This guide is offered to our contracted courier companies and their drivers to help them safely and legally package and ship medical specimens to Mayo Clinic Laboratories for testing.
Although this document makes many references to regulatory requirements, it is not intended to serve as a comprehensive training program for Department of Transportation (DOT) or International Air Transport Association (IATA) training requirements. We highly recommend that anyone involved in transporting medical specimens become familiar with the many governmental and airline regulations pertinent to these types of shipments. The US DOT Website contains technical information about compliance with the Dangerous Goods regulations. These regulations apply to both ground and air transport. In addition, the IATA Website provides information on airline requirements.
Various federal and international agencies have published rules and regulations that are available on the Internet regarding the transportation of medical specimens. These include:
|ICAO||International Civil Aviation Administration|
|IATA||International Air Transport Association|
|DOT||Department of Transportation|
|CDC||Centers for Disease Control|
|TSA||Transportation Safety Administration|
|FDA||Food and Drug Administration|
|OSHA||Occupational Safety and Health Administration|
|FAA||Federal Aviation Administration|
For more information, call Mayo Clinic Laboratories at 800-533-1710 and ask to speak with a Transportation Specialist.
As regulations, methods, and packaging materials change over time, we urge the reader to obtain the most current information available when shipping medical specimens. Refer to www.mayocliniclabs.com.
This guide has been developed to meet the following objectives:
Specimens must be packed and shipped properly for accurate testing, which helps ensure that patients receive optimal treatment. A specimen may not be viable for testing if it becomes too cold or too hot. It may be necessary to collect another specimen from the patient, which may delay treatment. People’s lives may depend on our work.
Mayo Clinic Laboratories’ goal is to ensure that all medical specimens arrive at the testing facility:
This guide has been prepared to help couriers understand their role in accomplishing these goals. By following the guidelines for proper specimen preparation, packing, shipping, and documentation, couriers can comply with regulations and safely transport Mayo Clinic Laboratories specimens.
Mayo Clinic Laboratories Transportation Specialists are available Monday through Friday, 6:00 a.m. to 4:30 p.m. CDT.
For emergency support 24 hours per day, 365 days per year, contact Customer Service.
For convenience, biohazard color-coded, temperature-specific bags are provided to client laboratories by Mayo Clinic Laboratories:
Medical samples being transported to testing laboratories must be maintained at an appropriate temperature: ambient, refrigerate, or frozen.
Specimens must be separated by temperature, and each of these temperature bags must be packaged in a specific manner. Mayo Clinic Laboratories provides a raspberry-colored shipping box that holds two Styrofoam (Styro) containers inside. Styro transportation coolers provided by Mayo Clinic Laboratories have corresponding color-coded labels and contain appropriate labeling for dry ice and biohazards. One of the Styro containers holds the cool packs needed to keep refrigerate/ambient specimens cool for up to 48 hours.
All specimens must be shipped in a leak-proof container, regardless of transport temperature. The color-coded bags also contain material that can absorb the full liquid content of the specimens placed inside.
The following pages provide couriers with detailed instructions for packaging specimens for shipping. This includes preparing the Styros, packing specimens at the appropriate temperature (refrigerated, ambient, and frozen), completing shipping documents, and shipping specimens. In addition, the guide includes information about shipping infectious substances, safety in the laboratory, and cleaning up leaks and spills.
The following information needs to be filled out completely on the Specimen Control Document that we provide for you:
|Client Name||Account Number||Number of Frozen Bags||Number of Refrigerate Bags||Number of Ambient Bags||Other Material Number and Description||Time of Pick Up||Client Initial|
Check with your dispatch department for any on-call clients who may have called in requesting a pickup. On-call clients are those clients not on your regular daily route.
The Specimen Control Document is a two-part form. Place the original in the Refrigerate/Ambient Styro and keep the copy for your records for future reference.
Prepare to pack the refrigerated/ambient specimens in the same Styro. The lid of the Styro has a pink label to indicate Refrigerate Specimens and a white label to indicate Ambient Specimens. Specimens should be in temperature color-coded bags that should match the color of the label on the Styro lid. Put on gloves prior to placing the specimen bags into the Styros.
Use the same refrigerated Styro, however:
The frozen cool pack helps keep specimens from becoming too warm.
Reminder: Do not use dry ice to freeze the cool pack. If dry ice is your only option, then remove the cool pack from the dry ice three hours before use.
Note: Pellet dry ice is preferred. Block dry ice must be reduced to small pieces (1 to 2 inches) to minimize the chance of damage to bags and vials.
Under normal conditions, 2.2 kg (5 lb), of dry ice will keep the specimens frozen until they arrive at the laboratory.
Reminder: Do not fill the frozen styrofoam shipping container too full of specimen bags. Leave room for dry ice on top of the topmost specimen shipping bag and make sure the styrofoam lid fits tightly. On passenger aircraft, such as Delta or American, put 2.2 kg (5 lb) of dry ice in the Styro. FedEx or AirNet allow more, because there is a higher maximum weight for dry ice on a cargo aircraft.
Mayo Clinic Laboratories provides clients with special containers for stool specimens. We prefer that stool specimens be packed in these containers. Any substitute containers must have a screw cap and be leakproof. A special 10-lb Styro in its own box is used for shipping one or two stool containers. Large-volume stool containers must not be mixed with other specimens. They must be shipped in a separate Styro. Special stool containers may be located in the client’s freezer or refrigerator.
The procedure for packing stool containers is as follows:
Mayo Clinic Laboratories provides clients with special containers for muscle biopsy specimens. A special 10-lb Styro in its own box is used for shipping these biopsies in a small container, completely surrounded by dry ice. They must be shipped as packaged by the client and must not be opened unless specifically directed by the client or by Mayo Clinic Laboratories (for example, to add dry ice in the case of a delayed shipment).
