Quality assurance during the pre-

analytical activity (specimen collection,

transport &storage )

Suhair.A.A./ Quality Assurance / 3rd

year 1
Specimen collection
◼ In order to carry out laboratory analyses,
it is necessary that the laboratory be
provided with both the correct specimen
for the requested test, and also
information that will ensure that the right
test is carried out and the result returned
to the requesting clinician with the
minimum of delay.

Suhair.A.A./ Quality Assurance / 3rd

year 2
◼ As much detail as possible should be
included on the request form to help both
laboratory staff and the clinician in the
interpretation of results.
◼ This information can be very valuable
when assessing a patient’s progress over
a period, or reassessing a diagnosis.
◼ Patient identification must be correct, and
the request form should include some
indication of the suspected pathology.
Suhair.A.A./ Quality Assurance / 3rd
year 3
◼ The requested analyses should be clearly
indicated.
◼ Request forms differ in design.
◼ A variety of specimens are used in
Clinical Laboratory analysis .

Suhair.A.A./ Quality Assurance / 3rd

year 4
Types of Specimens

Suhair.A.A./ Quality Assurance / 3rd year 5

 The result of any laboratory
examination is only as good as the
sample received in the laboratory

Suhair.A.A./ Quality Assurance / 3rd year 6

Sample vs. specimen

◼ sample is defined as “one or more

parts taken from a system and
intended to provide information on the
system”.
◼ The term “specimen” is very commonly
used in the laboratory to indicate a
sample taken from the human body,
the terms “sample” and “specimen”
should be considered interchangeable.

Suhair.A.A./ Quality Assurance / 3rd year 7

 Essential to
accurate
laboratory
diagnosis

Influences Good
Good Influences
laboratory sample
sample therapeutic
efficiency management decisions
management

Directly
affects
patient care
and outcome

Suhair.A.A./ Quality Assurance / 3rd year 8

 The Laboratory’s Responsibilities
Provide sample
collection information Provide appropriate
containers and supplies
What- When- How

Define a good
Assess all samples - labeling system
preexamination

Suhair.A.A./ Quality Assurance / 3rd year 9

Test Requisition
◼ patient ID
◼ tests requested
◼ time and date
of sample collection
◼ source of sample,
when appropriate
◼ clinical data,
where indicated
◼ contact information of
requesting physician
or authorized individual

Suhair.A.A./ Quality Assurance / 3rd year 10

Suhair.A.A./ Quality Assurance / 3rd year 11
Collection Requirements
◼ patient preparation
◼ patient identification
◼ type of sample required
◼ type of container needed
◼ labeling
◼ special handling
◼ safety precautions

Suhair.A.A./ Quality Assurance / 3rd year 12

 Provide
sample
collection
information

Suhair.A.A./ Quality Assurance / 3rd year 13

 Labeling
Each sample should be labeled with:
▪ patient’s name
▪ patient’s unique ID
number
▪ test ordered
▪ time and date of
collection
▪ collector’s initials

Use computer-generated bar codes when possible

Suhair.A.A./ Quality Assurance / 3rd year 14

 Nurse
Sample labelling from
different

error example Nurse not

familiar
ward

Regular
with task
staff off
sick

Wrong Cross- Samples Verbal Laboratory Nursing

blood match instruction Handbook station re-
group sample
not labeled given not easy organized
given mislabeled at bedside to locate

Shift Delay in
change admitting
Two
patients patient dept
major collected admit
transfusion
reaction Samples
taken to Switched
nursing samples
station

Suhair.A.A./ Quality Assurance / 3rd year 15

Outcomes of Improper Collection

◼ delays in reporting test results

◼ unnecessary re-draws/re-tests
◼ decreased customer satisfaction
◼ increased costs
◼ incorrect diagnosis / treatment
◼ injury
◼ death

Suhair.A.A./ Quality Assurance / 3rd year 16

Preexamination Steps
◼ Verify
 completeness of test request
 appropriateness of sample
 information on label

