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Specimen Collection,
Handling and Testing
Clinical Specimens
• BT agents may not be initially suspected.
• Exposed/ill patients will be seen in ER’s,
clinics, offices.
• Collect appropriate specimens based on
patient symptoms.
Nasal Cultures?
• NOT recommended for asymptomatic
patients with no known exposure.
• Sensitivity and specificity unknown
• A positive or negative nasal swab does not
predict infection.
• Collected for epidemiology purposes
ONLY after consult with MDCH.
Specimen Collection
• Anthrax
• Cutaneous: lesion material
• Inhalation: Blood, sputum
• Gastrointestinal: Blood, stool
Specimen Collection
• Brucellosis
• Blood
• Bone Marrow
• Serum
Specimen Collection
• Plague
• Pneumonic: Bronchial wash, TTA
• Septicemic: Blood
• Bubonic: Tissue, aspirate
Specimen Collection
• Tularemia
• Blood
• Biopsy
• Swab
Specimen Collection
• Botulism Toxin
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Stool
Serum
Autopsy
Food
Specimen Collection
• Melliodosis/Glanders
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Blood
Bone marrow
Sputum/bronchial washing
Urine
Abscess, tissues, aspirate, fluids
MDCH Kit No. 20
VTM
Smallpox Specimens
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Vesicular Fluid
Vesicular Roof
Vesicular Swab
Scabs
Biopsy
Blood and Serum
Throat swab
Autopsy tissues
Specimen Handling
• Clinical
• Follow storage guidelines established by
laboratory processing specimens
• Universal precautions
• Proper packaging and shipping
Specimen Collection, Processing
& Shipping
Exposure to Chemical Agents
Specimens Required by CTLN
• Urine-25 ml, screw capped container, no
preservative, frozen
• Whole blood, two 5 or 7 ml EDTA(purple),
unopened, 4 C.
• Whole blood, one 5 or 7 ml gray or green, 4 C,
plus an empty tube for each lot used as a blank.
• Whole blood, two 10 ml red (not SST or gel),
DO NOT centrifuge, 4 C.
Recommended Times of
Specimen Collection
• Blood should be collected as soon as
possible after exposure
• Urine should be collected 7-8 hrs after
exposure
• Testing is largely used to rule out
exposure (worried well) or document
exposure, cause of death
Processing & Shipping
(per the CDC for chemical agents)
• Before shipping specimens contact MDCH or
CDC.
• Specimens should be labeled with identification
#, collector’s initials, date & time (patient
names should not be included). “De-identify”.
• Sample identification # & patient names should
be maintained by the submitter.
• Results will be reported with identification #
• Use chain of custody form and forensic tape to
seal tubes and packages
Processing & Shipping
(continued)
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Use cool packs for blood and dry ice for urine
Package urine and blood separately
Include a shipping list of specimens with ID #s
Include a contact name and phone #
Label outside of box with:
• Non-infectious, diagnostic specimens, packed in
compliance with IATA, packing instructions 650
Contact Information
• MDCH Bureau of Laboratories
517-335-8063
• Division of Chemistry and Toxicology
517-335-9490
Shipping address: PO Box 30035,
3350 North Martin Luther King Jr. Blvd,
Lansing, MI 48909
After hours emergencies, 517-335-9030
Rapid Toxic Screen:
Groups of Chemical Agents
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Nerve Agents (metabolites of parent agent)
Sulfur mustards (metabolite)
Nitrogen Mustards (metabolite)
Lewisite Agents
Hydrogen Cyanide
Volatile Agents (Phosgene, Vinyl Chloride)
Heavy Metals (lead, arsenic, cadmium, uranium)
Rapid Handheld Equipment for
Chemical Agents
• Several vendors are now marketing products that may
meet this need.
• One high profile example is Airport Security
instrumentation for explosives, illicit drugs and chemical
warfare agents.
• Mobile labs for biological and chemical agents are being
designed.
• Rapid testing is needed to make decisions but
confirmation will be required
• This area of laboratory testing is unregulated &
performed by non-lab personnel
What about other Specimens to
be Tested for Chemical Agents?
• Laboratory expertise and testing capabilities can vary
greatly with the specimen type
• In human specimens, testing may target metabolites
and not the parent compound
• In non-clinical testing( unknowns, liquids, solids)
testing will likely target parent compound
• Foods and veterinary specimens need also be included
in the preparedness plan
• Funding is needed to develop all of these testing
programs
Michigan Emergency
Management Plan & Laboratory
• Office of Public Health Preparedness: provides
interdepartmental coordination of preparedness
• MI Department of Environmental Quality:
environmental, pesticides, chemical, nuclear,
water.