Mayo Clinic Laboratories provides clients with special containers for critical ambient specimens, such as bone marrow and some whole blood specimens that would be ruined if allowed to get too cold.
A 10-lb Styro inside a white fibreboard shipping box (T668) is used for shipping these critical ambients, which are completely surrounded by six room-temperature cool packs. They must be shipped as packaged by the client, and should not be opened by the courier unless specifically directed to do so by the client or by Mayo Clinic Laboratories. If the client has critical ambient specimens but does not have Mayo Clinic Laboratories’ Critical Ambient white box, the courier should package those bags surrounded by six room-temp cool packs in a separate Styro and box.
Sometimes materials that do not fit into Mayo Clinic Laboratories specimen bags or specimen containers must also be packed and transported. Examples include a box of glass slides or X-ray films in a large envelope. Following are instructions for preparing these materials:
You will see a blue “C” sticker on the bag and batch sheet of any culture specimen. In this case, place a blue “C” sticker on the Styro containing the culture and also on the outside of your berry box. Be sure not to obscure any other labels on the box.
Properly placed C stickers
Put at least three extra cold cool packs and a dozen paper towels in the refrigerate/ambient Styro of another berry box. It may be necessary to ship more than one refrigerated Styro.
Important: Refrigerated specimens cannot be shipped without a cold cool pack, so it is very important to have extras.
For additional assistance or questions regarding specimen packaging, supplies, or shipping, contact Mayo Clinic Laboratories at 800-533-1710 or visit www.mayocliniclabs.com.
Mayo Clinic Laboratories packaging materials are designed to protect everyone who handles them. However, couriers should always take special precautions in a laboratory:
Pack the courier vehicle with the following items (more about some of these items later):
Important: Always pack the boxes with the cool packs and dry ice just before leaving. Cool packs can freeze if left in a very cold car and dry ice can evaporate if left in a very warm car.
Fill out an airbill for every shipment.
After all the specimens are securely packed and logged:
Always ship both Styros in the Mayo Clinic Laboratories box set, even if one Styro is empty. Never take one or both Styros out and put specimens directly in the box. Wear latex gloves any time you reach into a Styro that contains specimens.
Mayo Clinic Laboratories will provide couriers with preprinted airbills for shipments or Category B substances.
Mayo Clinic Laboratories’ policy is that Category A Infectious Substances must be shipped by FedEx or AirNet. That procedure will be covered in the section on Category A Infectious Substances. Biological Substance, Category B specimens may generally be shipped by most major passenger airlines as well as by FedEx and AirNet.
The end of the courier’s route is the airline's drop-off location. Take the shipping boxes inside and hand them over to the airline's receiving person.
After delivering the shipment to the airline, call Mayo Clinic Laboratories to report the shipment. If no phone is handy at the airline's office, couriers can do this later from another phone. Mayo Clinic Laboratories’ "AUDIX call-in system" makes it very easy to report the shipment. These instructions have been printed on a handy wallet card as well.
Important: It is important to make this call within a few hours. Mayo Clinic Laboratories will need this information urgently if the shipment doesn't arrive on time.
The following information describes Mayo Clinic Laboratories' methods of packaging and shipping Category A Infectious Substances. We also provide detailed Dangerous Goods Training.
The packaging certified to transport infectious specimens legally and safely is a combination package consisting of inner and outer containers that have passed all tests required by IATA and DOT. Mayo Clinic Laboratories provides a certified shipping container (T570).
This combination package is certified to transport Category A Infectious Substances only if it is used properly. The box and the inner container by themselves are not considered certified.
Certified packaging for Category A specimens: Infectious Shipper and Infectious Container.
Write the courier's name and address in the space provided on the shipper (box).
It is not up to the courier driver to decide what is Category A Infectious Substance or Biological Substance, Category B. The physician or send-out staff at the hospital lab will perform that function. Couriers will know that they are handling and transporting an infectious specimen if the client has a UN-certified box for them to ship.
The client places the specimen in a primary receptacle (such as a tube or a vial) and puts the primary receptacle into a certified container. The container is placed in one of Mayo Clinic Laboratories’ color-coded bags. The client will place the bagged container in the white certified box.
Do not package infectious Category A Infectious Substance specimens with Biological Substance, Category B specimens. Category A Infectious Substance specimens must be shipped in certified packaging. Because many passenger airlines have restrictions or exclusions on shipping Dangerous Goods, Mayo Clinic Laboratories recommends that any infectious shipments sent to our laboratories be made via FedEx.
If the courier uses a passenger airliner to ship the Category B shipments, the infectious specimens must be shipped to Mayo Clinic Laboratories via FedEx.
Follow this procedure:
The courier must write the courier’s name and address on the space provided on the box.
Fill out the required sections of the Shipper's Declaration, including:
To be safe, treat every spill as if it were infectious. If any specimen container in the laboratory appears to be leaking, do not touch it. Bring it to the attention of lab personnel for repackaging. Do this even if the leaking container is inside another bag.
If something spills in the lab, immediately bring it to the attention of a laboratory staff person. Apologize, but let the laboratory staff clean it up.
If a leak or spill occurs away from a laboratory, the courier will have to clean it up, using either a commercial cleanup kit or bleach as follows:
Any leak or spill should be reported immediately to Mayo Clinic Laboratories or the courier’s employer. Do not wait for the end of the run. Call Mayo Clinic Laboratories immediately at 1-800-533-1710 and ask for the Transportation Department. Be sure to communicate whether the courier or anyone else came in contact with the specimen.