Introduction

This guidance is intended for all staff who send or transport specimens to the laboratory.
T­­his does not apply to the transportation of blood products.

Preparing Samples for Transport

All specimen primary containers must be placed in the plastic pouch attached to the request form and the integral sealing strip properly closed to contain any spillage and prevent contamination. This:

• Limits all unnecessary hand contact with specimen containers.
• Makes it easy to identify a leaking container among a batch.
• Prevents a leaking container from contaminating other containers, request forms, the hands of the person sorting a batch, and the immediate environment.

The request form must not be placed in the bag with the specimen and must not be stapled or pinned to the bag. Specimen transport bags are single use only. For large Histopathology samples and 24 hour urine etc., the request form can be attached to the outside of the container.
Samples sent from patients known or clinically suspected of carrying or having active infection caused by Category 3 micro-organisms must have both specimen and request form clearly identified using the “DANGER OF INFECTION” Biohazard label. These samples should be segregated from routine specimens.

Storage Prior to Arrival in the Laboratory

Temperature requirements for all samples are available under Laboratory Tests on the Laboratory Handbook.
Microbiology samples, in particular, deteriorate with time. Proper storage and timely transport can minimise deterioration and it is essential that samples are sent to the laboratory as quickly as possible. The use of swabs containing transport media helps to maintain the viability of organisms whilst preventing overgrowth.
Where transport or processing is delayed, the majority of Microbiology, Biochemistry, Haematology, and Cellpath samples should be stored at 2-8 degrees Celsius. However, CSF’s, Blood Cultures, Throat swabs for Neisseria meningitidis and cultures for Neisseria gonorrhoea, should be stored at room temperature (15-25oC) prior to collection and during transport.

Transport within the Hospital

Within the hospital, routine specimens are collected from wards by Portering staff where the pneumatic air tube system is not available.  Samples are delivered by porters to the laboratory in leak-proof specimen transport bags labelled with the universal Biohazard symbol.
Pneumatic air tube terminals are located at various points across the CAH site.
The following must NOT be sent by air tube:

• CSF samples
• Blood Gas samples
• Danger of Infection samples
• Items over 1.5 Kg
• Flammable substances
• Any sharps
• Any Histology samples in formalin or Cytology samples

Samples to be transported “on ice”
For samples requiring transport “on ice” where a ready supply of ice is not available the following procedure is used:
Contact the Laboratory Reception and request a “cool transport container”. The container will be available for collection from sample reception within 5 minutes and must be collected promptly to reduce thawing. The container should only be requested when the sample is ready to be taken. Place the sample into one of the two sample positions in the container and replace container lid. Send the full transport container to laboratory immediately along with fully completed request form in a leak-proof specimen transport bag.
If for any reason the cool container is not used it must be returned to the laboratory as soon as possible for re-use.

Transport of CSF samples

All CSF samples including those for RVH must be sent via the laboratory.
Sample transport to Belfast or to CAH from DHH will be organised by Lab staff for these samples.
In DHH the CSF sample must be recorded on the CSF receipt record and countersigned by lab staff as evidence of receipt.
To facilitate processing please keep the samples separated by location eg RVH forms in one bag, Micro and Biochemistry in another.

CSF Protein and Glucose analysis is available 24/7 and samples will be transported from DHH to CAH asap either by routine transport or taxi if transport not due.

Xanthochromia ( Spectroscopy) requests will be performed in CAH on the following morning unless approved by the Biochemistry Consultant for urgent processing.
Samples arriving out of hours in DHH will be transported to CAH on the next available transport.

Transport from outlying hospitals, GP surgeries, clinics and health centres

A transport service van is used to collect specimens from outlying hospitals, GP surgeries, clinics and health centres. Specimens must be packed in such a way that they will not break, be punctured or leak in normal circumstances.
Samples are transported in Specimen Transport Boxes which comply with UN3373 requirements:

• Constructed of a smooth impervious material with tightly fitting, fastenable lids, which will not leak.
• Transport boxes are easily cleaned and disinfected: containers are cleaned and disinfected weekly and if contaminated.
• Boxes must not be overfilled or used for any other purpose than carrying specimens.
• Box lids must be secured and the box transported upright.
• Boxes are labelled as containing ‘Biological Material (Category B)’ and display the laboratory’s address and telephone number to be contacted in the event of being found unattended.

Specialised sample handling by Microbiology BMS staff

Under exceptional circumstances, where Biohazard Group 4 pathogens e.g. viral haemorrhagic fever, are known or suspected, BMS staff may be required to visit wards in order to transport samples to the laboratory.
Prepared specimens are placed within a red-topped Bio Bottle, which is then placed inside a Specimen Transport Box.
Contact the Microbiology Laboratory for advice or to arrange transport.

Leaks and Spills

The risk of breakage or leakage of chemical or other material is extremely small if the samples are packaged correctly and placed in secure transport boxes. Samples should not be forwarded where a leakage is known to have taken place. It is the responsibility of the clinical staff dealing with the patient to deal with any leakage of this kind. For details refer to the Trust’s Decontamination Procedure in the Infection Control Manual.
Any leaks occurring during transportation should be contained within the secondary container, in which case proceed to the laboratory and inform staff when handing over the specimens.
Health and Safety guidelines state that leaking samples should be discarded. In this event the requesting source will always be contacted as soon as possible. If the specimen cannot be repeated, or is of particular importance, an attempt will be made to find a safe means to salvage and process the sample.
Any incident during transportation that may affect the quality of the specimen or the safety of personnel must be brought to the attention of the Lead BMS, who will investigate and issue instructions on further processing of samples.

Spills within the hospital:
In the event of a spillage of any kind Portering staff should not attempt to clean it up. Spills may release formaldehyde which can be identified by its pungent odour, in this case ventilation is particularly important.

• Ventilate the area
• Put a wet floor sign at the spillage
• Contact the laboratory staff
• Inform Ward/Department of incident
• Report it to their line manager/Supervisor or Site/Bed Manager
• Supervisor/Manager to complete Datix

Pneumatic Tube System:
Where leakage has spread beyond the bag then the entire contents of the pod will be discarded as clinical waste, assuming that it contains no specimens that cannot be repeated.
Where leakage has occurred beyond the pod then Estate Services must be contacted and suitable decontamination of the tube system initiated. For details, refer to Trust’s decontamination procedure in the Infection Control Manual

Spills in Transport van:
Spills may release formaldehyde which can be identified by its pungent odour,:

• Ventilate the area
• Contact Laboratory for advice

If there is no reason to suspect formaldehyde you should use the spill kit as directed, and proceed to the laboratory and inform staff when handing over the specimens.