To view the notes associated with this PowerPoint presentation, click the Edit button along the top - PowerPoint PPT Presentation


PPT – To view the notes associated with this PowerPoint presentation, click the Edit button along the top PowerPoint presentation | free to view - id: 149bf5-MDE1Z


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

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


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

Number of Views:74
Avg rating:3.0/5.0
Slides: 51
Provided by: bret47


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

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

To view the notes associated with this PowerPoint
presentation, click the Edit button along the top
tool bar and select the Edit Slides option.
Specimen Collection, Handling and Testing
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

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
  • Stool
  • Serum
  • Autopsy
  • Food

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

MDCH Kit No. 20
Smallpox Specimens
  • 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

Processing Shipping (per the CDC for chemical
  • 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

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

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
  • 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
  • Foods and veterinary specimens need also be
    included in the preparedness plan
  • Funding is needed to develop all of these testing

Michigan Emergency Management Plan Laboratory
  • Office of Public Health Preparedness provides
    interdepartmental coordination of preparedness
  • MI Department of Environmental Quality
  • environmental, pesticides, chemical, nuclear,
  • 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
  • MI Dept Labor Economic Growth
  • MSU Diagnostic Center for Population Animal
    Health Laboratory veterinary specimens

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
  • Wash hands
  • Wear PPE- as appropriate
  • Process contaminated supplies
  • Clean and disinfect environmental surfaces
  • Follow occupational health/blood-borne pathogen

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 Bureaus of Epidemiology and Laboratories at

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

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

How to Take Environmental Swabs
(No Transcript)
(No Transcript)
(No Transcript)
(No Transcript)
(No Transcript)
(No Transcript)
(No Transcript)
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
  • None were positive for B. anthracis

Rapid Hand-Held Assays for Biological Specimens
  • 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
  • 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
  • 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