• MI Department of Agriculture: food safety,
• 51st WMD Civil Support Team via MSP
(explosives,nuclear, biological, chemical)
• MI Poison Centers: Detroit & Grand Rapids,
• 800-222-1222
Michigan Emergency
Management Plan & Lab
(continued)
• MI Dept Labor & Economic Growth
• MSU Diagnostic Center for Population &
Animal Health Laboratory: veterinary
specimens
Safety
Safety – Chemical & Infectious
Agents
• Mixing of infectious and chemical agents
is a real possibility in a BT incident
• Best solution is still under development
• Gamma irradiation of specimens prior to
chemical analysis is being evaluated by
the CDC
Safety-Clinical Specimens
• BSL-2
• Processing specimens
• BSL – 3
• Culture manipulations that might produce
aerosols
Safety – Clinical Specimens
• Standard Infection Control Practices:
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Wash hands
Wear PPE- as appropriate
Process contaminated supplies
Clean and disinfect environmental surfaces
Follow occupational health/blood-borne
pathogen procedures
Environmental Testing for BT
Agents
• What do you do if you have a suspicious
item?
• Notify law enforcement
• What will they do?
• Threat assessment, package and transport
sample.
• Compile a list of contacts to the item
Sample Submission
• All testing is approved by the FBI after a
threat assessment has been performed
• Each sample must be certified risk-free before
the lab will accept it for testing
• Chain of Custody is initiated at delivery of
the sample to the laboratory
• Priority of testing is determined by the FBI
and the Bureau’s of Epidemiology and
Laboratories at MDCH
Environmental Samples for
BT Agents
• Rapid field testing may be done by law
enforcement, HazMat or 1st responders
• CDC has not yet endorsed any of the rapid field
tests for BT agents
• Samples must always also be tested at Public
Health Laboratories for definitive result
• MDCH will test environmental samples
including packages, liquids, letters, swabs and
food.
Packaging Environmental Samples
• All samples will be triple bagged as
evidence by law enforcement or HazMat
• All samples will be transported by the FBI
WMD Coordinator or another law
enforcement agency
• Transported using only one vehicle
• Transporting officer stays with sample at all
times
Environmental Laboratory Testing
•Samples obtained in an investigation will go to
the MDCH laboratory for testing
•Samples submitted will be preserved as evidence
•Samples will be retained at MDCH until a final
negative report is issued
•Samples are released to the FBI
 If part of a law enforcement investigation, samples are
sent to the MSP Forensic Laboratory or an FBI facility
 If no law enforcement action is to be taken, samples are
returned to the submitter or destroyed
How to Take
Environmental Swabs
Lab Results
• Reports on environmental specimens
submitted to MDCH go to:
• FBI
• Local Public Health Department
• MDCH Bureau of Epidemiology
Specimens Submitted to MDCH
• White powder hoaxes received from
October 2001until 12/31/03
• 265 environmental specimens
• 128 Postal Service specimens
• All were cleared by local law enforcement
and the FBI
• None were positive for B. anthracis
Rapid Hand-Held Assays for
Biological Specimens
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HHS – does not recommend use
False positives
False negatives
Sensitivity/specificity
Requires confirmation
Chain of Custody
• Chronological written record
• Acquisition until final disposition
• Assures continuous accountability
• Considered confidential/classified
• Maintained in a secure location
Chain of Custody
• Each chain of custody form is agency
specific
• If a sample is transferred to a second agency
that agency will start another chain of
custody form for the time that the sample
remains in its custody
• Each agency is responsible for retaining
records regarding sample
Chain of Custody
• Each person signing the form is responsible for
the care and preservation of that sample while in
their possession
• Form will account for all persons handling the
sample
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Who obtained
Who delivered
Who tested
Who disposed
• Those signing may be called on to testify in a
criminal proceeding
Chain of Custody
• Form will include:
• Sample information
• Source
• Condition
• Collecting/Submitting agency information
• Contact information
• Internal and external transfer information
• Transferred to whom, for what purpose
• Destruction of sample information
Chain of Custody
Product: ____________________
Sample Source: ______________
sampler: (name)
agency: ___________
date: ____________
time:
____________
condition: ___________
___________________
transferred to: (name)
agency: _____________
date: ________________
time: ________________
condition: ____________
____________________
signature: ____________
Helpful Websites
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www.bt.cdc.gov/
www.dhs.cahwnet.gov/ps/deodc/ehlb/cabu
www.cbwinfo.com/Chemical/CWList.shtml
www.asm.org
www.upmc-biosecurity.org
www.mipreparedness.org