PUPA 316: Management of sample
Specimen Collection, Transportation and Storage
Introduction
• Quality laboratory Result is as good as the quality of the
Clinical samples used.
• Sample management directly affects patient Care and
Outcome.
Sample Containers
• Clinical Sample should be collected into the appropriate test
containers.
• EDTA for FBC; Plain Tube with separator for LFT.
• Plain sterile container for Urine C/S and Sterile Swab Tube for
HVS to maintain specimen integrity.
Sample Containers
• Some Microbiological samples should be put into specific
Transport medium.
• This will ensure Viability of sample.
• Sample containers should be Sterile, Clean, Unbroken and
Leak proof.
Urine Container
Standard Operational Procedures
• The correct SOP must be followed in the collection of the
clinical sample.
• This includes Time, Date of collection and the Initials of the
collector.
• Sample must be well labeled with the collection details on
the accompanying request form.
Sampling Area
• Patient preparation where some test requires patient
Fasting, special timing issues and Drug levels must be
ensured when collecting samples.
• The patient must be accurately identified by the laboratory
personnel by questioning patient or accompanying relative
or by an identifying wrist band.
Sampling Area
• Sample should be collected Aseptically in an appropriate,
equipped and comfortable environment.
• The Phlebotomist/Health care provider should be in PPE.
-This include Laboratory Coat and Gloves Face mask
Sampling Area
• Where patient has to collect sample by himself the
appropriate collection kits with instructions for collection,
safety precautions must be provided.
• Collection information should be given to Health care
personnel at the collection site (bedside in a hospital
setting).
• Appropriate containers and collection supplies should be
made available at the sampling area.
Sampling Area
• Adequate amount/volume must be collected (Provision for
repeat test and further investigations).
• Some samples that may require special handling such as
immediate refrigeration, protection from light (Serum
Bilirubin), or prompt delivery to the laboratory should be
treated as such (CSF).
• Ensure the safety of laboratory personnel and client.
Sample Delivery
• Clinical sample: Must be promptly delivered to the
laboratory.
• Must be in sealed plastic bags with the request form in a
separate column.
• Delivery to other facilities must be well packaged with a
(Biohazard logo) inscription.
Urgent Requests
• Clinical specimen should be considered urgent where result
is needed for immediate management of the patient.
• List of test considered as urgent should be well stated and
made available to the clinicians (CSF, BF for Malaria
parasites, FBS).
• Clinician should notify the laboratory officer in the form of a
written notice attached to the request form taking into
consideration the turnaround time.
Urgent Requests
• Urgent notice should be clearly stated on the request form
including the contact address of:
- the Clinician who ordered the test and that of the Patient.
• Urgent request should be handled individually as soon as the
sample gets to the laboratory.
• The Result should be sent immediately to the Clinician or Patient
relative by phone or by the Health care personnel.
• Laboratory should offer a 24 hour service for all urgent requests.
Clinical Information
• The client must come with a well filled request form that
specifies all information that will be needed for proper
handling and reporting.
• Patient/Client identification (Name, Age and Sex).
• Tests requested.
Clinical Information
• Date and Time of sample collection.
• Clinical data/history (Diagnosis).
• Source of the specimen where applicable.
• Contact information for the clinician.
Rejection Factor
• The Facility reserves the right to reject and discard any
clinical sample incorrectly collected.
• The laboratory should establish rejection criteria, and
enforce them.
• Clinical specimen collected into wrong containers should be
considered unsuitable.
• Incorrectly, incomplete and illegibly complete requests
should be rejected.
Rejection Factor
• Clinical sample collected into leaking, dirty, broken and
cracked tube/container should be rejected.
• Inadequate quantity of sample should be rejected.
• Insufficient sample volume to quantity of preservative should
be rejected.
• Sample without test request form should be rejected.
Rejection Factor
• Non-fasting samples, for test that require fasting should be
rejected.
• Unlabeled or mislabeled samples should be rejected.
• Sample label and Patient label on the test request form that
do not match should be rejected
• Contaminated forms and other biohazards items should be
rejected.
Rejection Factor
• Hemolyzed and Clotted samples should be rejected.
(depending on test requested).
• Rejected samples should be retained pending a final decision
regarding disposition.
• Record the reason for rejection in the log book provided and
also in the incidence book; including all pertinent
information.
• Sample subjected to prolonged transportation time, or poor
handling during transportation should be rejected.
Sampling Handbook (Log Book)
• Handbooks should be developed and made available
throughout the network.
