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               SAMPLE COLLECTION MANUAL OF LABORATORY SERVICES               SAMPLE COLLECTION MANUAL OF LABORATORY SERVICES
                       SIR T HOSPITAL, BHAVNAGAR                        SIR T HOSPITAL, BHAVNAGAR 
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 Specific specimen requirements for each test are provided. Submit the quantity specified for each test requested. Tests will be cancelled as "QNS" (Quantity Not Sufficient) when the sample volume is inadequate and will be indicated as such on the report. As a general rule, the volume of blood drawn should equal 2-1/2 times the amount of serum plasma required. For example, to obtain 4mL serum or plasma, draw at least 10mL blood. When inappropriate or insufficient specimens are submitted, the laboratory will store them and contact the requesting facility to request that the specimen be recollected. Documentation of this action will appear on the report.  Specific specimen requirements for each test are provided. Submit the quantity specified for each test requested. Tests will be cancelled as "QNS" (Quantity Not Sufficient) when the sample volume is inadequate and will be indicated as such on the report. As a general rule, the volume of blood drawn should equal 2-1/2 times the amount of serum plasma required. For example, to obtain 4mL serum or plasma, draw at least 10mL blood. When inappropriate or insufficient specimens are submitted, the laboratory will store them and contact the requesting facility to request that the specimen be recollected. Documentation of this action will appear on the report. 
-**Specimen Storage**: Instructions for storage and transport of specimens for individual tests are listed. All serological samples are stored for 72 hrs and all positive serum samples are stored for 15 days then discarded, all HIV positive serum samples are stored for 3 months as per the NACO guidelines. Maintain the specimen at the temperature indicated for each test until specimens are delivered to the laboratory. Most specimens require refrigeration unless otherwise indicated. Most of the specimens require refrigeration unless otherwise indicated. All other samples are retained for 24 hrs and then kept in hypochlorite for 6 hrs before discarding. +**Specimen Storage**: Instructions for storage and transport of specimens for individual tests are listed. All serological samples are stored for 72 hrs and all positive serum samples are stored for 15 days then discarded, all HIV positive serum samples are stored for 3 months as per the NACO guidelines. Maintain the specimen at the temperature indicated for each test until specimens are delivered to the laboratory. Most specimens require refrigeration unless otherwise indicated. Most of the specimens require refrigeration unless otherwise indicated. All other samples are retained for 24 hrs and then kept in hypochlorite for 6 hrs before discarding. 
 **Stool Specimen Collection (24, 48 or 72-Hour)**   **Stool Specimen Collection (24, 48 or 72-Hour)**  
 Special gallon-size containers are available upon request for the collection of stool specimens. Refer to specimen requirements for each analyte. Special gallon-size containers are available upon request for the collection of stool specimens. Refer to specimen requirements for each analyte.
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 40%formaldehyde:100ml + Tap water:900ml                                                     40%formaldehyde:100ml + Tap water:900ml                                                    
   - Immediately after removal of organ/biopsy, it should be put in a wide mouthed screw-capped specimen jars of plastic containing 10%formalin fixative.                                                - Immediately after removal of organ/biopsy, it should be put in a wide mouthed screw-capped specimen jars of plastic containing 10%formalin fixative.                                             
-  - Volume of 10%formalin should be 10 times the volume of tissue.                                                   The histopathology requisition form should be complete with following details                           name of the patient, age, sex, requisition no., ward no., name of the incharge Doctor, history or clinical diagnosis, nature of the specimen, date of operation.                                             +  - Volume of 10%formalin should be 10 times the volume of tissue. 
-  - Specimens are sent to the Central Pathology Laboratory-transported by hospital class IV staff or patients only in case of OPD patients, between 9a.m.-5p.m.in a capped bottle  +  - The histopathology requisition form should be complete with following details                           name of the patient, age, sex, requisition no., ward no., name of the incharge Doctor, history or clinical diagnosis, nature of the specimen, date of operation.                                             
-  - of suitable size in formalin.                                                                                                                            +  - Specimens are sent to the Central Pathology Laboratory-transported by hospital class IV staff or patients only in case of OPD patients, between 9a.m.-5p.m.in a capped bottle of suitable size in formalin.                                                                                                                            
-  - On receipt of specimen/biopsy, details are verified by the technical assistant and if  +  - On receipt of specimen/biopsy, details are verified by the technical assistant and if necessary, returned for correction.                                                                                                              
-  - necessary returned for correction.                                                                                                              +
   - If all details are okay, then details are entered in receiving register and a card is given to OPD patients except skin and ENT patients indicating date and time for collection of report form histopathology laboratory.                                                                                                         - If all details are okay, then details are entered in receiving register and a card is given to OPD patients except skin and ENT patients indicating date and time for collection of report form histopathology laboratory.                                                                                                      
-  - Specimens are transported to histopathology laboratory in a closed container along  +  - Specimens are transported to histopathology laboratory in a closed container along with forms by class IV and on-duty driver at 12 noon and 4.30pm.                                                       
-  - with forms by class IV and on-duty driver at 12 noon and 4.30pm.                                                       +  - On arrival to histopathology laboratory, specimens and forms are again cross checked by laboratory assistant or technician.                                                                                                          
-  - On arrival to histopathology laboratory, specimens and forms are again cross checked  +  - If all details are okay, then specimen is opened, verified, the formalin changed and transported in new bottle by technical assistant/technician if **a.** Foamy,**  b.** Reddish,** c.** Top up with formalin if not 10 times the volume of the tissue,   ** d** .If organ is too large for container or, **e.** If container is cracked or not closing properly.               
