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the Edit button along the top tool bar and select the Edit Slides option. ... White powder hoaxes received from October 2001until 12/31/03. 265 environmental specimens ... – PowerPoint PPT presentation

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Title: To view the notes associated with this PowerPoint presentation, click the Edit button along the top


1
To view the notes associated with this PowerPoint
presentation, click the Edit button along the top
tool bar and select the Edit Slides option.
2
Specimen Collection, Handling and Testing
3
Clinical Specimens
  • BT agents may not be initially suspected.
  • Exposed/ill patients will be seen in ERs,
    clinics, offices.
  • Collect appropriate specimens based on patient
    symptoms.

4
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.

5
Specimen Collection
  • Anthrax
  • Cutaneous lesion material
  • Inhalation Blood, sputum
  • Gastrointestinal Blood, stool

6
Specimen Collection
  • Brucellosis
  • Blood
  • Bone Marrow
  • Serum

7
Specimen Collection
  • Plague
  • Pneumonic Bronchial wash, TTA
  • Septicemic Blood
  • Bubonic Tissue, aspirate

8
Specimen Collection
  • Tularemia
  • Blood
  • Biopsy
  • Swab

9
Specimen Collection
  • Botulism Toxin
  • Stool
  • Serum
  • Autopsy
  • Food

10
Specimen Collection
  • Melliodosis/Glanders
  • Blood
  • Bone marrow
  • Sputum/bronchial washing
  • Urine
  • Abscess, tissues, aspirate, fluids

11
MDCH Kit No. 20
12
Smallpox Specimens
  • Vesicular Fluid
  • Vesicular Roof
  • Vesicular Swab
  • Scabs
  • Biopsy
  • Blood and Serum
  • Throat swab
  • Autopsy tissues

13
Specimen Handling
  • Clinical
  • Follow storage guidelines established by
    laboratory processing specimens
  • Universal precautions
  • Proper packaging and shipping

14
Specimen Collection, Processing
Shipping Exposure to Chemical Agents
15
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.

16
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

17
Processing Shipping (per the CDC for chemical
agents)
  • Before shipping specimens contact MDCH or CDC.
  • Specimens should be labeled with identification
    , collectors 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

18
Processing Shipping (continued)
  • 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

19
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

20
Rapid Toxic Screen Groups of Chemical Agents
  • 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)

21
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

22
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

23
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

24
Michigan Emergency Management Plan Lab
(continued)
  • MI Dept Labor Economic Growth
  • MSU Diagnostic Center for Population Animal
    Health Laboratory veterinary specimens

25
Safety
26
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

27
Safety-Clinical Specimens
  • BSL-2
  • Processing specimens
  • BSL 3
  • Culture manipulations that might produce aerosols

28
Safety Clinical Specimens
  • Standard Infection Control Practices
  • Wash hands
  • Wear PPE- as appropriate
  • Process contaminated supplies
  • Clean and disinfect environmental surfaces
  • Follow occupational health/blood-borne pathogen
    procedures

29
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

30
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 Bureaus of Epidemiology and Laboratories at
    MDCH

31
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.

32
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

33
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

34
How to Take Environmental Swabs
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42
Lab Results
  • Reports on environmental specimens submitted to
    MDCH go to
  • FBI
  • Local Public Health Department
  • MDCH Bureau of Epidemiology

43
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

44
Rapid Hand-Held Assays for Biological Specimens
  • HHS does not recommend use
  • False positives
  • False negatives
  • Sensitivity/specificity
  • Requires confirmation

45
Chain of Custody
  • Chronological written record
  • Acquisition until final disposition
  • Assures continuous accountability
  • Considered confidential/classified
  • Maintained in a secure location

46
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

47
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
  • Who obtained
  • Who delivered
  • Who tested
  • Who disposed
  • Those signing may be called on to testify in a
    criminal proceeding

48
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

49
Chain of Custody
Product ____________________
Sample Source ______________
  • sampler (name)
  • agency ___________
  • date ____________
  • time ____________
  • condition ___________
  • ___________________

transferred to (name) agency
_____________ date ________________ time
________________ condition ____________ _________
___________ signature ____________
50
Helpful Websites
  • 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
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