Safe Handling of Laboratory SpecimensRuth BarrattInfection Control NurseWaikato Hospital

IntroductionClinical specimens: Consist of blood, body fluids or tissue Form the basis of laboratory diagnosis May harbour bacteria, viruses, fungi or parasites Are a biological hazardPresent exposure to blood borne pathogens(National Occupational Health & Safety Commission 2005)

OverviewStandard precautionsCollection of specimensLabellingTransportation Blood and body fluid spills Waste managementLaboratory Occupational Health and SafetyReferences

Standard PrecautionsFundamental to safe handling of specimensNew concept in 1995 - combined universal and body substance isolation precautionsApples to all patients irrespective of known or presumed disease statusApplies to blood, body fluid and body tissue(Garner 1996)

Standard Precautions (cont.)Hand washing or hand hygieneAntibacterial soap for invasive proceduresWaterless alcohol gels or rubsPersonal Protective EquipmentDisposable glovesDisposable aprons / impervious gownsFacial protection masks, eye gogglesSafe handling of sharps(The National Committee for Clinical Laboratory Standards 2004)

Collection of SpecimensKey to accurate laboratory diagnosisAims of specimen collection: To obtain an appropriate and useful specimen To prevent contamination of the specimen To prevent cross-infection during collection Use care and tact to avoid patient harm(Lee and Bishop 2003)

Collection (cont.)Obtain an appropriate and useful specimenUse a site of active disease or infectionUse proper technique and suppliesCollect adequate volumesConsider the timing of collection(Isenberg 2004)

Collection (cont.)Prevent contamination of the specimenAvoid contamination from indigenous flora normal flora interferes with interpretation of resultsovergrowth of normal flora hides true pathogenUse recommended site preparation and technique (Miller 2004)

Collection (cont.)Prevent cross infection during collectionStandard precautionsSafe sharps practicehandle sharps with care use needle safe technologyimmediate and safe sharps disposal by operatordo not recap needlesdo not transport needles with the specimenClean exterior of contaminated containers(Beltrami 2000)

LabelingCorrect labeling responsibility of collectorInclude:Patient IDSourceDate and time takenName of collectorRelevant clinical detailsNo special labeling for HBV or HIV(NCCLS 2004)

TransportationAims of transportation:The laboratory receives the specimen in a satisfactory time period and in the correct containerThe specimen is transported safely to prevent cross infection(Australian Health Minister's Advisory Council 2004)

Transportation (cont.)Specimen transported promptlyWithin 2 hoursStrict storage conditions for delayed laboratory processingSterile containersFaecal specimens an exceptionUse of transport mediaProvide written guidelines

Transportation (cont.)Secondary containersZip lock bagRigid containersPneumatic transport systemsCan become contaminatedRegulations for transport outside of facilityNational and international

Blood and Body Fluid SpillsClean up spills immediatelyUse appropriate disinfectantDo not send leaking specimensFollow-up process for incidentsWhen necessary handle any leaked specimens in a biological safety cabinet

Waste ManagementClinical wastesharps, human tissue and laboratory waste Disposal complies with local council and national standardsNZS 4304:2002 Management of Healthcare WasteAS/NZS 4261:1996 Non-reusable containers for the collection of sharps (New Zealand Standards 2002)

LaboratoryPolicies and procedures for safe work practices Standard precautionsAdditional transmission based precautions for some specimensTuberculosis SARS CoV Highly Pathogenic Avian Influenza(World Health Organisation 2004)

Occupational Health and Safety Provide protection from infectionPersonal protective equipmentImmunisationEducation and trainingSafe work practicesHealth screeningIncident reporting and follow-up(NZ Occupational Safety and Health Service 1997)

ConclusionClinical laboratory specimens are a significant part of patient care They must be handled and transported safely to prevent exposure of infection to healthcare workers Exposure can be minimised:standard precautions correct collection and transportation processes safe work practices provision of occupational health services.

ReferencesNational Occupational Health & Safety Commission (2005), Hazards and Solutions - Biological Hazards, viewed 30th May 2005, Garner JS (1996), Guideline for isolation precautions in hospitals. Part I. Evolution of isolation practices, Hospital Infection Control Practices Advisory Committee, American Journal of Infection Control; 24(1):24-31. The National Committee for Clinical Laboratory Standards (2004), Clinical Laboratory Safety; Approved Guidelines, 2nd ed., NCCLS, Pennsylvania.Lee, G. & Bishop, P. (2002), Microbiology and infection control for health professionals, Pearson Education Australia, Sydney.Isenberg H (2004), Specimen Collection, Transport and Acceptability, in Isenberg HD (ed.) Clinical Microbiology Procedures Handbook, ASM, Washington DC

References (cont.)Miller J et al. (2004) General principles of specimen Collection and Handling, in Murray P (Ed), Manual of Clinical Microbiology (8th ed), ASM, Washington DCBeltrami EM, Williams IT, Shapiro CN, Chamberland ME.(2000), Risk and management of blood-borne infections in health care workers, Clinical Microbiology Reviews,13(3):385-407.Australian Health Minister's Advisory Council, (2004), Infection control in the health care setting: guidelines for the prevention of transmission of infectious diseases, www.icg.health.gov.au NZS 4304:2002 Management of Healthcare WasteWorld Health Organisation (2004), Laboratory Biosafety Manual - Third Edition, www.who.int/csr/resources/publications/biosafety/