-  - by laboratory assistant or technician.                                                                                                          +
-  - If all details are okay, then specimen is opened, verified, the formalin changed and  +
-  - transported in new bottle by technical assistant/technician if                                                              a. Foamy,  b. Reddish, c. Top up with formalin if not 10 times the volume of the tissue,    d .If organ is too large for container or, e. If container is cracked or not closing properly.               +
   - Receipt details are entered in the Histopathology receiving register.    - Receipt details are entered in the Histopathology receiving register. 
 +
 +**Storage of Histopathology specimens:** All specimens of histopathology are routinely stored for 3 months and afterwards they are discarded. 
    
-  Fluid  Pap  +              CYTOPATHOLOGY SAMPLE COLLECTION AND TRANSPORTATION  
-Collecti on     +   
-Timing         +^ ^Fluid^^Pap^ 
 +|Collection Timing|Routine|8:00 am to 4:00 pm Transfer within 1 hour|During OPD timing| 
 +| |Saturday|8:00am to 12:00 pm. Transfer within 1 hour| | 
 +| |Sunday& Holidays|Avoid collection.If required to collect, aliquot and keep in ward refrigerator at 2-8 C and transport at 9:00 am on next working day| | 
 +|Amount|Ideal is 10 ml directly from tapping line. Minimum 2 ml. If taken from receptacle, aliquot should be mixed well||1 slide endocervix 1 slide ectocervix | 
 +|Container|Closed cap bottle. BAL fluid in BAL container||Either in wide mouthed closed bottle or wrapped in paper| 
 +|Transport|To be sent to laboratory within 1 hour of collection Ward Ayah or servant will bring to laboratory along with requisition||Patient will bring bottle with slides or dried slides (wrapped) to cytology laboratory|  
 +|Receiving|*R1 will receive it. Check the demographics and sign the register.||*R1 will receive the slides, check requisition form and give pap number on case paper.|  
 +|Responsibility|Collection| Clinical Resident/Consultant| Clinical Resident/Consultant|   
 +|              |Transport| Class IV of ward| Class IV of OPD/Patient’ relative| 
 +|              |Receiving| R1 Pathology | R1 Pathology|   
 +   
 +                    ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/RSH)1/1''
    
-  +**7.1 STANDARD OPERATING PROCEDURE OF RECEIVING ROUTINE SPECIMENS IN HISTOPATHOLOGY**  
-     +  * The histopathology requisition form should be complete with following details -name of the patient, age, sex, requisition no., ward no., name of the incharge Dr, history or clinical diagnosis, nature of the specimen, date of operation.  
-                       +  * Specimen should be received only if sent in formalin.  
-Rou +  * Note the date of receipt of specimen.  
-tine                8:00 am to 4:00 pm Transfer within 1 hour. During OPD timing.  +  * After checking all the details give histopathology no. to jar.  
-Fix immediately.  +  * Ask history from patient’s relatives if that found on requisition slip is inadequate.  
-  +  * Give receipt no. and date of issue of report to the patient.  
- Sat urd ay 8:00am to 12:00 pm. Transfer within 1 hour.  +  * Formalin and container should be changed s o s if..  
- Sun day +  - if  foamy.  
-&  +  - Reddish.  
-Holi Avoid collection.If required to collect,  +  - Top up with formalin if not 10times the volume of the tissue.  
-aliquot and keep in  +  - If organ is too large for container or if container is cracked or not closing  properly.  
-ward refrigerator at 2-8 C and  + 
-Storage of Histopathology specimens: All specimens of histopathology are routinely stored for 3 months and afterwards they are discarded.  + 
-  +                 ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/FSCP)1/1'' 
-CYTOPATHOLOGY SAMPLE COLLECTION AND TRANSPORTATION  + 
-  +**7.2 STANDARD OPERATING PROCEDURE OF FNAC SAMPLE COLLECTION PROCEDURE** 
-  + 
-  +  * Procedure is usually performed in sitting position in chair. For Thyroid lesion usually lying down position with pillow under the shoulder is preferred. 
