1. Specimen collection and shipment strategy
Lecture notes
Georgina Tzanakaki and Aftab Jasir
European Public Health Microbiology training program (EUPHEM)

2. Why collection of specimens is important?
Why transportation is important?

3. Learning objective
At the end of this part of the presentation, you should be able to understand the:
Procedures, preparation, processing and transport of specimens

4. Procedures Collecting specimens Marking and labeling Handling Packing
Package labeling
Necessary documents following the transporting sample

5. Procedures Collecting specimens Marking and labeling Handling Packing
Package labeling
Necessary documents following the transporting sample

6. Specimen collection: key issues
Consider differential diagnoses
Decide on test(s) to be conducted
Decide on specimen/s to be collected to conduct these tests
 consultation between microbiologist, clinicians and epidemiologist

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

8. Sample Management Influences the accuracy of laboratory diagnosis
Good sample management
Influences the
accuracy of laboratory diagnosis
Influences therapeutic decisions
affects patient care and outcome
Influences laboratory efficiency
Sample Management
PH events
Outbreaks
Surveillance
Complex Emergency situations 8

9. Procedures Collecting specimens Marking and labeling Handling Packing
Package labeling
Necessary documents following the transporting sample

10. Labeling specimens
Name (unique identifier)
Clinical specimen
Specimen type
Date, time and place of collection
Name/initials of the person responsible for collection

11. Criteria for rejecting samples
Mismatch of information on the label and the request
Inappropriate transport temperature
Excessive delay in transportation
Inappropriate transport medium
specimen received in a fixative
dry specimen
sample with questionable relevance
Insufficient quantity
Leakage

12. Case investigation form
Clinicians/test requester send:
Personal information
age (or date of birth), sex, complete address
Clinical information
date of onset of symptoms, clinical and immunization history, risk factors or contact history where relevant, anti-microbial drugs taken prior to specimen collection
Laboratory information
acute or convalescent specimen
other specimens from the same patient
Line listing – if large number of patients

14. Procedures Collecting specimens Marking and labeling Handling Packing
Package labeling
Necessary documents following the transporting sample

15. To protect: Biosafety Principles the patient yourself
the environment (FILM)

16. Biosafety: protect the people
Use single use equipment
Disinfect
Work in a clean, dedicated area

17. Biosafety: protect yourself
Use personal protective equipment (PPE):
disposable gloves
laboratory coats / gown
mask
protective eyewear

18. Biosafety: protect yourself
Collect sharps immediately to prevent needle-stick injury
Have first aid kit readily accessible
Do not reuse contaminated equipment

19. Biosafety: protect others, the environment
Package samples appropriately for transport
Decontaminate spills
Disinfect working areas for future use
Soak contaminated non-disposable material
Place waste in leak-proof biohazard bags
Ensure safe final management of waste
Protect cleaning personnel with PPE

20. Universal Precautions
Sample Handling
Handle all samples as if infectious
Universal Precautions

21. Procedures Collecting specimens Marking and labeling Handling Packing
Package labeling
Necessary documents following the transporting sample

22. Transport Regulations
Where do they come from?
Who develops them?
United Nations Economic and Social Council
National transport regulations
ICAO/IATA transport regulations
rail, road, and sea traffic agencies
postal services
private couriers 22

23. Dangerous Goods Classes
Class 2: Non-flammable non-toxic gases
Liquid nitrogen (refrigeration)
Class 3: Flammable liquids
Ethanol (preservation)
Class 6: Toxic and infectious substances
Division 6.1 addresses toxic substances Division 6.2 addresses infectious substances
Class 9: Miscellaneous dangerous goods
Dry ice Genetically modified microorganisms and organisms (not classified under 6.2)

24. Dangerous Goods Classes
Class 2: Non-flammable non-toxic gases
Liquid nitrogen (refrigeration)
Class 3: Flammable liquids
Ethanol (preservation)
Class 6: Toxic and infectious substances
Division 6.1 addresses toxic substances Division 6.2 addresses infectious substances
Class 9: Miscellaneous dangerous goods
Dry ice Genetically modified microorganisms and organisms (not classified under 6.2)

