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Collection and transport
Collection and transport
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  2. 2. Scope of the practical In this practical, you will: • Have an overview of specimen management • Get acquainted with common sample collection materials. • Demonstrate blood and urine sample collection procedures
  3. 3. Objectives • General consideration for sample collection • Sample safety considerations • Rejection criteria • Collection of different samples from different sites • Packaging & Transportation
  4. 4. Why Specimen Management? The Quality of any Laboratory Test Result is only as good as the specimen received in the laboratory
  5. 5. How do we achieve Quality?
  6. 6. Specimen Management Part of process control, one of the essentials of a quality management system. Encompasses:  Proper instructions to patient  Patient preparation  Specimen collection  Specimen handling  Specimen transportation  Specimen storage  Specimen preparation/processing
  7. 7. Specimen management activities
  8. 8. Specimen management  Pre-analytical stage  source for most laboratory errors
  9. 9. or Important questions before collecting a specimen • Are you suspecting an Infection ? • If so what is the Nature of infection, eg Bacterial, Viral, Mycological Parasitological • Which tests are your priority ? • When to collect the specimen ? • How to collect the specimen ? • Am I choosing the correct container ? • Why to send the specimens promptly, if not what I should do ?
  10. 10. Specimen management responsibilities
  11. 11. Specimen management responsibilities
  12. 12. Specimen management responsibilities .......improper instruction to patient!!!!
  13. 13. Sample Collection & transport
  14. 14. General consideration for proper sample collection -Every laboratory should provide proper guidelines for collection of samples -All diagnostic information depends on quality of sample recieved -If sample collection, transport, media are not proper, it will give false results
  15. 15. General consideration for proper sample collection Choice of specimen depends on the type of infection e.g. blood stream, GIT, urethral tract, etc.  Aseptic techniques essential  Anatomic sites and locations  Adequate amount/volume  Tissue/body fluids preferred to swabs  Proper timing for collection  Accompanied by request form
  16. 16. • Collect sample before administering antimicrobial agents when possible. • Collect sample with as little contamination from indigenous microbiota as possible to ensure that the sample will be representative of the infected site.
  17. 17. • Utilize appropriate collection devices. Use sterile equipment and aseptic technique to collect specimens to prevent introduction of microorganisms during invasive procedures. • Clearly label the specimen container with the patient’s name and identification number. Always include date and time of collection and your initials.
  18. 18. • Collect an adequate amount of specimen. Inadequate amounts of specimen may yield false-negative results. • Identify the specimen source and/or specific site correctly so that proper culture media will be selected during processing the laboratory.
  19. 19. • Collect specimens in sturdy, sterile, screw-cap, leak proof containers with lids that do not create an aerosol when opened. • Collect sample after proper preparation of area by spirit and povidone iodine
  20. 20. Sample Safety considerations • Follow universal precaution guidelines. Treat all specimens as potentially biohazardous. • Laboratory workers should use appropriate barrier protection (such as gloves and laboratory coat or gown) when collecting or handling specimens. If splashing may occur, protective eyewear, face masks, and aprons may be necessary.
  21. 21. • Do not contaminate the external surface of the collection container and/or its accompanying paperwork. • Minimize direct handling of specimens in transit from the patient to the laboratory. Use plastic sealable bags with a separate pouch for the laboratory requisition orders or transport carriers (for example, small buckets with rigid handles).
  22. 22. Label High risk Specimens • Sputum with suspected Tuberculosis • Fecal samples suspected with Cholera, Typhoid, • Serum when suspected with HIV/ HBV/HCV, infections
  23. 23. Specimen containers Must be:  Leak proof  Shatterproof (unbreakable)  Sterile (for culture and sensitivity)
  24. 24. Specimen containers Stool Sterile universal container with spoon attached to inside of the screw cap Urine Sterile wide mouthed container Sputum Squat wide-mouthed container Blood Sterile bottle, large enough to hold 50 ml of pre-added liquid medium and about 5 – 10 ml of patient’s blood Swabs A sterile pledget of absorbent material, usually cotton wool, mounted on a thin stick.
