crr icon -specimen management

CRRICON

Module

Synopsis

• Guidelines on Specimen Collection , Storage ,

Transport & Request for Microbiology

Testing ( Microscopy / Culture / Serology /

PCR)

• Standard work Precautions

• Biomedical Waste Management

Important questions before collecting a specimen

• Are you suspecting an Infection ?

• Which tests are your priority ?

• When to collect the specimen ?

• How to collect the specimen ?

• Am I choosing the correct container ?

• Why to send the specimens promptly, if not what I should do ? ( storage / transport)

General guidelines• Specimen should represent the disease process• Sufficient material collected • Before antimicrobial therapy• Aseptic precautions while collecting all specimens ( especially blood &

body fluids)• Avoid contamination from neighboring sites• Patients to be given proper instructions for collection ( urine , sputum etc.,)• Sterile, easy to open, leak proof, dry containers and free of disinfectants.• Avoid delay in transport to laboratory ( in that case proper cold storage )• Use of Transport media , wherever applicable• Request forms & labels….

Specimen collection & transportation are critical considerations, because any results the laboratory generates is limited by the quality of the specimen & its condition on arrival in the laboratory.

Problems in delay or inappropriate storage.

• Delay may lead to:pathogens die.contaminants overgrow.

• Blood cultures directly into incubator not refrigerator!• CSF & other body fluids straight to lab.• Urine , Blood ( for serology) - cold storage• Don't put an entire surgical specimen into formalin!

But: Send a portion to microbiology in a sterile container.

An Ideal Request Form

• Name: Age: Sex: • IP/OP No: Time: Date: • Ward: (Urgent/Routine )• Relevant clinical history:• Diagnosis :• Type of Specimen:• Investigation required:

Doctor/Staff Signature Contact No.

* Whether on antibiotic ? - if yes means Name & Duration

Label High risk Specimens

•Sputum with suspected Tuberculosis

•Feacal samples suspected with Cholera

•Serum when suspected with HIV/ HBV/HCV infections

Requirements

Blood culture

Body fluids

Urine - Voided

Urine – catheterized

Never collect from distal end of the indwelling catheter / uro bag

Culture of Foley’s catheter tip is not suitable/ reliable

Exudates / Tissues

Sputum

Throat swab

Nasal swab

IV Catheter – Central / Peripheral

Always Remember….

• The complete address of the patient along with their contact No. should be filled in the request form for the following diseases:

Dengue Chikungunya Japanese Encephalitis Typhoid Malaria Cholera Leptospira Hepatitis A Hepatitis E Influenza A H1N1

Standard Work Precautions

Set of precautions to protect Health Care

Workers (HCW) from occupational exposure to

blood borne pathogens

• Hand Hygiene

• Personal Protective wears

• Vaccination

• Safe Handling of Sharp items / waste

Effective Hand Washing

Personal Protective Equipments (PPE)

Gloves: Protect hands

Gowns/aprons: Protect skinand/or clothing

Masks and respirators: Protectmouth/nose

Respirators: Protect respiratory tractfrom airborne infectious agents

Goggles: Protect eyes

Face shields: Protect face, mouth,nose and eyes

Vaccinated: If you have received the vaccine (all 3 shots) & have developed Immunity ( antibody titre 100 IU/ML in India, 10 IU/ML in USA,virtually no risk for infection. Get Your Antibody titer estimated today

Unvaccinated: Risk from single needlestick or cut 6-30%,Depends on Viral Load Get your vaccine today if unvaccinated

Hepatitis B

Limited studies available but risk seems to be about 1.8%.

HIV

Average risk for HIV infection to develop after needlestick or cut exposure to HIV blood is 0.3%

Risk after exposure to HIV blood through splashes to eyes, mouth or nose is 0.1%

Hepatitis C

Hepatitis B Vaccination

Relative Risk of Seroconversionwith Percutaneous Injury

Source: CDC. MMWR 2001;50(RR11): 1-42

Biomedical Waste

• Bio-medical waste means any waste which is

generated during the diagnosis, treatment (or)

immunization of human beings (or) animals or

in research activities pertaining thereto or in

the production (or) testing of biological.

WasteCategory

NoWasteCategoryType Treatmentand

DisposalOptions

1 Human Anatomical Waste Incineration / deep burial

2 Animal Waste Incineration/deep burial

3 Microbiology andBiotechnological Waste

Autoclaving / microwaving /incineration

4 Waste Sharps Incineration / destructionandDisposal in secured landfills

5 Discarded Medicines &Cytotoxic drugs

Incineration / destruction andDisposal in secured landfills

Categories of waste

Courtesy: Tamilnadu Health System Project

WasteCategory

NoWasteCategoryType Treatmentand

DisposalOptions

6 Soiled wastes Incineration / deepburial

7 Solid wastesDisinfection/auto/Microwaving andmutilation/shredding

8 Liquid wastes Disinfection and dischargeInto drains

9 Incineration ash Disposal municipal landfill

10 Chemical waste Disinfection and dischargeInto drains

Categories of waste

Courtesy: Tamilnadu Health System Project

Colour coding for

bags/bins

Waste category TypeContainer

Type TreatmentatHospital

FinalDisposal

Blue15L25L50L

Waste sharpsBroken glass,Ampoules, vials & sutures

Plastic bag

1%sodiumhypochlorite

solution

autoclaving/microwaving

andmutilation/shredding

Broken needles,needles,blades,scalpels,lancet,etc

Puncture proofContainer (twin Bin system)

Red(big)50L

Solid wasteDisposable wast eitems liketubing’s,catheters,intraVenous sets, plastic salinebottles, pouche setc.,

Plastic bag1%sodiumhypochlorite

solution

autoclaving/microwaving

andmutilation/shredding

Red(small)15L25L

Microbiology andBiotechnology waste6.Soiled wasteBlood and body fluidContaminated items

Plastic bag NILIncineration/

Deep burial

Colour Coding

Colourcodingfor

bags/bins

WastecategoryType

ContainerType Treatmentat

HospitalFinal

Disposal

Yellow15L25L50L

Human wasteAnimal waste

Plastic bag NILIncineration/

Deep burial

Black15L25L

Expiry drugs,Cytotoxic drugsIncineration ashChemical waste

Plastic bag NILDisposal insecuredlandfill

Green15L25L50L

Municipal Waste Plastic bag NIL

AsundertakenBy municipalagencies

Colour Coding