25. Substance Categories (Division 6.2)
Category A (Infectious Substances)
e.g. Ebola virus, Bacillus anthracis (culture only)
Category B (Biological Substances)
e.g.Bacillus anthracis (patient specimen), Highly pathogenic avian influenza virus (patient specimen)
Exempt
Medical assessment has determined a minimal likelihood that pathogens are present
e.g. Pregnancy test, Drug screening

26. Category A: Infectious substances
An infectious substance which is transported in a form that, when exposure to it occurs, is capable of :
causing permanent disability,
life-threatening or
fatal disease in otherwise healthy humans or animals.

27. Category B – Biological Substances
An infectious substance which does not meet the criteria for inclusion in Category A and has not been determined by a medical professional to have a minimal likelihood that pathogens are present.
e.g. serum, CSF, blood etc

28. Exempt
Medical assessment has determined a minimal likelihood that pathogens are present
e.g. Pregnancy test, Drug screening

29. What is the difference between cultures
and patient specimens?

30. Cultures and Patient Specimens
Cultures are incubated samples (with purpose of multiplying pathogens)
Patient specimens are collected directly from humans/animals
These differences are important for the classification of infectious substances
This classification will affect the choice of packaging

31. Categorization and Identification
Proper Shipping Name
Situation
Categorization
Patient presents with suspected case of Hepatitis B virus and blood samples are sent.
Category B
Biological Substance, Category B
Sending a culture of Mycobacterium tuberculosis to a reference laboratory.
Category A
Infectious Substance, Affecting Humans
The Ebola virus has been found in bats and samples which have not been cultured are being shipped.
Category A
Infectious Substance, Affecting Humans
Medical professional declares human drug test as minimal likelihood for containing pathogens.
Exempt
Exempt Human Specimen

32. What are the requirements for packaging Category A and B substances?
2009
World Health Organization
What are the requirements for
packaging Category A and B substances?

33. Triple Packaging Primary container
Triple packaging provides three layers of containment to protect the substances being shipped. These layers are primary, secondary, and outer containers.
The following diagram shows the basic concept of triple packages.
Primary container
Absorbent and cushioning material
Secondary container
Outer container

34. Procedures Collecting specimens Marking and labeling Handling Packing
Labeling packages
Necessary documents following the transporting sample

35. Infectious Substance Label
Markings and Labels
Infectious Substance Label

36. Markings and Labels
Orientation Labels Mandatory on opposite sides when primary container exceeds 50 ml

37. Shipper’s and Receiver's Address
Markings and Labels
Shipper’s and Receiver's Address

38. Markings and Labels
Emergency Contact
Name and Number
(Cat A)

39. Proper Shipping Name and UN Number
Markings and Labels
Proper Shipping Name and UN Number

40. UN Specification Marking (Cat A)
Markings and Labels
UN Specification Marking (Cat A)

41. Markings and Labels

42. Procedures Collecting specimens Marking and labeling Handling Packing
Package labeling
Necessary documents following the transporting sample

43. Documentation for Shipping Infectious Substances

44. Overview
Air Waybill : goes with any shipment made by air
shipper or courier must complete the form
Completing the Shipper’s Declaration for Dangerous
Goods

45. Take home messages
For a good sample management and thus a good laboratory diagnosis you need to:
Follow carefully sample collection information
Label samples with all necessary information
Respect biosafety principles to protect the patient, yourself and the environment
Handle all samples as if infectious
Use appropriate packaging according to the category of sample
Respect norms and regulations for transport

46. Sources
This presentation used some information of the training package
„Laboratory issues for epidemiologists“ put in place by the:
Department of Epidemic and Pandemic Alert and Response of the World Health Organization
European Program for Public Health Microbiology (EUPHEM)

47. Thank you for your attention?