Appendix 4: Specimen collection and transport for suspected VHF

General principles

• Specimen collection should preferably occur at a designated hospital (RMH or RCH) whenever possible.
• If urgent transfer is not required and delaying collection may compromise diagnosis, venepuncture should be performed at the initial admitting hospital by an experienced clinician.
• Only essential specimens should be collected, and safety must take priority, in accordance with the National High Security Quarantine Laboratory Guideline for Management of Quarantinable Viral haemorrhagic Fevers.

Specimens to collect

• Preferred specimens for virus detection include:
  • whole blood (ethylenediaminetetraacetic acid (EDTA) tube – mauve top)
  • for RT-PCR, serology (storage) and virus isolation.
• Alternative specimens (if blood collection not possible) include:
  • throat swab (in viral transport medium, screw-capped plastic tube)
  • urine sample
  • oral fluids/swabs – only if collection can be performed safely without inducing vomiting or coughing.
• Post-mortem specimens (if available) – serum, liver, spleen and kidney tissues (fixed in 10% (100,000 ppm) buffered formalin or 2.5% glutaraldehyde (25,000 ppm)).

Table 2. Tests available

Preparation

• PPE requirements for all personnel include:
  • double gloves
  • impervious long-sleeve gown
  • enclosed, fluid and sharps-resistant footwear
  • P2/N95 respirator
  • full-face visor.
• Label all specimen containers in advance with:
  • ‘Infectious Risk’
  • patient details, date/time of collection, sample type, clinical context.

Specimen collection

• Perform venepuncture or alternative specimen collection using strict precautions.
• Do not recap needles – dispose of immediately into sharps container.
• Place specimens for transport in a tightly sealed, watertight collection container, such as a Bio-Bottle or rigid screw-cap plastic tube certified for Category A – UN2814 Infectious Substances, Affecting Humans, and seal the cap with Parafilm.
• Decontaminate each specimen tube – wipe with paper towel soaked in 0.1% sodium hypochlorite (1,000 ppm).
• Package immediately (as outlined in Packaging for transport).

Packaging for transport

• For transport of all pathology specimens and associated materials, the packaging must consist of three components, in accordance with Requirements for the packaging and transport of pathology specimens and associated materials (fifth edition), which are the:
  • primary receptacle
  • secondary packaging
  • outer packaging.
• Wrap the primary collection container in absorbent material (sufficient to absorb potential leaks and provide cushioning to prevent breakage)
• Place in two sealable, leak-proof specimen bags (double-bag).
• Wipe outer bag with 0.1% sodium hypochlorite (1,000 ppm).
• Place the double-bagged primary collection container in a durable, watertight screw-cap mailing tube, metal can or bio-bottle. This secondary container should be sealed with tape. Several primary containers may be placed in one secondary container to a maximum of 50ml of specimen material.
• On the outside of the secondary container, attach the specimen labels and other relevant information.
• Insert into a rigid outer container (for example, esky) approved for Category A transport. Address to:

National High Security Quarantine Laboratory
Victorian Infectious Diseases Reference Laboratory (VIDRL)
The Doherty Institute
792 Elizabeth Street
Melbourne, VIC 3000

• Attach to the outer packaging:
  • an infectious substance label (‘Infectious Substances, Affecting Humans’)¹
  • a request form (specifying required tests)
  • a list of contents
  • ensure documentation for traceability. See the VIDRL chain of custody form.
• Maintain specimens at 4°C during storage/transport (do not freeze). Transport specimen for virus isolation chilled on wet or dry ice as appropriate, depending on the duration of shipping.

Handling and registration

• Ensure specimens are registered via pathology reception at the relevant hospital laboratory:
  • DO NOT use pneumatic tube or automated systems to deliver specimens to laboratory.
  • Where possible, avoid unnecessary double handling of specimen/s at multiple locations within a health service, by consideration of ways to register specimen/s that minimise transport of specimens to different parts of the health service.
• Complete documentation to include the following:
  • Record all staff handling specimens (name, role, date, time).
  • The documentation must accompany the specimen through to VIDRL.
• Limit handling to essential staff only.

Transport to VIDRL

• Use a courier service approved for handling Category A specimens and biosecurity material. Call the department and advise of transport details. If health services courier does not transport Category A specimens, contact the department (1300 651 160) and they can arrange the courier in consultation with LPHUs.
• The department officer will notify the on-call VIDRL medical microbiologist before dispatch of the specimen with the courier or bill number, as required for transport of a Tier 1 security sensitive biological agent
• The department officer will contact the VIDRL Laboratory Manager on-call (0438 599 439) to confirm details.
• Transport directly to the Doherty Institute. VIDRL staff will meet directly with the courier:
  • During business hours, the courier is to deliver specimens directly to the Doherty Reception (who will call VIDRL).
  • After hours, the courier is to call VIDRL Laboratory Manager on-call (0438 599 439) who will organise the appropriate personnel to meet them at the Elizabeth Street entrance.
  • DO NOT leave specimen/s in VIDRL after hours drop box.
  • Do not leave specimens unattended.
• VIDRL staff will collect and transfer specimens directly to the PC4 laboratory.

Refer to the following key documents for more information on recommendations for specimen collection:

• PHLN national high security quarantine laboratory guideline for management of quarantinable viral haemorrhagic fevers
• PHLN laboratory procedures and precautions for samples collected from patients with viral haemorrhagic fevers: Part A: Guidelines for laboratories that are not associated with a designated isolation hospital
• PHLN laboratory procedures and precautions for samples collected from patients with viral haemorrhagic fevers: Part B: Guidelines for laboratories that are associated with a designated isolation hospital

Notes

¹ Australian Commission on Safety and Quality in Health Care. (2022). Requirements for the packaging and transport of pathology specimens and associated materials (5th ed.)