.g., refrigeration

Collection Requirements patient preparation patient identification type of sample required type of container needed labeling special handling safety precautions

جمع آوری نمونه خون وريدی انطباق مشخصات برگه درخواست آزمايش با مشخصات بيمار اطمينان ازرعايت رژيم غذايي پيش از نمونه گيري انتخاب وسايل مورد نياز استفاده از دستکش بستن تورنيکه( لاکتات) انتخاب وريد مناسب تميزكردن محل نمونه‌گيري نمونه گيري باز کردن تورنیکه دفع سر سوزن تخلیه خون برچسب گذاری: نام نام خانوادگی،شماره شناسایی ،تاریخ و زمان نمونه گیری، نام فرد نمونه گیر

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

نکته ها سرم يا پلاسما بايد در کوتاهترين زمان بدنبال نمونه گيري از سلول هاي خوني جدا گردد. حداکثر زمان مجاز جهت جداسازي سرم يا پلاسما 2 ساعت پس از نمونه گيري پيشنهاد مي گردد.( 10-15 دقیقه در 1000- 1200g ) سرد نمودن: بعضي نمونه ها بايد تا قبل از عمل جداسازي در سرما نگه داري شوند وجود در پوش وضعیت لوله زمان همولیز مجاورت به نور

:نواحی مناسب بند انتهایی انگشتان دست( سوم یا چهارم) سطح داخلی وخارجی پاشنه پا

Sample Tracking-Manual confirm receipt of samples, include date and time label samples appropriately; keep with the test requisition until laboratory ID is assigned track aliquots–traceable to the original sample

Specimen Rejection Criteria: Unlabeled specimen Insufficient patient information Hemolyzed specimen Wrong tube drawn Wrong specimen submitted Inadequate volume for the amount of preservative Insufficient quantity Prolonged transport

Specimen Handling

Specimen Handling Handle all specimens as if infectious Use tracking system for all specimens: Accession / logging process Confirm actual receipt of specimens Date and time of specimen receipt Track aliquots – traceable to the original sample

Specimen Handling Establish procedures for handling: Stat / urgent requests Delayed testing, e.g., storage, separation of serum/plasma from cells Leaking containers Contaminated forms Preservation of specimens

Specimen Transport Train personnel in appropriate safety and packaging procedures Package and preserve specimens appropriately Transport specimens at appropriate temperature Determine acceptable transport time Determine mode of transport Courier, ambulance, clinic/lab staff Adhere to the International Air Transport Association (IATA) regulations

Sample Transport Maintain integrity of sample: temperature preservation of sample special transport containers time limitations Assure safety regulations are met 27

ICAO/IATA transport regulations (air) Where do they come from? Who develops them? National transport regulations ICAO/IATA transport regulations (air) rail, road, and sea traffic agencies postal services private couriers 28

Sample Storage-Written Policy describe samples to be stored determine retention time determine location describe proper conditions establish method of organizing samples

Sample Retention set policy for retention monitor stored samples, including freeze/thaw cycles maintain an organized, accessible system establish a schedule to review all stored samples establish tracking procedures

Specimen Storage Establish policy Determine retention time What should be stored? Determine retention time Determine storage location Consider ease of access Assure proper storage conditions Indexing of specimens By day of receipt or accession number How to label specimen storage location: Freezer name/number Shelf number Box number/location Example: H-2-5A5

Sample Referral Record: Monitor / Track, and Record: samples referred date of referral name of person referring test Monitor / Track, and Record: turnaround time results delivery (from referral laboratory, to requestor) problems with referral

دستورالعمل ارجاع نمونه های بالينی معيارهای انتخاب آزمايشگاه ارجاع - کيفيت خدمات - کارايی ارايه خدمات (دامنه آزمايش ها، شيوه انتقال نمونه، زمان چرخه کاری،نحوه تفسير نتايج ،سيستم ارتباطی) - هزينه اثر بخشی عقد قرارداد بسته بندی وانتقال نمونه های آزمايشگاهی الزامات آزمايشگاه ارجاع دهنده الزامات آزمايشگاه ارجاع

Specimen Disposal Develop policy for disposal of medical waste Establish and follow disinfection procedures Comply with local regulations Include policy of disposal of rejected specimens Appoint someone with oversight responsibilities Establish a schedule to review all stored specimens

Summary provide a laboratory handbook with collection information to all users have a system for tracking samples as they move through the laboratory establish and implement a policy for sample storage and sample disposal maintain sample integrity assure that all transport regulations and requirements are met Always follow universal precautions

Key Messages laboratory must have good samples in order to ensure accuracy and reliability of testing and confidence in results Sample management directly affects patient care and outcome

ظروف وملزومات مورد نياز آماده سازی بيمار راهنمايی خاص مايعات نوع نمونه ظروف وملزومات مورد نياز آماده سازی بيمار راهنمايی خاص شرايط انتقال به آزمايشگاه شرايط نگه داری تا قبل از انجام آزمايش محيط های کشت اوليه مورد نياز تهيه گسترش مستقيم توضيحات مايع مغزی نخاعی لوله در پيچ دار استريل ضد عفونی کردن پوست قبل ازآسپيراسيون نمونه فوری-دمای اتاق 6 ساعت در دمای 37 درجه –جهت شناسايی ويروس ها نمونه تا 3 روزدر دمای 4 درجه قابل نگه داری است BA-CA گرم محيط تايو جهت تمونهCSF تهيه شده از شانت استفاده شود. گوش داخلی لوله در پيچ دار استريل يا حاوی محيط انتقالی غير هوازی تميز نمودن کانال گوش با محلول صابونی ملايم قبل از سوراخ نمودن پرده آسپيره نمودن ترشحات پشت پرده گوش-در صورت پاره بودن پرده جمع آوری ترشحات به کمک سواپ 6 ساعت در دمای اتاق BA-CA-MAC قبل از درمان استفاده از محيط تايو استفاده از محيط بی هوازی جهت نمونه های تيمپانو سنتزيس خارجی سواپ مرطوب شده با محيط استوات يا آميس پوسته ها به کمک سالين استريل پاک گردد سواپ داخل مجرای گوش محکم چرخانده شود تا4 2 ساعت دمای اتاق تا 24 ساعت چشم ملتحمه نمونه گيری از هر دو چشم-استفاده از سواپ مرطوب شده با سالين استريل گرم ،آکريدين نارنجي رنگ آميزی های هيستولوژيک(نظير گيمسا)

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