- day s transport at 9:00 am on next working day.  +  * Examine the swelling in terms of Location, Size, Shape, Consistency, Tenderness, Mobility and  Movement. 
-Amoun +  * Clear the area of swelling with skin disinfectant. 
-t Ideal is 10 ml directly from tapping line. Minimum 2 ml. If taken from receptacle, aliquot should be mixed well. 1 slide endocervix 1 slide ectocervix  +  * Allow it to evaporate. Explain the procedure to the patient. 
-Contain er Closed cap bottle. BAL fluid in BAL container. Either in wide mouthed closed bottle or wrapped in paper.  +  * Insert the needle (No. 23G) with 10 cc syringe within the target tissue. 
-Transpo +  * Pull the plunger to apply negative pressure. 
-rt To be sent to laboratory within  +  * Move the needle back and forth inside the target tissue. 
-1 hour of collection.Ward Ayah or servant will bring to laboratory along with requisition. Patient will bring bottle with slides or dried slides  +  * Release the negative pressure while needle remains in target tissue after obtaining the sample in the hub. 
-(wrapped) to cytology laboratory.  +  * Withdraw the needle. 
-Receivi ng *R1 will receive it. Check the demographics and sign the register. *R1 will receive the slides, check requisition form and give pap number on case paper.  +  * Put dry cotton swab with gentle pressure over the puncture site. 
-Respon +  * Detach the needle. 
-sibility   +  * Take out material from the needle on the clean dry glass slide. 
-                       +  * Make a smear by using another glass slide. 
-  Collec tion Clinical  +  * Fix the smear immediately in methanol for H & E stain( for Giemsa stain-air dry smear and then fix). 
-Resident/Consul tant Clinical  +  * Write the identity number on the slides and Stain the smear. 
-Resident/Consultant  + 
- Transp ort  +              ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/SRC)1/5'' 
-  Class IV of ward Class IV of OPD/Patient’ relative  + 
- Receiv ing R1 Pathology     R1 Pathology  +**7.3 SAMPLE REJECTION CRITERIA BLOOD SAMPLE REJECTION CRITERIA** 
-STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/RSH)1/1  +  * Improperly filled forms. 
-  +  * Improperly labeled samples. 
-  +  * Inappropriate quantity of sample. 
-7.1    STANDARD OPERATING PROCEDURE OF RECEIVING ROUTINE           SPECIMENS IN HISTOPATHOLOGY  +  * Clotted sample (in Pathology Section) 
-● The histopathology requisition form should be complete with following details -name of the patient, age, sex, requisition no., ward no., name of the incharge Dr, history or clinical diagnosis, nature of the specimen, date of operation.  +  * Spill over sample. 
-● Specimen should be received only if sent in formalin.  +  * Hemolyzed sample. 
-● Note the date of receipt of specimen.  +  * Sample received after 4 hours of collection. 
-● After checking all the details give histopathology no. to jar.  +  * Diluted Sample 
-● Ask history from patient’s relatives if that found on requisition slip is inadequate.  +  * Improper Vacutainers  
-● Give receipt no. and date of issue of report to the patient.  + 
-● Formalin and container should be changed s o s if..  +**CRITERIA FOR SAMPLE REJECTION IN HISTOPATHOLOGY** 
-- if  foamy.  +  * Grossly autolysed specimen 
-- Reddish.  +  * Sample sent without 10/ formalin  
-- Top up with formalin if not 10times the volume of the tissue.  +  * Container sent without tissue 
-- If organ is too large for container or if container is cracked or not closing  properly. +  * Quantity of formalin should be approx . 10 times of tissue 
 +  * Appropriate size of container 
 +  * Incomplete sample labeling 
 +  - Patient’s Name , Reg. no, Ward 
 +  - Specimen name 
 +**Incomplete requisition form** 
 +  - Patient’s Name, Reg. no, Ward/Unit 
 +  - Name of unit Incharge 
 +  - Related history and investigation 
 +  - Clinical diagnosis 
 +  - Specimen name 
 +  - Name and signature of authorized person 
 + 
 +**FNAC REJECTION CRITERIA** 
 + 
 +  * Incompletely filled up form. 
 +  * Smears not properly labeled. 
 +  * Smears are not properly spread. 
 +  * Smears containing clots. 
 +  * Smears (Material) diluted with blood. 
 +  * Smears not properly fixed. 
 + 
 +         ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/SRC)2/5'' 
 + 
 +**REJECTION CRITERIA OF MICROBIOLOGY SPECIMENS** 
 + 
 +**Purpose:** To provide Microbiology specimen rejection criteria & the procedure to follow when rejecting specimens for process. 