◼ Record in register or log

◼ Enforce sample rejection

criteria

Suhair.A.A./ Quality Assurance / 3rd year 17

Labeled samples, Spilled urine sample,
completed requisitions a cause for rejection

Suhair.A.A./ Quality Assurance / 3rd year 18

 Actions for Rejected Samples
◼ inform authorized person
◼ request another sample
◼ record rejected samples
◼ retain rejected sample
based on preset criteria
◼ extraordinary circumstances
may require testing
suboptimal samples
Suhair.A.A./ Quality Assurance / 3rd year 19
Sample Register or Log
A register should include:
▪date and time of collection
▪date and time of receipt
▪sample type
▪patient name
▪demographics as required
▪laboratory assigned identification
▪tests to be performed

Suhair.A.A./ Quality Assurance / 3rd year 20

Sample Handling
Handle all samples as if infectious

Suhair.A.A./ Quality Assurance / 3rd year 21

Sample Storage-Written Policy
◼ describe samples to be stored
◼ determine retention time
◼ determine location
◼ describe proper conditions
◼ establish method of
organizing samples

Suhair.A.A./ Quality Assurance / 3rd year 22

Sample Retention
◼ set policy for retention
◼ monitor stored samples,
including freeze/thaw
cycles
◼ maintain an organized,
accessible system
◼ establish a schedule to
review all stored samples
◼ establish tracking
procedures
Suhair.A.A./ Quality Assurance / 3rd year 23
Sample Referral
◼ Record:
 samples referred
 date of referral
 name of person referring test

◼ Monitor / Track, and Record:

 turnaround time
 results delivery (from referral
laboratory, to requestor)
 problems with referral

Suhair.A.A./ Quality Assurance / 3rd year 24

 Sample Disposal

▪ set policy for sample disposal

▪ compliance with local and country
regulations
▪ disinfection procedures

Suhair.A.A./ Quality Assurance / 3rd year 25

 Sample Transport
▪ Maintain integrity of sample:
 temperature
 preservation of sample
 special transport containers
 time limitations

◼ Assure safety regulations

are met

Suhair.A.A./ Quality Assurance / 3rd year 26

Transport Regulations
Where do they come from?

Who develops them?

✓ National transport regulations

✓ air transport regulations
✓ rail, road, and sea traffic agencies
✓ postal services
✓ private couriers

Suhair.A.A./ Quality Assurance / 3rd year 27

Transport Regulations
Mandatory Compliance

Violation

Deal with accidents and spills

– reduce biohazards

Safety: couriers, laboratory

staff, passengers, carriers

Suhair.A.A./ Quality Assurance / 3rd year 28

Classification of Infectious Substances

Category A: infectious substances capable of causing

• permanent disability
• life-threatening or fatal disease to
humans or both human and animals

Packaging: most durable triple packaging with full

dangerous goods documentation

Training of transport staff

Suhair.A.A./ Quality Assurance / 3rd year 29

Category A

Suhair.A.A./ Quality Assurance / 3rd year 30

Classification of Infectious Substances

Category B: infectious substances not

included in Category A

less stringent triple packaging

no dangerous goods documentation
required

Suhair.A.A./ Quality Assurance / 3rd year 31

 Exemptions
▪ substances that do not contain infectious substances
▪ substances containing organisms that are non-pathogenic
▪ substances containing neutralized or inactivated pathogens
▪ environmental samples that pose no risk of infection
▪ blood or blood components collected for transfusion
▪ tissues or organs cleared for transplantation
▪ dried blood spots and fecal occult blood screening tests
▪ decontaminated medical or clinical waste

Suhair.A.A./ Quality Assurance / 3rd year 32

Key Messages

◼ the laboratory must have good

samples in order to ensure accuracy
and reliability of testing and
confidence in results
◼ sample management directly affects
patient care and outcome

Suhair.A.A./ Quality Assurance / 3rd year 33

 Comments?

Questions?

Suhair.A.A./ Quality Assurance / 3rd year 34