1. Specimen Management
Dr.KHODAVERDIAN

2. 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.

3. 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

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

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

6. 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

7. 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

8. 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.

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

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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

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

17. 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

18. 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

19. 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.( دقیقه در g )
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

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

21. 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

22. 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

23. Specimen Handling

24. 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

25. 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

26. 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

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

28. 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

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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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)

38. Question