 + 
 +**General Principle:** 
 +Proper collection & transport of specimens is critical to the quality of results produced by the microbiology Laboratory & cannot be overemphasized. The validity of all diagnostic information produced in the lab is contingent on the quality of the specimen received. Consequences of poorly collected and/or poorly transported specimens include failure to isolate the causative organism, and recovery of contaminants or normal flora could lead to improper treatment of the patient. The saying is “garbage in—garbage out”. 
 + 
 +**General Consideration:** 
 +When a specimen is received in the laboratory, it is subjected to scrutiny & must meet certain minimum requirements before being accepted for testing. 
 +A specimen shall not be rejected until appropriate efforts have been made to correct the problem, but it may be rejected for failing to meet acceptability criteria. 
 +If, needed the specimen is rejected, it is listed on the microbiology disposition log for rejected specimens, along with reason for rejection & documentation of notified personnel. 
 + 
 +**Rejection criteria:** 
 +A. //SPECIMEN RECEIVED WITHOUT A LABEL OR WITH AN IMPROPER LABEL// 
 +  * At a minimum, specimen label must include patient name & reg. no. as the two patient identifiers. 
 +  * Call unit, ward or person responsible & notify of the problem. 
 +  * If any doubt exists as to origin of specimen, reject & order recollection. 
 +B.//SPECIMEN IMPROPERLY COLLECTED OR TRANSPORTED// 
 +  * Check with person responsible for collection to determine reason for deviation from procedure. Give instruction in the proper method of collection & transport to prevent repetition of the error.  
 + 
 +C.//SPECIMEN CONTAINER EXHIBITS GROSS EXTERNAL CONTAMINATION OR LEAKING SPECIMEN// 
 +  * Container exteriors must be clean & free of gross contamination. Leaking specimens indicate integrity of the specimen has been compromised & puts transport & laboratory personnel at risk. 
 + 
 +D.//SPECIMEN NOT OF SUFFICIENT QUANTITY//:If specimen has multiple orders, request priority listing of tests. 
 + 
 +E.//SPECIMEN MUST BE RECEIVED IN A TIMELY MANNER// Order recollection if specimen has exceeded recommended limits for transport. 
 + 
 +^Sr. No.^Specimen type^Test^Rejection Criteria^Report Comment^ 
 +|1|Stool|C&S|1.Not submitted in enteric pathogen transport media. 2.Multiple specimens collected from the same in-patient the same day(only one specimen per patient per test per day is to be processed).3.All formed stools except when S. typhi requested.|1.Specimen not received in enteric transported medium.2.Multiple specimens received. Only the most recently collected specimen has been processed.3.Formed stool received. Test cancelled.| 
 +|2|Sputum|C&S|More than 25 squamous epithelial cells/lower power field|Greater than 25 squamous epithelial cells per low power field.| 
 +|3|Urine|C&S|  * Condom catheter  * Foley catheter tips & bags  * Leaking specimens  * Inappropriate/swabs/non sterile container  * > 24 hr delay before specimen received  * Duplicate specimens (more than one processed urine within 24 hrs)|“Specimen unsuitable for culture…. Because of….add qualifier.”| 
 +|4|Dry swabs|C&S|If received in the lab > 1 hr after collection.|“Specimen not received in transport medium & was in transit for > 1 hr.”| 
 +|5|Blood cultures, tissues, Sterile body fluids e.g. CSF|C&S|If received in the lab > 48 hr after collection.| Process specimen. EnterReport Comment:”Specimen was received in the lab>48 hrs after it has been collected; results should be interpreted accordingly.”| 
 +|6|All specimen type except: Tissue Sterile, body fluid,Brain & liver abscess, Aspirated pus, Bone & soft tissue biopsies with diagnosis of gas gangrene, necrotizing fasciitis or necrotizing cellulitis |Anaerobic culture| Not submitted in special anaerobic transport media.| “No Anaerobic swab received; anaerobic culture not done.”| 
 +|7|Blood | For serology|* Sample hemolysed.* Not submitted in Red vacuette| * So kindly repeat the sample.” * Please collect blood in Red vacuette.| 
 + 
 + 
 + 
 + 
 +^ Name of Laboratory : Laboratory Services Sir T. Hospital (LSSTH),Bhavnagar ^^^ 
 +^**Document Name**: Documented procedure for primary sample collection & handling(Sample collection manual)^^^ 
 +^**Unique ID**: LSSTH/B/Central/DP/7.2.4/22^^^ 
 +^Issue No. : 01^Issue Date :30/04/2024^Copy No. :01^ 
 +^Authorized by:Laboratory director^ Review Date:23/09/2024^Reviewed by:Deputy Quality Manager^