• The laboratory should keep a register of all samples received.
• Log books should be provided to provide a way to keep track
of all samples receive at the laboratory at any given time.
• Date and time of receipt of sample must be entered in the
Log book.
Sampling Handbook
• Sample information should be recorded into the Log book.
• Every sample received must be assigned a Laboratory
Identification Number which is entered in the log book and
also on the request form.
• The log book should include the following data:
- Date and Time of collection of sample
Sampling Handbook
- Date and time of receipt in the laboratory.
- Type of sample.
- Patient name and required demographics.
- Laboratory assigned identification numbers.
Staff Training
• The laboratory should periodically provide training sessions
to staff who are responsible for the collection of clinical
samples.
- Health care providers and Laboratory personnel.
• New staff should be trained on sample management,
- to ensure that all samples are properly managed and have
the needed information.
Staff Training
• Training on sample collection should be conducted for the
staff after periodic review of the number of rejected samples
and reasons for rejections.
• Periodic review of written procedures for management of
sample as needed.
Sample Transport
• Sample should be well package when there is inter facility
transportation for further testing; or when sample collected
outside the laboratory must be transported for subsequent
processing and testing.
• To maintain the integrity and viability of the sample, special
transport containers must be used as well as time limitation.
• It is also important to ensure the safety of those handling the
sample before and after transport (Courier and Laboratory
personnel).
Sample Transport
• Inter facility transportation of samples by the various
transport means must conform to a number of Regulations.
• These regulations are designed to deal with transportation
accidents and spills, reduce biohazards, and keep samples
intact for testing.
• Compliance with standards, rules and regulations.
• Sample transport requirements are based on the category of
sample being transported.
Sample Transport
• Infectious samples are classified as Category A (Infectious
samples capable of causing permanent disability or life
threatening or fatal disease to humans and animals).
• Category B (Infectious samples that are not life threatening
or cause fatal disease to humans and animals).
• Category C (sample that have minimal likelihood that
Pathogens are present).
Sample Transport
• All three Categories of samples should have specific
packaging instructions depending on their classification.
• All potentially hazardous samples should have triple
packaging (Primary, Secondary and Tertiary containers).
• There should be specific packaging for samples requiring
shipment on dry ice.
• Couriers who transport samples should be trained in the
proper procedures, both for safety and integrity of the
samples.
Sample Storage
• Written policies should be developed on sample storage.
• Type of sample to be stored and the retention time should
be stated.
• Location (consider ease of access, and this should be stated).
• Condition of storage should be stated ( appropriate
atmospheric condition at all times).
Sample Storage
• Clinical specimen should be kept at Appropriate
temperatures.
• Room temperature (25oc -30oc ); at 37 oc
• Refrigerator: (2oc - 8oc); Frozen (-20oc and - 80oc).
• System for storage organization: one method being to store
sample by day of receipt or accession number.
• Sample should be stored for the appropriate period: (1 day, 1
week, 2 weeks, 6 months, 1 year e.t.c).
Sample Retention
• Written policy should be developed on sample retention.
• Some samples can quickly be discarded, and others may need
to be retained for longer periods.
• Stored samples should be monitored, and should not be kept
for longer than necessary.
• Sample freeze/ thaw cycle must be monitored, as samples may
deteriorate with these conditions.
• The inventory of stored samples should be reviewed at specific
intervals to determine when they should be discarded.
Sample Referral
• Sample for referral should be labeled correctly in an appropriate
container and must be accompanied by a requisition form.
• The requisition form should specify the required test and the
sending laboratory’s contacts information.
• The referred samples should be carefully monitored, keeping
record of all samples, name of person referring the test.
• Record reports and results received for each referred sample,
and must monitor turnaround times; also record any problems
encountered.
Tracking Sample
• The laboratory should establish a system to allow for tracking
a sample throughout the system from the time it is received
until results are reported.
• The tracking can be done manually by careful keeping of
records; confirmation of receipt of samples including date
and time.
• Label samples appropriately and keep it with the test
requisition until laboratory identification is assigned.
• Track aliquots traceable to the original sample.
Sample Disposal
• The laboratory is responsible for ensuring that disposal of all
laboratory samples are handled in a safe manner.
• The laboratory should establish and follow procedures to
decontaminate and disinfect samples prior to disposal.
• A policy for disposal of samples which will take care of local
and country regulations for disposal of medical waste should
be developed.
THANK U