  25. 25. A Request form • Should include: -Name ,Age ,Sex,Address -IPD/ OPD No ,ward, -Time and Date, -Urgent / Routine, -Type of specimen -Investigation needed -History of patient -Provisional diagnosis -Doctor’s name and sign
  26. 26. When to Request Transport Medium • When facilities are not available to perform the desired tests at the place of collection or laboratory located far away, request the Diagnostic laboratories to advice on transportation of specimens, and consider how to preserve and transport in ideal medium before it is processed • Popularly used transport medium are -Amie 's transport Medium: Gonococcal infection -Carry blair medium: stool -V.R Medium: Stool
  27. 27. Collection of different samples • Blood • Urine • Stool • Rectal swab • Sputum • Csf • Mycology samples • Wound swabs • Water sample
  28. 28. Urine For females • Rinse area with soap and water • Clean it with sterile gauze piece • With both labia apart allow first few ml of urine to drain • Take mid stream clean catch urine • This will prevent contamination • Collect it into wide,sterile,leak proof container For males • Wash hands and retract prepuce before collecting sample
  29. 29. • If it is not possible to obtain urine, suprapubic aspiration or catheterization may be used • Catheterised urine should not be used ideally bcz of presence of bacteria in urethra • For that first apply disinfectant over infusion port and then collect urine
  30. 30. Blood for serology • Take proper precaution (gloves) • Avoid contamination • Palpate vein • Apply disinfectant • Use sterile needle and syringe • Collect blood into plain vacutte • It will coagulate • Centrifuge it at 1500-2000 rpm for 5 mins • Thus serum will be separated
  31. 31. Sputum • Wide container of 50-100 ml capacity • For M.TB two samples are collected • 1st at on the spot and 2nd at next day morning • Morning sample is more reliable bcz of colonization of bacteria in LRT at night • Before this ask patient to gargle with normal saline and take deep breath and then take sample in one bout
  32. 32. • This will prevent contamination • There should not be saliva or liquid • If there are >25 epithelial cell per LPF, sample is rejected as it shows contamination • It should be collected before antibiotic treatment has started
  33. 33. Stool • Collect it into wide mouth,clean, sterile,leak proof container • Label properly • Min 5 gms is needed if solid stool • And 2 ml if liquid stool • It should not be contaminated with urine • If not possible to collect it as in children, elderly, debilitated patients– collect rectal swab
  34. 34. • Do not referigerate stool • If delay in transport preserve it into 10% formalin, buffered glycerol saline
  35. 35. Rectal swab • Take sterile swab • Apply it in anal canal • Rotate it for 10 seconds • Avoid contact with skin • Seal it directly into swab container to prevent contamination • Transport immediately to lab , if not possible,preserve at 4-6 degree centigrade
  36. 36. Procedure to collect CSF • Collect only 3-5 ml into a labeled sterile container • Removal of large volume of CSF lead to headache, • The fluid to be collected at the rate of 4-5 drops per second.
  37. 37. Preservation of CSF • It is important when there is delay in transportation of specimens to Laboratory do not keep in Refrigerator, which tends to kill H. Influenza • If delay is anticipated leave at Room Temperature.
  38. 38. MYCOLOGY SAMPLES • Clean site with 70% ethanol to help eliminate surface contaminants. Using a scalpel, skin scrapings should be made from the active periphery of the lesion. For nails Scrapings should be deep enough to assure acquiring recently invaded tissue Submit scrapings in a sterile Petri dish or container. • Hair - Use forceps to pluck involved hairs from the edges of the patches. Submit hair, including shaft, in a sterile Petri dish or container.
  39. 39. Water for bacteriology • Water course or reservoir - collect from a depth of at least 20 cm • Dug well - do not allow the bottle to touch the sides of the well
  40. 40. Specimen Transportation •Necessary when specimens are collected outside the testing laboratory •Collection and transportation system Sterile, self contained Transport medium Aerobic or anaerobic •Specific environmental conditions for specific specimens must be provided during transportation
  41. 41. Transportation of samples • Stool, csf and sputum should be transported at room temperature, not in refrigerator • Urine , swabs, skin samples,water & food samples are transported asap at room temp,but if it is not possible, preserve them in refrigerator
  42. 42. Specimen Transportation Examples of transport media Transport media for stool specimens Transport medium for viral pathogens: Virus Transport Medium (VTM) Transport medium Use Carry-Blair All enteric organisms Stuart All enteric organisms Amies All enteric organisms Buffered glycerol saline All enteric organisms except Vibrio and Campylobacter Alkaline peptone water Vibrio V-R fluid Vibrio
  43. 43. Specimen Transportation Transport medium A nutrient solution used to maintain the viability of patient specimens as they are being carried the site of collection to the laboratory for culture Purpose:  Keeps suspected microorganisms alive  Suppresses growth of unwanted organisms.
  44. 44. Specimen Packaging  Biological specimens are classified as dangerous goods.  International safety requirements and regulations should be followed when shipping:  National transport regulations  International Civil Aviation Organization (ICAO)  International Air Transport Association (IATA)  Rail and road traffic agencies  Postal services.
  45. 45. Specimen Packaging Specimen Packaging • Category A: An infectious substance that if an exposure occurs when transported is capable of causing permanent disability, life threatening or fatal disease in otherwise healthy humans.  Infectious substance, affecting humans, UN 2814  Infectious substance affecting animals only, UN 2900 • Category B: An infectious substance which does not meet the criteria for inclusion in Category A UN 3373
  46. 46. Safe packaging  All categories require triple packaging:  Leak proof primary container (tube/vial containing the specimen)  Leak proof secondary container (holds more than one primary container) absorbent material added to absorb fluid in case of breakage. Cushioning if more than one specimen.  Rigid tertiary container (strengthened cardboard or cool box)
  47. 47. Triple packaging
  48. 48. Triple packaging
  49. 49. REJECTION CRITERIA  Based on specimen acceptance/rejection criteria.  Documented and communicated to specimen collection points.
  50. 50. REJECTION CRITERIA • Leaking/broken container • Insufficient amount • Improper labelling • More time lag between collection and transport • Improper transport media • Improper transport temperature • Hemolysed sample
  51. 51. Thank You