Safe Handling of Laboratory

Specimens
Ruth Barratt
Infection Control Nurse
Waikato Hospital

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

Overview

Standard precautions
Collection of specimens
Labelling
Transportation
Blood and body fluid spills
Waste management
Laboratory
Occupational Health and Safety
References

Standard Precautions
Fundamental to safe handling of specimens
New concept in 1995 - combined universal
and body substance isolation precautions
Apples to all patients irrespective of known
or presumed disease status
Applies to blood, body fluid and body tissue
(Garner 1996)

Standard Precautions (cont.)

Hand washing or hand hygiene
Antibacterial soap for invasive procedures
Waterless alcohol gels or rubs

Personal Protective Equipment

Disposable gloves
Disposable aprons / impervious
gowns
Facial protection masks, eye goggles

Safe handling of sharps

(The National Committee for Clinical Laboratory Standards 2004)

Collection of Specimens

Key to accurate laboratory diagnosis

Aims of specimen collection:
1. To obtain an appropriate and useful
specimen
2. To prevent contamination of the specimen
3. 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

specimen
Use a site of active disease or
infection
Use proper technique and supplies
Collect adequate volumes
Consider the timing of collection

(Isenberg 2004)

Collection (cont.)

Prevent contamination of the specimen

Avoid contamination from indigenous flora

normal flora interferes with

interpretation of results

overgrowth of normal flora

true pathogen

Use recommended site

and technique

hides

preparation
(Miller 2004)

Collection (cont.)

Prevent cross infection during collection

Standard precautions
Safe sharps practice

handle sharps with care

use needle safe technology
immediate and safe sharps
disposal by operator
do not recap needles
do not transport needles with the specimen

Clean exterior of contaminated containers

(Beltrami 2000)

Labeling
Correct labeling responsibility of collector
Include:

Patient ID
Source
Date and time taken
Name of collector
Relevant clinical details

No special labeling for HBV or HIV

(NCCLS 2004)

Transportation
Aims of transportation:
The laboratory receives the specimen
in a satisfactory time period and in
the correct container
The specimen is transported safely
to prevent cross infection

(Australian Health Minister's Advisory Council 2004)

Transportation (cont.)
Specimen transported promptly
Within 2 hours

Strict storage conditions

for delayed laboratory processing

Sterile containers
Faecal specimens an exception

Use of transport media

Provide written guidelines

Transportation (cont.)
Secondary containers
Zip lock bag
Rigid containers

Pneumatic transport systems

Can become contaminated

Regulations for transport outside of facility

National and international

Blood and Body Fluid Spills

Clean up spills immediately
Use appropriate disinfectant
Do not send leaking specimens
Follow-up process for incidents
When necessary handle any
leaked specimens in a
biological safety cabinet

Waste Management
Clinical waste
sharps, human tissue and laboratory waste

Disposal complies with local council and

national standards
NZS 4304:2002 Management of Healthcare
Waste
AS/NZS 4261:1996 Non-reusable containers
for the collection of sharps
(New Zealand Standards 2002)

Laboratory
Policies and procedures for safe work
practices
Standard precautions
Additional transmission based
precautions for some specimens
Tuberculosis
SARS CoV
Highly Pathogenic Avian Influenza

(World Health Organisation 2004)

Occupational Health and Safety

Provide protection from infection

Personal protective equipment
Immunisation
Education and training
Safe work practices
Health screening
Incident reporting and follow-up

(NZ Occupational Safety and Health Service 1997)

Conclusion
Clinical 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.

References
1.

National Occupational Health & Safety Commission (2005),

Hazards and Solutions - Biological Hazards, viewed 30th May 2005,
<http://www.nohsc.gov.au/smallbusiness/businessentrypoint/hazards/>

2.

3.
4.
5.

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.)
6.

7.

8.

9.
10.

Miller J et al. (2004) General principles of specimen Collection and

Handling, in Murray P (Ed), Manual of Clinical Microbiology (8th
ed), ASM, Washington DC
Beltrami 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 Waste
World Health Organisation (2004), Laboratory Biosafety Manual Third Edition, www.who.int/csr/resources/publications/biosafety/