Specimen Packaging and Shipping

Submitters are responsible for the following:

• Ensuring specimens are not batched (exception includes certain surveillance monitoring) and shipped as soon as they are ready.
• Ensuring an appropriate specimen is properly collected for the test ordered.
• Storing specimens at required temperatures prior to shipment.
• Shipping specimens promptly after collection. Delays may render specimens unsatisfactory for testing. Specimens should not be batched and should be shipped as soon as they are ready.
• Packaging, labeling, and shipping specimens according to their classification and in compliance with all applicable federal regulations governing biological and infectious substances.
• Ensuring all required patient information and documentation are complete and accurate.
• Maintaining appropriate training in specimen handling, packaging, and shipping, including current certification when required for the transport of infectious substances. All individuals who handle, package, procure carriers for, or transport specimens must complete applicable training.

Liquid Specimens (blood, serum, urine, other body fluids, stool in transport media, and broth cultures)

1. Place specimens in a securely sealed, watertight primary container appropriate for the specimen type (e.g., blood tube, UPT tube, screw-capped plastic tube, etc.). The container must be labeled with two patient-specific identifiers.
2. Place the primary container in a watertight secondary container (e.g., clear plastic specimen bag). Include sufficient absorbent material (e.g., paper toweling or gauze) to absorb the full contents of the primary container in the event of leakage or breakage.
   • Specimens that leak or break during transit are typically not processed. An “Unsatisfactory for Testing” report will be issued with a recommendation for recollection.
   • While not preferred, serum separator tubes (SST) and/or blood tubes from multiple patients may be placed in a single secondary container for shipment. When feasible, group tubes by test type (e.g., syphilis, HIV) in separate bags. Total volume per secondary container must not exceed 50 mL. All other specimens should be shipped in individual secondary containers.
   • CT/GC collection tubes from multiple patients that are placed in the same secondary container will not be processed. “Unsatisfactory for Testing” reports will be issued for each specimen with a recommendation for recollection.
   • Multiple specimens packaged in individual secondary containers, and requiring the same temperature conditions, can be placed in a large plastic bag for shipment.
3. Clearly label the outside of the secondary container with required transport conditions (e.g., “Room Temperature,” “Refrigerated” or “Frozen”).
4. Place test requisition forms in the outer pocket of the specimen bag or inside the shipping container. Do not place forms inside specimen bags or wrap them around individual containers.
5. Maintain specimens at the appropriate temperature until courier pickup or shipment. Specimens requiring frozen transport should be frozen immediately after collection and shipped on dry ice. If site is unable to provide dry ice for shipment, please call the OSDH PHL at 405-564-7750 at least 24 hours ahead of scheduled submission to arrange shipment via the OSDH-contracted courier.

Microbial Isolates on Solid Media (Plates and Slants)
Isolates should be grown on appropriate media until active growth is present. Plates must be sealed with Parafilm, and slants must be securely closed. Each specimen must be placed in an individually sealed bag, with the requisition form placed in the outer pocket of the bag or inside the shipping container.

Newborn Screening, PKU Monitoring and Sickle Cell Screening Forms
For storage and shipping instructions related to NBS, PKU monitoring, and adult/child hemoglobinopathy (sickle cell) testing, refer to:

• Guidance for Collection of Newborn Dried Blood Spots
• Guidance for Collection of Adult and Child Blood for Hemoglobin Analysis

Diagnostic Specimens (excluding NBS)
Each diagnostic specimen must be accompanied by:

• OSDH PHL Test Requisition Form
• Specimen Shipping Manifest

Each specimen requires its own requisition form; specimens for different tests must not be bundled under a single requisition. Incomplete or missing documentation may result in delays or test cancellation.

Surveillance Specimens
Surveillance submissions (e.g., influenza typing/subtyping, SARS-CoV-2 variant sequencing) should preferably include the appropriate surveillance form:

• Influenza Surveillance Form
• COVID-19 Surveillance Form

Alternatively, specimen lists containing all required information may be accepted.

Courier Service
The OSDH PHL contracts with a courier service for routine specimen pickup from County Health Departments and participating sites, Monday through Friday. NBS specimens are also collected on weekends at most birthing facilities.

• Requests for unscheduled (emergency) pickup require prior approval; call the OSDH PHL at (405) 564-7750.
• Frozen specimens require advance notification at least 24 hours prior to pickup to allow for dry ice arrangements; email PublicHealthLab@health.ok.gov or call the OSDH PHL at (405) 564-7750.
• Pickups occur at approximately the same time each workday per site. Specimens collected after scheduled pickup will be retrieved the next business day.
• Testing typically begins no earlier than the day following pickup.
• Submitters should carefully plan collections around weekends, holidays, and scheduled pickup times to avoid delays.

Other Delivery Methods
While the contracted courier is preferred, specimens may also be delivered via private courier, commercial carrier (e.g., FedEx, UPS), or U.S. Postal Service. Overnight shipping should be used when possible or when required by the test.

Regulations
Specimens must be packaged and labeled in compliance with all applicable state, federal, and international regulations. Classification of the specimen determines packaging and documentation requirements:

• Category A: Infectious substances capable of causing severe or fatal disease
  • Proper shipping name: UN 2814 – Infectious Substance, Affecting Humans
• Category B: Infectious substances not meeting Category A criteria
  • Proper shipping name: UN 3373 – Biological Substance, Category B
• Exempt Human Specimens: Specimens with low likelihood of containing infectious agents
  • Proper shipping name: Exempt Human Specimen

Applicable regulations include U. S. Department of Transportation (49 CFR 173.196 – Category A infectious substances and 173.199, Category B infectious substances), International Civil Aviation Organizations (ICAO) Technical Instructions for the Safe Transport of Dangerous Goods and International Air Transport Association (IATA). Category A shippers must complete training every two years and maintain certification. Personnel handling Category B specimens must also be trained in proper handling and submission procedures. Dangerous goods training is required for submission of dangerous goods to public carriers. Various training resources are available online, including the Centers for Disease Control and Prevention (CDC); US Department of Transportation (DOT) U.S. Pipeline and Hazardous Materials Safety Administration (PHMSA); and International Air Transport Association (IATA).

General Packing and Shipping Guidance
Submitters should follow CDC guidance for packaging and shipping biological specimens and comply with all relevant regulatory standards.

Submitting facilities are encouraged to maintain a Specimen Referral Log or equivalent electronic tracking system to document submissions and receipt of results. Logs should be reviewed periodically to ensure timely reporting. If expected results for a specimen are not received, the OSDH PHL should be contacted to inquire about the status of testing of the specimen.