Infection Control
Specimen Collection, Handling and Transport Guidance
To be read in association with:
Communicable Diseases Policy
Environmental Policy & Objectives
COSHH Policy
Infection Control Guidance and Procedures
Review date: Dec 2011
Contents
1. Purpose page 3
2. Scope page 3
3. Background page 3
4. Specimen collection, handling & transporting page 4
4.1 Specimen transport page 4
4.2 Collection of specimens page 4
4.3 Labelling page 5
4.4 High risk ‘Biohazard’ specimens page 5
4.5 Storage of specimens page 6
4.6 Leaking specimens page 6
4.7 Designated collection points page 6
5. Staff Training page 6
6. References page 7
1, Purpose
The purpose of this guidance is to set out the standard for the collection, handling and transport of clinical specimens by staff of Nugent Care. Nugent Care is committed to the welfare, health and safety of their staff, patients and visitors. As such they will ensure, so far as is reasonably practicable, that all employees, patients and visitors to their respective sites are protected from potential biological hazards or emotional stress, that may arise from the collection, dispatch, transportation and receipt of any biological materials.
This guidance excludes specimen handling procedures used by external laboratory staff these are subject to separate protocol. It remains the prime responsibility of the sender to package specimens according to the relevant legislation in force.
2, Scope
Specimens are transported under the assumption that all are potentially infectious. This guidance will apply to all staff working within Nugent Care who are involved with the collection, handling and transport of clinical specimens.
3, Background
A specimen is a body substance, such as blood, sputum, pus, urine or faeces, taken from a person for the purpose of analysis. The aim of such analysis is to identify micro-organisms that cause disease and to provide direction for appropriate treatment.
Specimens, if not handled and transported safely, can pose a risk of infection to all people involved, including care workers, patients and their volunteer carers, receptionists, office workers and transport personnel.
Any accidental spillage must be cleaned up by staff using personal protective equipment (PPE) provided to prevent potential contamination.
All staff managing clinical specimens should be offered the appropriate Occupational Health advice and seek inoculation from their GP’s, where required.
Accurate analysis is crucial in determining the correct diagnosis, or detecting an infectious agent, so that appropriate and timely treatment can be commenced. To support this, factors such as the correct collection technique, storage conditions, and interval before reaching the laboratory, the collation of supporting information and the supplying of correct service user details should be observed.
In the community, specimens are collected in a wide variety of settings including the patient’s home, but also samples are taken in Nugent Care residential settings and this policy should be applied to both service types.
4, Specimen collection, handling and transportation.
4.1 Specimen transport containers
Specimen transport containers should always be used and these must be sufficiently robust to withstand reasonable stresses likely to be put upon them during transportation to the point of collection. The containers should be insulated to avoid extremes of heat or cold and also be a secure rigid, robust and leak proof container with a handle and a tight fitting lid These boxes must not be used for any other purpose than carrying Pathology specimens, and must be labeled accordingly.
All staff must be aware of what to do in the event of spillage and refer to the appropriate procedure and policy(s). Containers for transporting specimens should be cleaned daily to reduce the risk of transmission of micro organisms and this should be done by using hot water and detergent (or detergent wipe if available), and then rinsed and dried. Should the container become contaminated with blood or body fluid it must be decontaminated. Refer to the procedure / risk assessment or safe system of work to undertake this task in safety.
Specimens to be transported to the GP Practice or hospital site from a home must be bagged or contained in a way which is appropriate for the type of specimen, following the guidance / instruction supplied with this appropriate packaging type and then placed in a designated specimen transport container.
4.2 Collection of specimens
· Always follow infection control precautions when handling specimens e.g. ensure appropriate protective clothing (PPE) is used and waste, including sharps waste is disposed of safely and correctly.
· Write details on container immediately after taking the specimen, DO NOT take away and label prior to filling. Details should include patient’s name, and date of birth, type of specimen. The specimen should then be placed directly into the clear bag and then into the specimen transport container.
· Ensure positive identification is displayed on the container / swab.
· Ensure correct specimen container / swab is used.
· Whenever possible always take specimen prior to commencing antibiotics.
· Where appropriate, obtain all specimens with sterile equipment and place in sterile containers, ensuring that the outside of these containers are always free from contamination with bodily fluids (stool and sputum specimens are not sterile specimens).
· Collect fresh specimen material which is as free from extraneous contamination as possible, take material only from the site of infection.
· Prior to taking swabs from a dry area; i.e. nasal screening, the tip should be moistened in sterile normal saline.
· Do not overfill containers especially faecal containers. These can ‘explode’ on opening.
· Any container containing a specimen that will be sent to a GP for analysis must be robust and not leak during normal use and be suitable for its purpose. Any failings of the integrity of these containers must be monitored and an incident form should be completed, where failure occurs.
· Secure the lids of containers immediately after their use, in order to avoid spillage and contamination during transportation.
· Store specimens in a cool place - some samples may require refrigeration (see 4.5 ‘Storage of Specimens’ below).
· Do not allow the outside of the container to become contaminated. .
· Enter individual details on both the container and the request form.
· Place the container into the accompanying specimen plastic bag, with one compartment containing the request form and the other containing the specimen.
· Wash hands after specimen handling and glove removal.
4.3 Labelling
· Every specimen container and request form must describe the nature of the specimen and its source, full resident or service user information allows the receiving laboratory staff to identify the source quickly in the event of the specimen and form becoming separated.
· All specimens must be placed in a specimen bag with the request form in the separate pocket of the bag.
· An additional 'Danger of Infection' label must be attached to specimens and request forms for known or suspected “high risk” pathogens. If staff do not have access to such labels then the form and specimen must be clearly identified as ‘high risk’ (staff may wish to write in red or use a highlighter pen).
4.4 High risk “Biohazard” specimens
Specimens containing or suspected of containing high risk micro-organisms require handling and processing differently in the receiving laboratory in order to protect laboratory staff and to reduce the risk of cross infection. All such specimens and the request forms must have an appropriate biohazard sticker attached. Various stickers are available but they must be yellow in colour and state “biohazard”.
High-risk micro-organisms include:
Human Immuno-Deficiency Virus (HIV) Viral haemorrhagic fevers
Hepatitis B Virus (HBV) Rabies
Hepatitis C Virus (HCV) Anthrax etc
Tuberculosis (TB) Prions
Hepititis E E-Coli 0157
Salmonella Typhimurium etc.
· NB: Swabs for MRSA carriage are not high risk.
4.5 Storage of specimens
Any fridge that is used for the storage of specimens MUST NOT be used for the storage of any food items or drugs, including vaccines.
· The fridge should have a minimum / maximum thermometer and be regularly cleaned and serviced as directed in the cleaning schedule, inline with recognised frequency standards
· Sputum should be sent to the laboratory as soon as possible on the daily specimen pick up. Respiratory pathogens will not survive for prolonged periods.
· Do not leave specimens, including Sputum, over the weekend or bank holidays.
4.6 Leaking specimens
Where specimen containers are leaking into sealed transport bags, the bag and its contents should be discarded as clinical waste and collection of a new specimen should take place. If the specimen is unrepeatable, it should be carefully transported to the laboratory - the laboratory will have its own policies and procedures for dealing with the occurrence of these circumstances.
4.7 Designated collection point
All specimens are to be taken to the designated secure collection area identified within the workplace until they are ready for collection or transport.
5, Staff Training
All staff must receive training in infection control as part of their induction program and as per Nugent Care’s training matrix. Infection Control information will also be delivered in house, as regular updates during meetings and talks etc.
Infection Control should be discussed at staff appraisals and objectives set within
Personal Development plans. All staff with responsibility for Specimen collection, handling and transport must be adequately trained and made aware of the importance of following this Nugent Care policy, this is essential for both to meet the standards required and to achieve staff safety. Regular on-the-job training is provided to ensure all staff are aware of current practices and procedures.
Training should include:
· Induction
· Update training annually
· Infection Control
· Correct Cleaning Methods
· Standards required
· COSHH regulations
· Personal Protective Equipment
· Decontamination techniques
6, References and further information
Carriage of Dangerous Goods (Classification, Packaging and Labelling)
Regulations
Use of Transportable Pressure Equipment Regulations
Legislation
Health and Safety at Work etc Act 1974
Control of Substances Hazardous to Health Regulations
The Management of Health and Safety at Work Regulations
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
The Carriage of Dangerous Substances by Road and Rail (Classification
Packaging and Labelling) Regulations
The Genetically Modified Organisms (contained use) Regulations
The Health and Safety (Dangerous Pathogens) Regulations
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