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Appendix B

Routines for collection and handling of specimens and reporting of specific patient information vary depending on agency protocols, the clinical setting, and specialty laboratory requirements. Chart B.1 defines various substances and diagnostic specimens that can be encountered in a clinical setting for possible transport. The primary objective in the transport of diagnostic specimens is to maintain the sample as near to its original state as possible with minimum deterioration and to minimize hazards to specimen handlers. Specimens should be collected and transported as quickly as possible to the laboratory for analysis. For urine transport, a small amount of boric acid may be used; a holding or transport medium can be used for most other specimen types. Carefully follow the instructions for handling and transport of specimens provided on the kit by the manufacturer or by the laboratory that has provided these collection kits. Infectious substances must be handled with the utmost care. Chart B.2 lists the current classifications of substances and diagnostic specimens. Chart B.3 lists examples of category A infectious substances.

  1. When the patient delivers the specimen directly, provide a biohazard bag and include clearly written directions about the specific handling precautions, storage conditions, and specific directions for locating the physical facility.

  2. Specimens may be mailed or transported to specialty laboratories located in other cities or distant areas. To avoid delays in specimen analysis, it is important to follow specific instructions for collection, packaging, labeling, and transporting of specimens. Some specimens must be received in the laboratory within an exact time frame, under specified storage conditions. Regulatory agencies (e.g., the Department of Transportation [DOT] or the International Air Transport Association [IATA]) require training to ensure that samples are properly packaged. The DOT requires training every 3 years, whereas IATA requires training every 2 years.

    1. When packaging a specimen for shipping to a specialty laboratory, place the specimen in a securely closed, watertight container (e.g., a test tube, vial, or other primary container), and then enclose the entire primary container in a second durable, watertight container (secondary container). Each set of primary and secondary containers should then be enclosed in a sturdy, strong outer shipping container.

    2. Follow appropriate labeling for etiologic agents and biomedical materials (Figures B.1 and B.2). If the package becomes damaged or leaks, the carrier is required, by federal regulations, to isolate the package and notify the Biohazards Control Office, Centers for Disease Control and Prevention, in Atlanta, Georgia. The carrier must also notify the sender that (improper) packaging not meeting regulatory requirements can cause a significant delay in specimen analysis, reporting of results, and medical diagnosis and treatment of the patient’s problem. Examples of specialty laboratory requirements for transporting, packaging, and mailing of specific specimens are shown in Table B.1.

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Clinical Alert

  • No person may knowingly transport or cause to be transported in interstate traffic, directly or indirectly, any material, including, but not limited to, diagnostic specimens and biological products which such persons reasonably believe may contain an etiologic agent unless such material is packaged to withstand leakage of contents, shocks, pressure changes, and other conditions incident to ordinary handling in transportation.

The Code of Federal Regulations governing the shipment of etiologic agents (42 C.F.R. 72.2 Transportation of Diagnostic Specimens, Biological Products, and Other Materials; Minimum Packaging Requirements) reads as follows: