iron hematoxylin stain or the modified trichrome formulation
Shipment of Diagnostic Specimens, Biological Products, Etiologic Agents, or Infectious Substances
Biological materials shipped domestically or internationally must be packaged in compliance with hazardous-materials transport regulations (33, 34). The United States has incorporated the United Nations Recommendations on the Transport of Dangerous Goods into law, making the U.S. regulations consistent with foreign shipment regulations. The U.S. regulations for packing diagnostic specimens and infectious agents for shipment were modified in 2006. The Public Health Service, Department of Transportation, and Postal Service specify requirements for packaging and shipping of biological materials. These regulations, plus those for packaging and shipping of materials via air, are similar; most carriers elect to follow the international shipping regulations within the International Air Transport Association (IATA) Dangerous Goods Regulations (Table 2.5).
Anyone packaging diagnostic specimens or infectious agents for shipment must receive training and be tested every 2 years. Those who complete the training and test will receive a certificate. The regulations are designed to protect all personnel who may come in contact with the package; compliance with these rules is the responsibility of the sender. Definitions of relevant terms can be found in Tables 2.5 and 2.6.
Double mailing containers should be used in shipping any parasitologic specimens other than microscope slides. The inner container is an aluminum screw-cap mailing tube that fits into an outer cardboard screw-cap mailing container. The specimen vials or tubes in the inner aluminum cylinder should be packed in cotton to absorb any moisture or material that might result from leakage or breakage. Instruction sheets, patient information sheets, etc., may be wrapped around the metal cylinder before it is placed in the outer cardboard mailer. For all packages containing infectious substances, an itemized list of contents must be enclosed between the secondary packaging and the outer packaging (33, 34). Training and training material for the transportation of dangerous goods and infectious substances are available at the American Society for Microbiology and IATA (training manuals).
Prepared slides, such as stained fecal smears or blood films, do not require double mailers for shipment. They may be packed in boxes, cardboard slide holders, or any other suitable container that will prevent damage or breakage. Slides should be individually wrapped in toilet tissue or facial tissue. If a number of slides are to be mailed, they can be wrapped in toilet paper as follows: place a slide on the tissue, wrap the slide several times, place the next slide on top of the first, and continue to wrap the slide several times. The series of slides will be padded and can be easily unwrapped on arrival. When you place slides in the flat cardboard containers, they need additional protection; some slides will arrive broken if this thin cardboard container is merely placed in an envelope for mailing. A plastic slide container with a snap top is an excellent option for shipping microscope slides (holds four to five slides).
Note If the slides are mounted with Permount or other mounting media, they should be completely dry before being packed.
All packages prepared for mailing should contain a complete information sheet about the specimen. An address label should be enclosed inside the package, as well as being on the outside container. All labels should be checked to ensure proper delivery. Also, remember that if you use an overnight carrier, the address must also contain a street address, not just a P.O. Box or general address such as department and institution.
Documentation
The Shipper’s Declaration for Dangerous Goods is a legal document that serves as a contract between the shipper and carrier; it must be accurate and legible and have no spelling errors. However, if minor discrepancies in typing or punctuation are present, they are no longer considered errors if they do not compromise safety. The document must be either handwritten by one person or typed. Two copies of the Shipper’s Declaration must be completed and signed for each shipment. One copy is retained by the shipper, and the other is forwarded with the package; one copy can be a carbon copy. This document is required for shipping infectious substances and toxic substances; it is not required for shipping diagnostic specimens or biological products. If there are no dangerous goods in a shipment with dry ice, the Shipper’s Declaration is not required. It is important for personnel within the laboratory to thoroughly understand these regulations and to have sample copies of appropriate documentation for referral. A checklist used by carriers to decide to accept or reject a package is widely used; a copy of this document should also be on file within the laboratory.
The current editions of the Code of Federal Regulations can be obtained from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402. Inquiries about Postal Service publications may be directed to U.S. Postal Service, 475 L’Enfant Plaza, Washington, DC 20260-5365. Dangerous Goods Regulations can be obtained from Publications Assistant, International Air Transport Association, 2000 Peel Street, Montreal, Quebec, Canada, H3A 2R4.
References
1. Clinical and Laboratory Standards Institute. 2005. Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved guideline M28–2A. Clinical and Laboratory Standards Institute, Villanova, PA.
2. Garcia LS. 2009. Practical Guide to Diagnostic Medical Parasitology, 2nd ed. ASM Press, Washington, DC.
3. McVicar JW, Suen J. 1994. Packaging and shipping biological materials, p. 239–246. In Fleming DO, Richardson JH, Tulis JJ, Vesley D (ed), Laboratory Safety: Principles and Practices, 2nd ed. ASM Press, Washington, DC.
4. Code of Federal Regulations. 1991. Occupational exposure to bloodborne pathogens. Fed Regist, 29CFR1910.1030.
5. Sapero JJ, Lawless DK. 1942. The MIF stain-preservation technique for the identification of intestinal protozoa. Am J Trop Med Hyg 2:613–619. PMID 13065626
6. Garcia LS, Voge M. 1980. Diagnostic clinical parasitology. I. Proper specimen collection and processing. Am J Med Technol 46:459–467. PMID 6155783
7. Cartwright CP. 1999. Utility of multiple-stool-specimen ova and parasite examinations in a high-prevalence setting. J Clin Microbiol 37:2408–2411. PMID 10405376
8. Chan RJ, Chen J, York MK, Setijono N, Kaplan RL, Graham F, Tanowitz HB. 2000. Evaluation of a combination rapid immunoassay for detection of Giardia and Cryptosporidium antigens. J Clin Microbiol 38:393–394. PMID 10618122
9. Church D, Miller K, Lichtenfeld A, Semeniuk H, Kirkham B, Laupland K, Elsayed S. 2005. Screening for Giardia/Cryptosporidium infections using an enzyme immunoassay in a centralized regional microbiology laboratory. Arch Pathol Lab Med 129:754–759. PMID 15913423
10. Garcia LS, Shimizu RY. 1997. Evaluation of nine immunoassay kits (enzyme immunoassay and direct fluorescence) for detection of Giardia lamblia and Cryptosporidium parvum in human fecal specimens. J Clin Microbiol 35:1526–1529. PMID