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Provision of key clinical information on laboratory specimen request forms

Health and Safety Executive - Safety Notice
Department Name: HID SI4 (Biological Agents Unit)
Bulletin No: HID 5-2011
Issue Date: 9 December 2011
Target Audience: Health Services (Health & Social Care Sector). The Notice is of particular relevance to medical staff within organisations that provide specimens from patients to laboratories for testing.
Key Issues: Provision of sufficient information on Specimen Request forms to staff in Clinical Diagnostic Laboratories to enable them to apply the correct safety measures to control the risk. Recent investigations have identified there has been lack of sufficient relevant clinical details being provided on specimen request forms. This has resulted in samples being handled at the wrong biological containment level with resulting increased risk of infection to laboratory staff.

Introduction:

The purpose of this Safety Notice is to alert health and social care services to potential risks to laboratory staff, if specimen request forms do not contain relevant details.

It will be of particular relevance to medical staff within organisations that provide specimens from patients to laboratories for testing. This will include all persons who have direct patient contact who complete the electronic or paper specimen request forms e.g. clinicians, nurses and General Practitioners.

Following reports made under The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR), HSE's Biological Agents Unit (BAU) have conducted a number of investigations at Clinical Diagnostic Laboratories.

A common theme is the lack of sufficient relevant clinical details being provided on specimen request forms. This has resulted in samples being handled at the wrong biological containment level with resulting increased risk of infection to laboratory staff.

Medical staff should ensure that appropriate information, including relevant travel history is provided in order to alert laboratory staff of potential dangers.

The most common occurrences have been in relation to the isolation and handling of Hazard Group 3 agents, Brucella or Salmonella spp from clinical samples that were initially processed at Containment Level 2. Similar problems could also occur when handling specimens that may contain other Hazard Group 3 or 4 Biological Agents.

Where appropriate arrangements have not been implemented; HSE Inspectors will take appropriate enforcement action in line with our enforcement policies and procedures.

Background

Where a laboratory sample or specimen is considered likely to contain a human pathogen, it is important that the appropriate level of laboratory containment is provided in order to ensure the effective control of the risk of exposure / infection.

Specimens processed for microbiological analysis and considered likely to contain Hazard Group 3 or 4 pathogens must be processed within appropriate containment conditions.

Specimens liable to result in propagation or culture of Hazard Group 3 pathogens for example must be processed in a Containment Level 3 laboratory with associated management arrangements.

Specimens should be supplied with relevant clinical details from requesting clinicians. This can be used to inform the assessment and further laboratory processing e.g. the types of organisms that might be present in specimens from a returning traveller or those associated with an outbreak scenario.

In clinical laboratories, specimens are sorted and processed on the basis of the information provided. If clinical details are inaccurate or incomplete or there is delay in disclosing new information to the laboratory then this can result in specimens being processed under insufficient laboratory containment conditions.

In a number of recent investigations this has resulted in laboratory staff being placed at increased risk of infection by hazard group 3 agents such as Brucella spp. and Salmonella typhi.

Had the relevant clinical information been included on the initial form, then the specimen is likely to have been processed using appropriate containment with all protective control measures in place.

Action required:

Relevant legal documents:

References:

Further information:

Biological Agents Unit
Health and Safety Executive
Hazardous Installations Directorate
5S.2 Redgrave Court
Merton Road
Bootle
Merseyside
L20 7HS

HSE: www.hse.gov.uk
Biological Agents Unit: www.hse.gov.uk/biosafety/
E mail: germs.gmos@hse.gov.uk

General note:

Please pass this information to a colleague who may operate this type of process.

2011-09-12